Synonyms in a broader sense

Medical: epistaxis

English: nosebleeding

introduction

Almost everyone has had a nosebleed (epistaxis) at some point in their life. Be it after blowing your nose vigorously or applying force to the nose. The causes of nosebleeds are many. The frequency and amount of blood can provide an indication of the cause. In most cases, however, the nosebleed is harmless and does not require medical treatment.

causes

How does a nosebleed occur?

  • In the tip of the nose there is a dense vascular network (Locus Kiesselbach). Mechanical stimuli, boring fingers and fingernails can injure precisely at this point and trigger a nosebleed.
  • The notorious "blow on the nose" can damage the nasal bone, the nasal septum and the nasal mucosa considerably. This also ruptures small vessels from which, depending on the severity of the injury, it can bleed heavily (Please also read: Pain in and around the nasal bone).
  • Colds, such as runny nose (rhinitis) and sinus infections (sinusitis) lead to increased blood flow to the mucous membrane. The increased pressure on the small vessels of the mucous membrane makes them more vulnerable. A cold can quickly lead to a nosebleed.
    You can find further information under our topics:
    • sniff
    • Sinus infection
    • Treatment of a sinus infection
  • Dry room air, such as that produced by radiators and air conditioning systems, can dry out the nasal mucosa to such an extent that it is severely damaged. The smallest changes in pressure or mechanical stimuli can now damage the previously damaged mucous membrane.
  • Medicines and other substances
    Some medications are given to thin the blood to treat cardiovascular disease (Marcumar for atrial fibrillation, artificial heart valves, vascular replacement; aspirin after a heart attack). If there are now small injuries in the area of ​​the nasal mucosa, the bleeding time can be longer. Epistaxis from nasal sprays is also a possible cause.

Read more about this topic: Causes of nosebleeds and nosebleeds while sleeping

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Conditions that can cause nosebleeds

Nosebleeds can also Expression of a serious illness be. If nosebleeds occur frequently and persist for a long time, you should definitely consult your doctor. This will ask you about the frequency and intensity in order to obtain information on a possible cause. The following diseases can cause a nosebleed:

  • High blood pressure (hypertension): High pressure on the delicate mucous membrane vessels leads to their fragility and a prolonged bleeding time. In patients with high blood pressure, it mainly occurs with excitement and stress increased nosebleed.

    In advance, the attending physician will ask you a few questions about the frequency and triggering circumstances of your nosebleed. He will be interested in your lifestyle, i.e. exercise, diet and luxury food habits.
    Pre-existing illnesses and the current use of medication also fall into the questionnaire.

    This is followed by a thorough physical examinationsg performed with blood pressure measurement, inspection of the nasopharynx and oral cavity. Here, the examiner expands the front area of ​​your nasal cavity using a nasal spreader and can thus visually inspect and assess structures such as the nasal septum, the turbinates and the lower and middle nasal passage. Dried crusts of blood in the nasal entrance and possibly obstructed nasal breathing usually indicate this Epistaxis from the Vascular network of Locus Kiesselbachi the front nose.

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    The doctor diagnoses deeper and further back bleeding sources via the so-called posterior nasoscopy. Here he inserts a mirror through the mouth into the back of the nose and throat and can thus see the back of the nostrils. The tongue is held down by applying pressure with a spatula. In addition to these easy-to-use examination methods, nosebleeds can be diagnosed using a so-called nasal endoscope for complicated questions. Under local anesthesia of the nasal mucous membranes, a tube-shaped, flexible optical device is pushed over the nostrils, into the throat and up to the larynx. This allows specific sources of bleeding, but also changes in the mucous membranes, to be determined.

    At Bleeding in the field of Sinuses and if a tumor is suspected, the doctor will have a special image taken of your face.

    Additional blood tests are used to clarify frequent nosebleeds and can, for example, indicate a deficiency or a changed composition of the Clotting factors discover.

    therapy

    Nosebleed therapy

    What should be done first if there is a nosebleed?

    If you have a nosebleed, your head should be in an upright position. Either sit up straight in a chair or put a pillow behind your head when lying down. Under no circumstances should you bend over in front of a sink.
    Then squeeze the nostrils firmly together with your thumb and forefinger. This pressure can be uncomfortable, but initially it is the only way to bring the small vessels of the mucous membrane to stop bleeding. Hold this pressure for at least five minutes!
    A cold rag on the neck reflexively leads to a narrowing of the vessels in the nasal mucosa. However, this should be really cold!
    A moistened handkerchief has no effect. The blood should not be swallowed or inhaled. Just let it run out or spit it out! If the bleeding has stopped, avoid blowing your nose, rinsing your nose, or tilting your head for the next ten hours.

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    If the nasal bleeding does not stop, a doctor must be consulted or the emergency doctor must be alerted.

    Read more on the topic:

    • How can I stop a nosebleed
    • What can I do about a nosebleed
    • Homeopathy for nosebleeds

    What action does the doctor take?

    Of the ENT doctor the bleeding becomes punctiform Chemical burn breastfeeding. The burn is done with a trichloroacetic acid or chromic acid bead. If the chemical burn does not lead to success, one will Electrocoagulation tried that To scorch nosebleeds. This is usually even more effective than the chemical burn. If bleeding cannot be stopped, the nose must be packed. A cotton tampon (Bellocq-Tamponade) stays for a maximum of four days and must then be changed if necessary.

    In rare cases, if the bleeding is completely insatiable, a Vascular ligation be made. This is a surgical procedure under anesthesia, in which the main vessels (maxillary artery, External carotid artery, A. ethmoidales), which the Nasal mucosa supply, be disconnected.

    Nosebleeds cease to exist

    At light nosebleed, which by a Bleeding of the blood vessels of the anterior nasal septum and the source of the bleeding is clear, it is possible that the ENT doctor will obliterate it.
    It is usually not a major procedure.

    There is a Spray stunning. Then on one Cotton swab an acid applied and after that occurs a Neutralization.
    It is also possible one Desolation with the help of electricity, a so-called Electrocoagulation perform. Some doctors also offer one Laser coagulation on.

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    In the Aftercare becomes a ointment recommended for the nasal cavity. Besides, that should Avoid bending over and exercising as there is a risk that the deserted vessels will burst open again.

    Read more about the topic here: Nosebleeds, what exactly is happening?

    Complications

    • nausea and Vomit
    • When a nosebleed occurs, a large amount of blood runs down the throat and is swallowed. Blood clumps in the stomach and acts like an emetic. Nausea and vomiting can increase the pressure on the nasal lining and increase bleeding. For this reason, one should simply let the blood drain outwards.
    • Ingestion (aspiration)
      If blood is inhaled while bleeding is profuse, aspiration occurs. In debilitated patients, blood aspiration can lead to a loss of consciousness. Now at the latest, the patient must receive emergency care.
    • High blood loss
      If the nosebleed does not stop, there is a risk of bleeding (volume deficiency shock). Here, too, there is unconsciousness.

    prophylaxis

    How can nosebleeds be avoided / prophylaxis?

    Avoid all possible damage to the nasal mucosa. The Blowing your nose should be done gently. Many people squeeze their nose too tightly when blowing their nose and build up a lot of pressure. However, stubborn crusts and crusts can be easily removed with Nasal ointments and oils (Bebanthen® nasal ointment, Coldastop® nasal oil). Regular inhalation with steam and sea salt solutions can prevent nasal congestion, moisten the nasal mucous membrane and promote its regeneration. Also avoid mechanical stimuli from nose picking. The room air should be kept humid. Regular ventilation in strongly heated rooms ensures a natural climate and pleasant humidity. If you Room humidifiers change the liquid regularly in order to avoid germ contamination of the container. In order to give the nasal mucosa the opportunity to humidify itself, you should ensure that you drink enough fluids. Underlying diseases, in the first place the high blood pressure (Hypertension) must be treated by your family doctor.

    Nosebleeds while sleeping

    Epistaxis during sleep is more common and is common in the harmless in most cases.
    The root cause for night nosebleeds is still largely unknown.
    The vessels in the dream phase of sleep are rather narrow and in the deep sleep phase they are rather wide, so they are accordingly Blood flow and blood pressure different. This could be im Connection with the autonomic nervous system, the sympathetic and the parasympathetic nervous system, explain night nosebleeds in the beginning. However, research is still being carried out and the causes of night nosebleeds are controversial.

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    Other triggering factors can be dry aire.g.Heating air in winter or air conditioning in summer. These can dry out the mucous membranes and thereby become the Mucous membranes more sensitive and more fragile and can tear faster. Since fluid intake is minimized, especially at night, the risk of nosebleeds could be higher at night due to the reasons mentioned.

    Also can allergic causes cause night nosebleeds. Because, for example, there is more pollen at night and when the window is open the pollen can irritate the nose and trigger nosebleeds at night. The vessels of the anterior nasal septum are often affected. The blood appears dark red and is usually easy to stop.
    It often helps to pay attention to better indoor air. It may be helpful to use a humidifier.

    In rare cases they tear Vessels of the posterior septum a. The Blood is bright red and often splashing and difficult or impossible to stop. In these cases it should absolutely consulted a doctor become. It should be the Root cause, such as increased nocturnal blood pressure, or other causal underlying diseases be clarified.

    You can find out more about the topic here: Nosebleeds while sleeping

    Epistaxis from stress

    Probably nosebleeds can also through psychic or physical stress to be triggered. One suspects one Connection with the autonomic nervous system, especially the Sympathetic-Proportion of.
    According to this, the nasal septum vessels could not withstand the pressure due to the increase in blood pressure triggered by the sympathetic nervous system. However, these causes are controversial and are still being explored.

    Read more about the topic here: Epistaxis during stress

    Nosebleeds during pregnancy

    Nosebleeds (epistaxis) during pregnancy can of course be annoying or stressful for women, but there is no risk to the unborn child, on the contrary. Nosebleeds are almost a classic pregnancy symptom that, like nausea, affects some women more and others less.

    The cause of the increased nosebleeds is, on the one hand, a general increase in blood volume. After all, the expectant mother not only has to supply her own body with blood, but also that of her baby. Therefore, there is an increase in blood volume during pregnancy. This also improves blood circulation in the mucous membranes. There is a particularly thin mucous membrane in the nose. This can dry out slightly, especially in the cold, i.e. mostly in winter. This quickly leads to the characteristic nosebleed, which, depending on the disposition and thinness of the mucous membrane, can sometimes be gushy.

    The reason for the increased tearing of the veins is the hormone estrogen, which is increasingly formed during pregnancy. This hormone loosens the mucous membranes on us, thus, on the one hand, ensures that the nose is always slightly blocked and, on the other hand, it makes the veins under the mucous membrane more sensitive and easier to burst.

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    Since the mucous membranes are slightly swollen, there is also a narrowing of the nasal passage and the woman finds it difficult to breathe, especially when lying down, which can then lead to snoring. This triad of symptoms: nosebleeds, nasal congestion and light snoring are typical signs of pregnancy and should not be a concern for the expectant mother.

    You can already achieve a lot with the help of nasal ointments, nasal showers and an elevated head position while sleeping. Especially in winter, nosebleeds can be avoided if you lubricate the nasal mucosa with a particularly fatty cream, for example Vaseline, and thus counteract the drying out.

    In addition, you should avoid blowing your nose too vigorously, as this makes it easier for the veins to tear and then for a nosebleed. Should it nevertheless come to nosebleeds, the pregnant woman should stay calm and always keep in mind that it is a completely harmless side effect. You should sit down with your head bent slightly forward and possibly place a cool washcloth on your neck. After a few seconds to minutes, the nosebleed should be over.

    Read more on the topic: Nosebleeds during pregnancy

    Nosebleeds in toddlers and babies

    Nosebleed (epistaxis) is a very bothersome symptom for most patients. Especially Children, toddlers and babies suffer more often from nosebleeds. Mostly it is a harmless nosebleed, which disappears after a few seconds to minutes. Especially in winter, when it's very cold, nosebleeds can easily occur. The cause of the nosebleed is one Several small veins rupture in the nose. These veins can be very severe in some children thin-walled be and therefore tear faster.

    By frequent nose picking or through blowing your nose too hard You can then easily develop a nosebleed. It is always important to ask the child whether there is something put in the nose which then led to the bleeding. It is well known that younger children in particular like to stick a small object into their noses, which can then damage the veins. It is important to have this Remove the object from the nose!

    You should also consider the psychological component. Some children get under Pressure to perform or at to severe psychological stress Epistaxis. For example, fear of school or classmates can lead to increased nosebleeds. In addition, that should be too frequent use of nasal sprays in children as in adults avoided otherwise the children tend to have nosebleeds very quickly due to the permanent strain on the mucous membranes. If the nosebleed suddenly occurs while playing and romping around, it can of course also be that the child has bumped their nose badly and one of the veins is torn.

    In some cases, children are very often plagued by nosebleeds. This can be a abnormal vasculature act, which then leads to sometimes very frequent nosebleeds. Sometimes the only thing that helps here is the To desolate vessels so that no more bleeding is possible. In very rare cases there is one in children purulent inflammation (abscess) or a tumor, a so-called neoplasm, behind the nosebleed. Therefore, if children have frequent nosebleeds, the Consulted an ENT doctor so that it can examine the nose and cause any obliteration.

    • Epistaxis in young children
    • Nosebleeds in children
      and
    • Nosebleeds in babies

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