Frequent nosebleeds are a common reason for visiting a doctor. In some cases, it even leads to hospitalization of the patient, especially if the bleeding occurs after any injury. However, if there was mechanical impact, there are no problems with making a diagnosis and prescribing treatment, but in other cases it is quite difficult to understand the causes of the pathology. Why does nosebleed occur, how dangerous is it, and what treatment can be prescribed for this condition?

There are many reasons for nosebleeds. Nasal cavity well supplied with blood, anterior nasal septum saturated with blood vessels. Even a minor blow or any injury immediately leads to bleeding. Every person has encountered this unpleasant phenomenon at least once, but most often the bleeding itself stops after a while, and more problems does not arise.

However, it is necessary to sound the alarm if nosebleeds begin to occur without visible reasons, they repeat themselves and have great difficulty stopping.

There are several common external causes:

• Solar and heat strokes. When the body overheats, dizziness and nausea are observed; a common symptom associated with increased blood pressure is nosebleeds. Overheating can be very dangerous; it is necessary to take the victim to a cool place as soon as possible and provide first aid.
• Intoxication, poisoning, exposure to various chemicals. The blood vessels of the mucous membrane are subject to constant negative impact for chemical production workers, for those who work with various volatile substances, etc. Chronic poisoning leads to serious disorders in the body, manifested by frequent bleeding.
• Taking antihistamines and some other medications. Long-term use of aspirin can lead to bleeding - it helps reduce clotting and thins the blood.

In addition to external causes, frequent nosebleeds can occur due to various infectious diseases. These include tuberculosis, syphilis, and liver and kidney diseases also negatively affect the condition of the mucous membrane. Blood often walks with his nose with high blood pressure: in this case, the patient experiences tinnitus, dizziness, and weakness.

Also, frequent nosebleeds occur with increased fragility of blood vessels, bleeding disorders and other diseases of the circulatory system.

In any case, if frequent causeless bleeding is observed, it is necessary to undergo treatment as soon as possible. full examination to identify and eliminate the cause.

First aid for nosebleeds

If a nosebleed begins, it is important to provide the patient with first aid correctly. Often people begin to panic at the sight of blood - this further increases blood pressure and only increases bleeding. But if you know what to do, you can easily avoid unpleasant consequences for the body.

The person must be seated, ensuring peace. The head is not thrown back: blood should not enter the stomach, otherwise it may provoke vomiting. You should not blow your nose when bleeding - this will not help the patient, and the bleeding will be more difficult to stop. The head should be slightly tilted forward, a cotton swab should be placed in the nostril: it helps to form a plug and stop the bleeding.

You need to apply a cold object to the bridge of your nose - this will help narrow the blood vessels, and the blood will stop faster.

If the patient has lost consciousness, he should be placed on his back with his head turned to the side to avoid blood entering the stomach. If first aid for a nosebleed does not produce results, you must call an ambulance.

Useful video on how to properly stop a nosebleed.

What can you use and how to properly make a solution for rinsing your nose?

When is it necessary to urgently call a doctor? You need to pay attention to the warning signs:

• Heavy bleeding that doesn't stop for a long time. It is necessary to stop the bleeding as quickly as possible, and for this you have to use medical assistance.
• The appearance of weakness, cold sweat, black spots before the eyes. As a rule, this condition is observed with severe blood loss, which needs to be stopped as quickly as possible.
• General deterioration in health. Nosebleeds are just one symptom that may indicate a serious illness.

Treatment

Treatment for nosebleeds depends on the cause pathological condition. First of all, it is necessary to exclude exposure to hazardous factors: mechanical and chemical influences, negative influence medicines, etc.

It is necessary to avoid overheating the body, too intense physical activity and other factors that can cause bleeding. If their cause cannot be immediately established, the doctor will prescribe a full examination, based on the results of which treatment will be prescribed.

Depending on the identified cause, the doctor may choose one of following methods Treatment of nosebleeds:

• If they are caused by polyps (benign tumors) in the nasal cavity, surgical treatment may be prescribed. The doctor will perform an operation and remove all formations from the nasal cavity, after which the bleeding will completely disappear.
• If bleeding occurs due to chronic or other inflammatory processes, the doctor will prescribe and special aerosols, treatment methods depend on the severity of the disease.
• If it is due to damage chemicals, it is necessary to achieve complete elimination damaging factor, after which a diet is prescribed and special means with vitamins A and E. They contribute to more fast healing and recovery blood vessels.
• For bleeding due to long-term use blood thinning medications, the course of treatment has to be reconsidered. Long-term use of such drugs is serious threat for human health: blood can come not only from the nose, serious internal bleeding with the unpredictable.
• If they are caused by any systemic diseases, complex therapy will be prescribed. It is necessary not only to remove the symptom, but to eliminate the very cause of its occurrence - this could be an infection, an allergic reaction, a benign or malignant tumor, etc. In all cases, after eliminating the cause, nosebleeds will disappear.

If alarming symptom manifested itself at least several times, treatment must be started. Bleeding from the nose is one of the first symptoms of such terrible diseases as cancer, diabetes, atherosclerosis, heart failure, etc. For frequent bleeding, the doctor will prescribe drugs that help increase blood clotting: these are Vikasol, calcium chloride and gluconate, as well as large doses vitamin C.

Surgery

In approximately 10% of cases, nosebleeds have to be stopped surgically.

The doctor may use one of the following techniques:

• Cauterize the damaged vessel with a cotton swab dipped in a solution of silver nitrate. This procedure allows you to reliably stop bleeding due to crust formation.
• In difficult cases, vessel coagulation is prescribed: modern technologies allow it to be carried out painlessly using a laser or electric current. Severe blood loss may even require plasma and donor blood transfusions.
• For local bleeding, solutions of lidocaine or novocaine can be injected directly into the mucosa. In progress surgery the doctor performs cartilage resection and gentle local intervention in the mucous membrane.
• Cryotherapy is freezing the damaged area using liquid nitrogen. This technique avoids the appearance of scar tissue. In addition, it causes minimal discomfort to the patient.

Modern technologies have expanded the capabilities of specialists: operations are carried out using the most gentle methods that do not require long recovery and allowing you to get a guaranteed result.

Possible complications

Nose bleed can be not only anterior, but also posterior: in the second case, blood begins to flow from the posterior wall of the nasal cavity, and in this case it is difficult to assess the extent of blood loss. If blood enters the stomach, it provokes vomiting with dark blood, which will only worsen the patient’s well-being. In this case it is very difficult to stop the bleeding on your own; you need to call ambulance and provide assistance to the patient as quickly as possible.

Nosebleeds occur when the blood vessels of the nasal mucosa are damaged. Children under 10 years of age and adults over 50 years of age are most likely to experience nosebleeds.

Causes of nosebleeds

There are many reasons for bleeding. Weak vessels nose is one of the most common. For some people, blowing their nose sharply or simply rubbing their nose is enough to cause their nose to bleed. This is not a rare occurrence for people with high blood pressure. Nosebleeds can also occur in a completely healthy person due to sudden changes atmospheric pressure. Another common cause of bleeding is nasal trauma.

Nosebleeds can be caused by local or systemic factors

Local factors:

• inflammatory processes of ARVI, chronic sinusitis, allergic rhinitis, etc.);
• developmental anomalies vascular system nasal cavity;
• snorting drugs (especially cocaine);
• tumors of the nasal cavity;
• low relative humidity of inhaled air;
• use of a nasal oxygen catheter (dries out the nasal mucosa);
• use of certain nasal sprays;
• surgery in the nasal cavity, etc.

System factors:

colds;

side effects of medications;

alcohol consumption (causes vasodilation);

blood diseases;

liver diseases;

increased vascular permeability during severe infections (measles, influenza), hypovitaminosis C, hereditary diseases, etc.;

professional activity associated with sudden changes in barometric pressure (pilot, diver, climber, etc.);

hormonal disorders(for example, during pregnancy), etc.

Types of nosebleeds

It is customary to distinguish between 2 types of nosebleeds - "front» And "back" .

"Anterior" bleeding not intense, can stop on its own (or as a result of taking the simplest measures) and does not pose a threat to human life.

For “posterior” nosebleeds, which arise as a result of damage to fairly large vascular trunks localized in the walls of the deep parts of the nasal cavity, a large amount of blood loss is possible. Such bleeding is intense, does not stop on its own, and therefore often requires professional medical attention.

There are also minor, mild, moderate, severe or massive degrees of blood loss during nosebleeds.

Nosebleeds in children

In the anterior section of the nasal septum there is a rather delicate area where many capillaries are located. It is from this part of the nose that nosebleeds in children occur in 90% of cases. These nosebleeds are not dangerous and can be stopped fairly quickly.

Sometimes the child may bleed from the large vessels of the nose. In such cases, quite strong and intense bleeding occurs. Therefore, it is urgent to call a doctor to help with nosebleeds.

It happens that a child has bleeding from the nose, but the source of bleeding is other organs - the trachea, bronchi, lungs, esophagus or stomach. This is why it is so important to understand the cause of nosebleeds in children. When bleeding from the nose, the blood is of a normal color and flows down the back wall throats. Very dark colors coffee grounds, blood may indicate bleeding from the stomach.

Rapid and large blood loss is dangerous for the health and life of the child. If there is significant blood loss, the child may develop general weakness, dizziness, and pallor. skin, noise and ringing in the ears; lines before the eyes, thirst and rapid heartbeat.

Then blood pressure decreases, the child may lose consciousness.

When bleeding from posterior sections nose, the child can swallow blood, and only by vomiting with blood clots can one understand that he has a nosebleed.

Causes of nosebleeds in children

Damage to the vessels of the nasal mucosa can occur in a child in the most different cases. Among the main causes of nosebleeds in childhood the following can be distinguished:

• nasal injuries (fracture, bruise, damage to the nose by a foreign object stuck into it);
• medical operations performed on the nose;
• tumors, polyps, ulcers in the nose;
• rhinitis, sinusitis, adenoiditis;
• sun and heatstroke;
• sudden surges in pressure;
• intensive for child's body physical exercise;
• lack of calcium, potassium and vitamin C;
• low blood clotting;
• hormonal changes in adolescence;
• hepatitis, liver diseases, etc.

Diagnosis of nosebleeds

Diagnosis of nosebleeds in adults and children is carried out using an external examination, examination of the nasal cavity, nasopharynx and pharynx. Sometimes it is necessary to differentiate nosebleeds in adults and children from bleeding, the source of which is other organs - the lungs, esophagus or stomach. In such cases, blood enters the nasal cavity and then flows out of the nostrils. It is necessary to undergo examination by other specialists and identify the cause.

Treatment of nosebleeds

If you have a nosebleed, you need to stop the bleeding as quickly as possible to prevent blood loss. Next, it is necessary to eliminate the cause that caused the bleeding - for example, normalize blood pressure. Prevention is required possible consequences acute blood loss(decrease in circulating blood volume, for example), conduct hemostatic therapy.

First aid for nosebleeds

Stopping nosebleeds can be done in the following ways:

In case of “front” nosebleeds, it is necessary to sit the victim down or lie him down, slightly raising his head. It is not recommended to tilt the patient’s head back too much: this could cause blood to get into the Airways. A cotton or gauze swab moistened with a 3% solution of hydrogen peroxide must be inserted into the bleeding nostril, then, pressing the wing of the nose from the outside to the nasal septum with your fingers, hold it in this position for 10-15 minutes - this way the damaged vessel is thrombosed. Vasoconstrictor drops (Nazivin, etc.) can also provide a good hemostatic effect. In this case, the drops are not instilled into the nose, but are moistened with a tampon. Cold should be applied to the bridge of the nose.

If your efforts are unsuccessful, and you do not know how to stop a nosebleed on your own, you need to call an ambulance. You should also seek emergency medical help if blood flows from the nose in a stream, without clots.

Treatment of nosebleeds at MedicCity

MedicCity hosts complex treatment nosebleeds using conservative and, if necessary, surgical methods.

Conservative therapy is aimed at stopping bleeding, restoring damaged tissues and erosive vessels of the nose, and preventing relapses. Homeostatic and metabolic vascular therapy is used using local and systemic drugs.

In case of heavy nosebleeds, the patient undergoes tamponade of the nasal cavity with gauze swabs, the duration of which can be up to 2 days. Hemostatic drugs are also prescribed. After removal of the tamponade, the nasal cavity is examined using endoscopic equipment, which allows you to determine the cause of the disease.
In order to prevent relapses, medications aimed at strengthening blood vessels are prescribed. Usage conservative treatment allows you to achieve optimal results in 7-10 days.

If the therapeutic effect is ineffective, it is carried out surgical treatment for the purpose of coagulation of a bleeding vessel.

For extensive destruction of blood vessels, we use radio wave and laser method, manipulations are carried out under the control of endoscopic equipment.

Our methods allow you to treat nosebleeds on an outpatient basis in 1 day.

Nosebleeds are not only unpleasant, but also dangerous, as they can lead to significant blood loss. Therefore, if bleeding recurs repeatedly, or you are unable to stop the nosebleed on your own, contact a specialist! Our otolaryngologists will provide you with qualified assistance with nosebleeds and any other diseases of the ear, nose and throat!

Epistaxis - nosebleeds or nosebleeds?

Strange as it may seem, these two phrases, similar in content, reflect completely different concepts, united by a common name - epistaxis.

Nosebleeds occur in people of different age groups. It can be spontaneous, or due to various external causes that have caused a violation of the integrity of multiple networks of capillaries that actively supply the mucous layer of the sinuses or nasopharynx. It is with this pathology that up to 10% of patients are treated in outpatient otolaryngology departments.

Frequent nosebleeds may be one of the symptoms of serious pathologies. Such cases in medicine are already considered as nosebleeds, which can provoke intracavitary vascular damage skull or nasal mucosa.

The respiratory system, esophagus or stomach may well serve as a source of pathology. With such vascular disorders, blood flows out as a result of flow through the natural openings (choanae) connecting the oropharynx to the nasal cavity.

Forms of manifestation

Nosebleeds, according to their manifestation, are divided into several forms - mild, moderate and severe form. In addition, they differ according to certain criteria:

By location– vascular lesion of the vestibule (anterior) or posterior vessels, bleeding from one sinus or bilateral.

Bleeding from the anterior parts of the nasal cavity is caused by multiple branching of vessels in the anterior zone of the Kisselbach plexus of both nostrils. It is the damage to the anterior circulatory system of the nose that is the main cause of nosebleeds from one nostril.

Bleeding from the posterior region is due to injury circulatory systems in the deep areas of the nose and is very dangerous. Blood loss can be unpredictable, and it is almost impossible to stop and stop it at home.

According to time indicator the duration and short duration of the pathological process is determined.

The quantitative indicator is determined by a profuse course (abundant) or insignificant (small amount, drops).

By number of manifestations– rarely occurring (or one-time), repeated many times (recurrent) and spontaneous (injuries or surgical interventions). The danger of recurrent manifestations is due to the development of anemia.

According to view vascular lesion – blood capillaries, deep arterial vessels, or venous network.

Etiology of nosebleeds

causes of nosebleeds, photos

The manifestation of epitaxy in patients of any age is due to various reasons general and local reasons, among which prevail:

• drying out mucous epithelium in a hot and unventilated area, which leads to capillary brittleness. Typically, sleeping in such conditions causes nosebleeds at night.
• thinning and thickening of the intracavitary mucous membrane of the nasal sinuses during the development of specific atrophic rhinitis;
• the presence of angiofibroma of the nasopharynx, tumor-like growths (hemangiomas) or polypous formations.

What can nosebleeds in adults tell us?

Causes of nosebleeds in adults and children local character, are complemented by many pathologies.

They can be caused by physiological, traumatic and compensatory curvatures of the cartilaginous septum of the nose, which entails changes in the air flow in both nasal sinuses, provokes them and maxillary sinuses irritation and dryness, development of long-term infectious processes, swelling and congestion, joint fragility.

Thermal, radiation and chemical burns cause necrosis of the mucosal epithelium and damage to the capillary vascular walls in the nasal cavity.

The manifestation of unilateral or bilateral epistaxis is facilitated by surgical manipulations and interventions (puncture, endoscopy, probing, piercing installation).

Common reasons include:

1. Cardiovascular pathologies that provoke increased permeability of the vascular walls. Eg, different kinds atherosclerosis, causing hardening of arterial walls and the development of hypertension.
2. Vascular abnormalities in cervical area and head, caused by an increase in intravascular pressure provoked by disseminated syndrome of intravascular hemostasis.
3. Pathological conditions in hemorrhagic diathesis, manifested by increased vascular bleeding caused by the presence of pathologies associated with the process of impaired blood coagulation (clotting).
4. A sharp change in barrological pressure, characteristic of certain professions (divers, pilots, climbers).
5. Kidney pathologies and liver diseases. For example, cirrhosis, accompanied by high blood pressure and severe vascular fragility, and renal pathologies are often accompanied by uremic bleeding syndrome, manifested by epistaxis.
6. Taking medications that interfere with normal hemostasis.
7. Congenital anomalies - hemorrhagic angiomatosis or hemophilia.

In a completely healthy person, signs of epistaxis can appear with prolonged exposure of the nasopharynx to frosty and dry air, causing dryness of the mucous membrane and vascular damage.

In the older generation, nosebleeds occur more often due to age characteristics, when in the posterior section of the nasal sinuses the vessels lose their elastic properties and are damaged, causing posterior vascular hemorrhage.

With posterior bleeding, blood drains into the throat and can go unnoticed and cause significant blood loss. In older women, the cause of dystrophic changes in the mucous endothelium and blood vessels is due to a hypertensive crisis or a natural factor of menopause.

The delicate and easily injured mucous layer of the children's nasopharynx is supplied with blood by the largest vascular branch - the artery of the neck and head. The greatest predisposition to bleeding is observed in the vessels of the lower nasal passage.

In children, the causative factors are largely similar to those in adults, but are also complemented by external factor, caused by pathologies in the mucous epithelial layer due to the introduction of foreign irritants - peas, pencils, buttons and many objects that small children often stick into their noses.

The registry of common causative factors includes:

1. Infections that cause high temperature, provoking under the influence of viral toxins headache and nosebleeds (colds) viral infections or general intoxication with scarlet fever).
2. Diseases that cause disruptions in coagulation processes, or congenital pathology hemostasis systems.
3. Sunstroke and overheating, or the influence of atmospheric pressure surges.
4. Problems of intracranial and blood pressure. More often appear in puberty as a result of overload (physical, emotional or sports-related). Blood flows from the nose, pressure decreases. The advantage is that it comes out through the nose and does not pour into the brain. This is how a kind of protection of the body manifests itself, trying to stabilize the condition at least temporarily.
5. Hormonal changes - the release of hormones in children at puberty is accompanied by a narrowing of capillary vessels and an increase in blood pressure. Cyclic manifestations of nosebleeds in girls are observed during the formation of the menstrual “lunar” cycle.
6. Avitaminosis is an imbalance with vitamin “C”, manifested by vascular fragility and fragility in the spring, vitamin “K” deficiency is the main cause of poor hemostasis, which is manifested by epistaxis.

Epistaxis during pregnancy

Nosebleeds during pregnancy can cause various reasons. Manifestations at the beginning of the 1st trimester are caused by restructuring of the woman’s body.

Increased synthesis of estrogen provokes extensive accumulation of fluid in the intercellular space of the upper layer of the mucous epithelium and blood overflow vascular network, which provokes increased fragility and permeability of capillaries

Natural stresses during pregnancy, and supine position causes increased snoring. To alleviate the condition, a woman is forced to use vasodilators, which dry out the mucous membrane, damage blood vessels and cause signs of dry rhinitis. They usually manifest themselves as bleeding in the morning, even with light blowing of the nose.

In subsequent trimesters - the 2nd and 3rd, epistaxis may be a consequence of vitamin deficiency with subsequent development pathological changes in the walls of capillaries.

The presence of hypertension contributes to pathology and provokes fetal hypoxia and problems with fetal development. In a state of pregnancy, to ensure fetal nutrition, blood circulation in the female body, which increases the load on the heart and blood vessels.

Not abundant rare manifestations epistaxis does not cause a threat, but the appearance of blood from the nose every day threatens termination of pregnancy and requires timely correction and medical care.

Main symptoms of nosebleeds

The vast majority of pathologies begin without previous symptoms. TO characteristic symptoms may include: vertigo (manifestation of dizziness), migraine attacks, tachycardia, hearing impairment with tinnitus caused by impaired blood flow. Accompanied by hypertension and severe weakness, pose a serious problem.

Various forms of pathology correspond to certain symptoms:

• At initial form pathological manifestations symptoms are manifested by minor blood loss with signs of lung dizziness.
• IN mild form weakness and tachycardia, tinnitus, signs of thirst and vertigo are noted.
• The average severity of the manifestation is characterized by severe dizziness, shortness of breath, a drop in blood pressure and tachycardia, signs of cyanotic changes in the skin.
• The severe form is manifested by hemorrhagic shock, severe lethargy, a drop in blood pressure, tachysystolic disturbances, and fainting.

A severe form of bleeding with large blood loss can become recurrent in nature, periodically recurring and causing mental disorders caused by oxygen starvation.

First aid for nosebleeds will not be difficult if you clearly know how to do it correctly. It is necessary to firmly understand that you cannot wait for the problem to be resolved on your own. The situation may worsen serious complications from the outside of cardio-vascular system, manifestation of fainting and anemia.

To quickly stop the bleeding, you need to sit down with your head slightly tilted back. Press your nose with two fingers for 10-15 minutes. During this time, the blood inside should clot and block the passage of the damaged vessel. Make sure to breathe freely through your mouth.

You can stop bleeding using a tamponade, after moistening the tampon with peroxide or apple cider vinegar. The tampon is inserted into one nasal opening or into both. Ice or ice is applied to the bridge of the nose. cold compress. For 2 or 3 hours, you should refrain from blowing your nose and breathing through your nose.

If there is bleeding from one nasal opening, for example, on the left side, you should raise it above your head left hand and vice versa if on the right side.

Helping a child with a nosebleed is similar. But with kids you should take into account psychological factor, because small children are usually very scared of this condition. It is necessary to distract him, calm him down and organize him medical care as soon as possible.

Diagnostic examination

Often the manifestation of a one-time minor epistaxis is due to a traumatic cause. In this case, rhinoscopic examination of the anterior zone of the Kisselbach plexus provides a complete picture of the source of bleeding.

If the source is located in the deep zone of the nasal cavity, an endoscopic examination method (probing) is used.

To determine the general characteristics of the lesion (hemodynamics), in the recurrent stage, a blood test is prescribed - a coagulogram (clotting test), a thromboellastogram, which makes it possible to make a general assessment of the patient’s condition based on the parameters of hemoglobin and platelets.

Biochemical and general tests, blood pressure indicators, help to establish the underlying cause that provokes epistaxis and formulate the correct treatment therapy.

Methods for treating nosebleeds

Drug therapy is the main step in treatment. Due to careful selection of appointments:

1. Hemostatic drugs - “Epsilon”, “Abmen”, calcium and hemostatic agents are widely used.
2. Strengthens healing effect"Vikasol". Its use is justified in cases of underlying liver pathology.
3. To strengthen the vascular walls, drugs are prescribed that increase hemostatic functions - “Ascorutin”, “Vipraxin”.
4. Drugs that prevent blood clots - “Kontrikal” or “Trasylol”.
5. Coagulation correctors and immunoglobulin preparations that eliminate heavy bleeding.
6. IN complex therapy include medicinal products, eliminating the background pathologies that caused epistaxis.

All prescriptions, dosages and treatment regimens are strictly individual for each patient.

1. As local treatment To stop nosebleeds, use tampons soaked in plasma or citrate (sterilized) blood, hemostatic hemostatic sponges, fibrinous antiseptic biological tampons.

2. For nosebleeds from small vessels, use various methods cauterization – laser cauterization and electrocoagulation, cryodestruction or ultrasonic disintegration.

3. Catheter oxygen therapy (inhalation of humidified oxygen), anterior or posterior tamponade - tampons from long bandages moistened with a hemostatic drug are inserted into the nasal cavity to stop blood discharge.

As surgical techniques apply:

1. Vestibuloplasty – incision of the mucous membrane with and without detachment, removal of the submucosal layer from the nasal septum, curettage of granulation growths.

2. For more serious pathologies - vascular ligation, dermoplasty, replacement of the mucous membrane with a postauricular skin flap.

Characteristics of possible complications

Large blood loss during epistaxis can lead to acute process circulatory disorders (collapse) with a sharp violation blood supply and acute hypoxia tissues, organs and systems. This especially affects the brain, kidneys and heart tissues.

The progression of this condition causes shock and loss of consciousness in the patient, which without medical intervention may end in death.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Introduction

Nosebleeds and nosebleeds are similar concepts, but not synonymous.

Nose bleed– bleeding from the vessels of the nasal cavity, paranasal sinuses, nasopharynx when the integrity of these vessels is impaired.

Nosebleed may arise from vessels located in the cranial cavity when damaged top wall nasal cavity. The source of bleeding can be the respiratory tract, esophagus and stomach. In these cases, blood can flow into the nasal cavity through the choanae (internal openings connecting the nasal cavity to the oropharynx) and flow out.

The nasal mucosa is actively supplied with blood: it has a network of plexuses of small blood vessels (capillaries). Frequent nosebleeds may be the first sign of a serious illness. But nosebleeds can also occur in healthy people.

Nosebleeds can occur at any age. Such situations occur frequently - in first place among spontaneous bleeding. From 3% to 10% of patients hospitalized in the ENT department are patients with nosebleeds.

Causes of nosebleeds

The causes of nosebleeds at any age are divided into local and general.

In children

The mucous membrane of the nasopharynx and nasal cavity in children is delicate and easily injured. Blood supply to the mucosa is provided by the branches of the carotid artery (one of the largest vessels). Most often (in 90% of cases), small vessels bleed in the anterior inferior part of the nasal septum, where the superficial choroid plexus– bleeding zone (Kiesselbach zone).

In childhood, in addition to local and general causes of nosebleeds, there are also external ones.

TO external reasons includes damage to the vessels of the nasal mucosa:

• foreign body (pea, pencil, button, toy parts);
• when picking your nose.

Local reasons:

• nasal injuries (bruise or fracture);
• atrophic rhinitis;
• tumors in the nasal passages (angiofibromas, hemangiomas, polyps);
• drying out of the nasal mucosa, leading to fragility of blood vessels (when in a hot, unventilated room).

Common reasons:

• infectious diseases (scarlet fever, influenza, ARVI and others);
• increased body temperature;
• blood diseases with a violation of the coagulation system;
• hereditary diseases (hemophilia);
• increased arterial or intracranial pressure;
• liver diseases;
• hormonal changes;
• lack of vitamins in the body;
• physical activity (for example, sports);
• overheating in the sun, sudden changes in atmospheric pressure.

In teenagers

Local and general causes of nosebleeds are the same as in children, since teenagers are also children. But at this age possible reason Hormonal changes during puberty can also cause bleeding.

Nosebleeds in adolescents can also be associated with increased blood or intracranial pressure due to excessive stress - psycho-emotional or educational. In other words, overwork is one of the causes of nosebleeds in teenagers.

In adults

Local reasons:

• acute and chronic (atrophic) rhinitis;
• deviated nasal septum;
• benign (polyps, hemangiomas, angiofibromas) and malignant tumors in the nasal cavity;
• burns (thermal, chemical, radiation);
• surgery or medical manipulations(puncture of the paranasal sinuses, nasogastric intubation, endoscopy and others);
• foreign bodies (piercing, for example);
• bad habit (nose picking).

The general reasons are also quite varied:

• pathology of the cardiovascular system (heart defects, vascular anomalies with high blood pressure in the vessels of the neck and head, hypertonic disease, vascular atherosclerosis);
• bleeding disorders, blood diseases (leukemia), hemorrhagic diathesis;
• lack of vitamins C and K, lack of calcium in the body;
• increase in body temperature (in case of infectious diseases, overheating, etc.);
• pathological conditions as a result sharp changes pressure (for divers, pilots, climbers);
• hormonal imbalances (menopause, pregnancy);
• kidney and liver diseases in the stage of decompensation;
• congenital pathology (hemophilia, Rendu-Osler disease);
• taking medications that prevent blood clotting (Heparin, Warfarin, Pentosan, Aspirin).

Nosebleeds in healthy people can be triggered by significant physical exertion or stressful situation. The cause may also be inhalation of frosty or dry air for a long time, which causes dry mucous membranes and fragility of blood vessels.

Nosebleeds in healthy people are not profuse, short-lived, and usually stop on their own.

In older people

Possible causes of nosebleeds in old age are all those listed for adults, with some nuances.

A feature of this age is that the vessels of the posterior sections of the nasal cavity lose their elasticity and “posterior” bleeding may occur, when blood flows into the throat, and significant blood loss may become invisible. Such bleeding may even be life-threatening.

In old age, nosebleeds occur more often than in young people, which may be associated with atrophic rhinitis. They are especially common in older women, since during menopause there is wrinkling and drying of the nasal mucosa and increased fragility of the vascular walls.

A very common cause of nosebleeds in older people is hypertension. With this disease, nosebleeds may occur due to various reasons: with significant physical stress, with overheating, with changes in atmospheric pressure, during a hypertensive crisis.

In addition, in old age, patients are more likely to take medications that can contribute to bleeding (Aspirin, Naprosyn, Ibuprofen, Tolectin and others).

In pregnant women

The causes of nosebleeds in pregnant women can be different.

At mild degree – blood loss is 500-700 ml in an adult or 10-12% of the total blood volume. Manifested by the following symptoms: tinnitus, weakness, dizziness, flickering of spots before the eyes, thirst, rapid heartbeat, pallor of the skin and mucous membranes.

At medium degree – blood loss is 1000-1400 ml in an adult or 15-20% of the total blood volume. In addition to the above symptoms, increased heart rate, shortness of breath, decreased blood pressure, and bluish lips and nails appear.

In severe cases (blood loss of more than 20% of the total blood volume) develops hemorrhagic shock: pulse is very frequent, weak filling ("thread-like" pulse), sharp decrease in blood pressure, impaired consciousness.

Causes and symptoms of nosebleeds - video

Severe, frequent, profuse nosebleeds

Nosebleeds are considered severe or profuse, in which blood loss per day exceeds 200 ml (can reach 1 liter or more). Such bleeding represents real threat for life.

In weakened patients and children, the blood leaking out does not always correspond to true blood loss, since some of the blood can be swallowed. This may cause vomiting of blood and black stool.

Severe blood loss is clinically manifested by increased heart rate, decreased blood pressure, thirst, dizziness, pallor of the skin and mucous membranes.

• More often heavy bleeding occur in severe injuries with damage to the branches of the carotid artery. Such bleeding is often not only heavy, but also recurrent. Moreover, the bleeding may recur (recur) after a few days (or even weeks). Recurrent bleeding can lead to mental disorders: loss of orientation in place and time, anxiety, panic fears. This is due to hypoxia (insufficient oxygen supply) to the brain.
• A common cause of severe nosebleeds is excessively high blood pressure.
• Heavy and frequent nosebleeds combined with bruising and bleeding gums may indicate bleeding disorders. Such manifestations can occur with leukemia, hemorrhagic diathesis, hemophilia (hereditary pathology in males), and cirrhosis of the liver.
• Frequent nosebleeds may be the first sign of a malignant or benign neoplasm.

Patients need careful examination and treatment. If you have heavy, frequent nosebleeds, you should not hesitate to see a doctor.

Nosebleeds at night

The causes of nosebleeds at night can be different and in many cases are far from harmless. Highlight following reasons night bleeding:
1. Damage vascular wall as a result of injury or illness. The vessels of the nasal mucosa can be injured by roughly blowing your nose or picking your nose. And injured vessels may begin to bleed at night.
2. Changes in blood composition or increased permeability of the vascular wall.
3. Increased intracranial or blood pressure.
4. Venous congestion in the sinuses of the brain can also lead to nosebleeds at night.
5. Sleeping in a hot, unventilated room.
6. Change in atmospheric pressure.
7. Disturbances in the blood coagulation system.

In any case, you should not ignore visiting a doctor and examination to clarify the cause of night bleeding.

Nosebleeds in the morning

Bleeding in the morning can be caused by:

• coagulopathies (blood clotting disorders) – due to blood disease, vitamin deficiency;
• diseases of the cardiovascular system (heart disease, hypertension, vascular abnormalities, atherosclerosis, etc.); increased blood pressure;
• hormonal changes in the body (during puberty, pregnancy, etc.);
• elevated temperature (in case of infectious diseases);
• overheating in the sun on the eve of bleeding;
• increased intracranial pressure as a result of a sharp morning rise;
• lack of calcium in the body;
• injury received the day before or in the morning (picking your nose, for example);
• dryness of the nasal mucosa (with atrophy of the nasal mucosa or sleeping in a hot, unventilated room).

In any case, the patient or parents should not be involved in the diagnosis. A consultation with a doctor and examination will help determine the cause and provide treatment.

Recurrent nosebleeds

If the nosebleed was single and not profuse, then the cause of its occurrence is easier to establish and it does not cause much concern to the person. Recurrent (repeated) nosebleeds are alarming because... it is impossible to predict when bleeding may begin or how long it will last.

There are many reasons for nosebleeds. The cause of recurrent nosebleeds can be general and local factors, or more often a combination of both.

TO local factors include diseases of the nasal mucosa (dry rhinitis, atrophic rhinitis), benign vascular neoplasms(angiofibroma, hemangioma), malignant neoplasms and other factors.

Common causes include disorders of the blood coagulation system, hypertension, systemic diseases (vasculitis, thrombocytopenia, leukemia, etc.).

In case of recurrent nosebleeds, it is necessary to conduct a series of examinations and consultations with specialists to clarify the diagnosis and the cause of the bleeding.

There are a number of measures to prevent recurrent bleeding:

• you should not blow your nose or even touch your nose after the bleeding has stopped;
• after the bleeding has stopped, use saline solutions purchased at the pharmacy to moisten the nasal mucosa; For this purpose, you can use Vaseline gel;
• control the air humidity in the room and use humidifiers if necessary;
• If you need constant or frequent use of aspirin or non-steroidal anti-inflammatory drugs, discuss with your doctor the possibility of switching to Acetaminophen.

What to do if you have a nosebleed (emergency care)

For nosebleeds, it is recommended:

• Sit down and tilt your head forward a little. You should not tilt your head back, as this can cause blood to be swallowed and cause vomiting or enter the respiratory tract. In addition, when throwing back the head, it becomes difficult venous drainage blood from the head and neck. This increases blood pressure in the vessels of the head and increases bleeding.
• If the cause of bleeding was overheating in the sun, you should immediately take the person into the shade or into a well-ventilated area.
• Unfasten the collar and open the window for fresh air.
• Apply a bag, bag or ice pack to the nose area. If it is not possible to apply ice, then you need to apply a bandage, cloth or handkerchief moistened cold water. The same should be done in case of injury to the nose by changing its configuration. In this case, urgent consultation and help from a doctor is needed.
• If the bleeding continues, then you need to press the wing of the nose (nostril) from the outside to the nasal septum with your finger for 5-10 minutes.
• If the bleeding continues, you can moisten a bandage tampon with a runny nose remedy (Naphthyzin, Naphazolin, Sanorin, etc.) or a 3% solution of hydrogen peroxide and insert it into the nasal cavity.
• If the cause of bleeding was overheating in the sun, you should immediately take the person into the shade or into a well-ventilated area.

First aid for nosebleeds - video

Helping a child with nosebleeds

First of all, you need to calm the child down, sit him down and ask him to tilt his head forward. If the cause of bleeding is overheating in the sun, take it to a cool, well-ventilated room. You can also lay the child down, but with the head end of the bed or the upper half of the body raised.

Place an ice pack or cloth soaked in cold water on the nose area. Apply cold to the back of your head as well. At the same time, keep your feet warm.

Press the wing of the nose against the nasal septum for 5-10 minutes.

It is advisable for the child to inhale through the nose and exhale through the mouth.

You can insert a small bandage swab moistened with a 3% hydrogen peroxide solution into the nasal passage. Instead of hydrogen peroxide, you can use nasal drops (Sanorin, Otrivin, Naphthyzin, Galazolin, Tizin).

If it is not possible to stop the bleeding within 20-30 minutes, you need to call an ambulance or consult an ENT doctor.

If the cause of bleeding was a hit foreign body into the child’s nasal cavity - you should not try to remove it yourself. A foreign body can move into the respiratory tract and lead to suffocation. You need to immediately call an ambulance or see an ENT doctor.

You should also contact an ENT doctor in case of a nasal injury with the development of swelling and a violation of the configuration of the nose.

After stopping the bleeding, it is recommended to lie down for half an hour. During the day, physical activity and blowing your nose should not be allowed in order to avoid resumption of bleeding. It is also necessary to explain to the child that picking his nose is inadmissible.

Treatment of nosebleeds

Treatment of nosebleeds is based on the following principles:

• rapid stop of bleeding to prevent an increase in blood loss;
• hemostatic drug therapy;
• impact on the cause of bleeding.

Drug therapy

Drug treatment is one of the main steps in helping with bleeding, regardless of its cause.

Such drugs as sodium etamsylate (Dicinone), Aminocaproic acid (Epsilon), Vikasol, calcium preparations, Ambien are quite effectively and widely used. Adroxon, Exacil, and Gumbix are used somewhat less frequently.

Dicynone can be used both in the form of injections and in the form of tablets. This is a drug with rapid hemostatic action. Can be used for a long time (if necessary).

Aminocaproic acid administered intravenously. A good hemostatic effect can also be obtained by administering Aminocaproic acid into the nose in the form of drops. Calcium chloride and calcium gluconate are also administered intravenously.

If the cause of bleeding is hypertension, then an important step in treatment is the appointment drugs to lower blood pressure to normal levels. For this purpose, fast-acting drugs (Corinfar, Nifedipine, Clonidine), injections of magnesium sulfate, dibazole are prescribed. You can also use Pentamin, Benzohexonium in small doses intramuscularly or subcutaneously.

Used to stop nosebleeds and biological drugs. Blood plasma is used locally: tampons are moistened with it before inserting them into the nasal cavity. Very widely used hemostatic sponge, fibrin film, biological antiseptic swab (BAT). These drugs are made from dried blood plasma. Before insertion, tampons can also be moistened with Vivicol (made from citrated blood).

Biological drugs are especially effective for bleeding that develops due to various hemorrhagic diathesis (hemorrhagic vasculitis, hemophilia, Werlhof's disease, etc.), with leukemia, cirrhosis of the liver.

For heavy traumatic nosebleeds, Contrikal is used, Trasylol. These drugs prevent intravascular thrombus formation.

Cauterization of the nasal mucosa

Cauterization (coagulation) of the nasal mucosa is carried out in cases where the source of bleeding is the small vessels of the anterior part of the nasal septum. This method of treatment is indicated in case of recurrent nosebleeds and in the absence of effect from the treatment.

Cauterization can be carried out in different ways: electricity (electrocoagulation), laser ( laser coagulation), trichloroacetic acid or liquid nitrogen (cryodestruction), ultrasound (ultrasonic disintegration).

The procedure is performed under local anesthesia. To do this, lubricate the nasal mucosa with a 3-5% solution of cocaine with adrenaline. Before cauterization, the blood is removed, the exact location of the bleeding is determined and quickly cauterized.

Oxygen therapy

Oxygen therapy is also used to stop nosebleeds - inhaling oxygen from an oxygen pillow through the nose. The patient should breathe calmly and evenly. The bleeding stops quite quickly.

It is more effective to administer humidified oxygen through a catheter into the patient's nose or mouth. The procedure lasts 5-10 minutes. and repeats 2-3 times within an hour. In severe cases, oxygen therapy is used 5-6 times a day.

Nasal tamponade

There are anterior and posterior tamponade of the nasal cavity. Nasal tamponade is performed only by a doctor. Tamponade can be performed with gauze swabs or a hemostatic sponge.

Anterior tamponade is used if there is no effect from simple methods of stopping bleeding within 15 minutes.

To carry it out, narrow (up to 2 cm) and long (up to 60 cm) strips are prepared from a bandage, from which a tampon is made. The tampon is moistened with hemostatic paste (or, in its absence, petroleum jelly).

Using cranked tweezers and a nasal speculum, the nasal cavity is tightly filled, starting from the deep sections. Usually 2-3 such tampons are used (i.e. up to 1.5 m of bandage). If bleeding occurs from both halves of the nose, then tamponade is performed sequentially on the other half of the nose.

After this, the viability of the tamponade is assessed. If there is no external bleeding or flow down the back wall of the pharynx, then the tamponade is effective. Apply a sling bandage.

Properly performed anterior tamponade allows you to stop bleeding from the anterior sections of the nasal septum and even, in many cases, bleeding from “posterior” sources.

If, after anterior tamponade, it is discovered that blood is flowing down the back wall of the pharynx, a posterior tamponade of the nasal cavity is performed.

It is performed by an otolaryngologist (ENT doctor) using special tampons.

Removal of tampons is carried out very carefully on the second day after anterior tamponade and on days 7-9 after posterior tamponade. First, the tampons are generously soaked in a 3% hydrogen peroxide solution.

Sometimes pneumatic or latex hydraulic swabs are used instead of gauze swabs.

The disadvantages of tamponade are: painful procedure for inserting and removing a tampon, trauma to the mucous membrane, and the possibility of re-bleeding. Tampons quickly become saturated with mucus and blood, thereby creating conditions for the proliferation of microorganisms.

In order to overcome these disadvantages, tampons are moistened before insertion in addition to hemostatic (hemostatic) solutions and antiseptic liquids(Dioxidin, Iodoform, antibiotic solution). From hemostatic solutions, in addition to aminocaproic acid, Feracryl and Kaprofer are used. Feracryl has quick action, also has a pronounced antiseptic (antimicrobial) effect and a moderate analgesic effect.

Surgical methods to stop nosebleeds

If cauterization and tamponade have no effect, they can be used surgical methods treatment. There are a number of surgical techniques.

Light surgical interventions: injection of a 0.5% solution of novocaine or 0.5-1% solution of quinine dihydrochloride into the bleeding area under the mucous membrane of the nasal septum; incisions of the mucous membrane without peeling or with peeling; submucosal removal of the nasal septum; curettage of vascular growths (granulations).

What could be the causes of frequent nosebleeds and how they can be cured, says Olga Pavlovna Soloshenko, an otorhinolaryngologist at the Semeynaya clinic.

If bleeding does not occur from injuries and recurs periodically, it is better not to delay a visit to the ENT specialist. After all, bleeding can be anterior or posterior - the second happens less often, but it is much more dangerous. For anterior bleeding blood is flowing only outward, with the back it flows into the mouth or stomach along the back wall of the pharynx. Posterior is usually caused by damage to larger vessels that are located deep in the nasal cavity. Stopping posterior bleeding without a doctor is very difficult.

Causes of nosebleeds:

• Injuries. Injury to the nose often results in cartilage fractures. As a rule, this is accompanied by swelling and pain.
• High blood pressure. A very common reason. Due to the sudden jump, the capillary walls easily burst. Blood pressure increases due to overload, as well as in the presence of diseases of the cardiovascular system.
• Sunstroke and any sharp increase body temperature.
• Overwork.
• Changes in hormonal levels. Bleeding can occur in women during pregnancy or menopause, and in adolescents during puberty.
• Dry air. It causes dry mucous membranes.
• Poor blood clotting.
• ENT diseases. Sinusitis, sinusitis, rhinitis - all of them can cause bleeding, especially with constant use of medications that thin the mucous membrane.
• Problems with blood vessels. Even infectious diseases such as chickenpox, measles, influenza, etc. can lead to them.
• Polyps, adenoids, tumors. In addition to periodic bleeding, it simply makes breathing difficult.
• Foreign body entry- can damage the mucous membrane and blood vessels.
• Deficiency of vitamins K, C and calcium.

First aid rules for nosebleeds:

• Position yourself (or position the patient) with your legs down
• Tilt your head forward
• Place a cold compress on the bridge of your nose for a few minutes.
• Pinch your nose with your hand or insert a tampon previously soaked in hydrogen peroxide
• You can use drops to narrow blood vessels

Attention, this cannot be done!

• Throwing your head back (contrary to popular belief) - blood can enter the respiratory tract
• Blow your nose so as not to increase the bleeding.

What cases require immediate calling a doctor and an ambulance?

• In case of loss of consciousness
• If there is too much bleeding
• Blood flows with clear liquid(this can happen after trauma and indicate a basal skull fracture)
• If you vomit blood (this may indicate bleeding in the esophagus or stomach)
• Blood with foam (possible due to lung injury)
• If a patient has diabetes mellitus
• If the patient is known to have poor blood clotting

Treatment

Treatment of bleeding is carried out comprehensively. Often, an otorhinolaryngologist works together with a therapist, neurologist, endocrinologist and hematologist.

At the first examination, the doctor determines the type of bleeding - anterior or posterior. The patient is also required to pass general analysis blood and coagulogram (analysis of blood clotting indicators). In addition, it is important to measure the pressure, because if it is higher than normal (the absolute norm is 120/80 mmHg, but these indicators change depending on age), the blood will not stop until it decreases.

If there is significant blood loss, the patient may be left in the hospital.

As a treatment for bleeding, it is possible to pack the nasal cavity, cauterize blood vessels (with drugs, laser, ultrasound, etc.) and remove polyps. If there is no result, surgical ligation of the vessels in problem areas is performed. In addition, they are appointed medicines, increasing blood clotting.

Prevention

• Taking medications that strengthen the walls of blood vessels
• Diet rich in vitamins and minerals
• Air humidification during the heating season
• Preventing Possible Injuries
• Monitoring blood pressure and taking medications that lower it

A nosebleed is not only unpleasant, but also dangerous. Therefore, as soon as it begins to bother you regularly, it is important to consult a doctor as soon as possible. It is better to exclude all the most terrible reasons such a phenomenon, and then it will be calmer to engage in further treatment.

Making an appointment with an otolaryngologist

Be sure to get a consultation qualified specialist in the field of nasal diseases at the Semeynaya clinic.