Five years ago or to be precise four years, 10 months ago, I had the arduous task of managing nosebleed of a monarch. I spent the whole night in his palace controlling the nosebleed.
Then four days ago that was on Friday February 7, 2025, at Igbere when I attended the burial of my cousin, I was alerted again of a highly placed personality an Ezeogo of our Igbere Clan, who also had nosebleed. I was bombarded by his courtiers on what causes nosebleed. I searched my archives and surprisingly found that over the years I had not written anything on nosebleed.
Simply put, a nosebleed is the loss of blood from the tissue that lines the inside of your nose. Nosebleeds (also called epistaxis) are very common. Some 60 percent of Nigerians will have at least one nosebleed in their lifetime.
The location of the nose in the middle of the face and the large number of blood vessels close to the surface, in the lining of your nose make it an easy target for injury and nosebleeds.
Nosebleeds are usually described by the site of the bleed. There are two main types anterior and posterior. Research has shown that posterior is more serious than the anterior nosebleeds.
An anterior nosebleed starts in the front of the nose, on the lower part of the wall that separates the two sides of the nose (called the septum). The capillaries and small blood vessels in the front area of the nose are fragile and can easily break and bleed. This is the most common type of nosebleed and is usually not serious. These nosebleeds are more common in children and are usually able to be treated at home.
A posterior nosebleed occurs deep inside the nose. This nosebleed is caused by a bleed in larger blood vessels in the back part of the nose near the throat. This can be a more serious nosebleed than anterior nosebleed. This type of nosebleed is more common in adults. The monarch I managed had a posterior nosebleed.
Bleeding typically occurs when the mucosa is eroded and vessels become exposed and subsequently break. More than 90 percent of bleeds occur anteriorly and arise from Little’s area, where the Kiesselbach plexus forms the septum.
Most bleeds do not have an easily identifiable cause. However, trauma to the nose is very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose, from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:
• Exposure to warm, dry air for prolonged periods of time.
• Nasal or sinus infections.
• Allergic rhinitis.
• Nasal foreign body (object stuck in the nose)
• Vigorous nose blowing.
• Nasal surgery.
• Deviated or perforated nasal septum
• Cocaine use.
Less commonly, an underlying disease process or taking certain medications, may cause a nosebleed or make it more difficult to control.
Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), Clopidogrel bisulfate (Plavix), non-steroidal, anti-inflammatory drug (NSAIDS) or Aspirin.
Topical nasal medications such as corticosteroids, and antihistamines, may sometimes lead to nosebleeds.
Liver disease, chronic alcohol abuse, kidney disease, platelet disorders and inherited blood clotting disorders, can also interfere with blood clotting, and predispose to nosebleeds.
Vascular malformations in the nose and nasal tumours are rare causes of nosebleeds.
High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with nosebleed that leads to the elevation of blood pressure.
The first step in managing it is to stop the bleeding at home. Follow this sequence of actions:
• Sit down and pinch the soft parts of your nose firmly, breathe through the mouth.
• Lean forward (not backward), to prevent blood from draining into the sinuses and throat; which can result in inhaling the blood or gagging.
• Sit upright; so that the head is higher than the heart, this reduces blood pressure and slows further bleeding.
• Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of five minutes and up to 20 minutes, so that the blood clots.
• If bleeding persists for more than 20 minutes, then medical attention is required.
• Apply ice pack to the nose and cheek, to soothe the area and avoid strenuous activity for the next few days.
It is recommended that individuals shoujd seek medical attention if they suffer from frequent nosebleeds (it could be an indication of an underlying problem), like you had an injury to the head, or you take anticoagulants (blood thinning medications), and the bleeding does not stop. Whenever you have nosebleed that refuses to stop at home please consult your doctor. The doctor will conduct a physical examination to determine the cause. He will check your nose for signs of a foreign-object. He will also ask questions about your medical history and current medications.
There is no single test to determine the cause of nosebleed. However your doctor might use diagnostic tests to find the cause. These tests include: full blood count (FBC) or complete blood count (CBC), which is a blood test to check for blood disorder.
Partial Thromboplastin Time (PTT), which is a blood test that checks how long it takes for your blood to clot
Nasal Endoscopy.
CT Scan of the nose.
X-ray of the face and nose.
Treatments of nosebleeds depend on the cause and could include: nose packing gauze, special nasal sponges or foam or inflatable latex balloon, which is inserted into your nose to create pressure at the site of the bleed.
The material is often left in place for 24 to 48 hours before being removed by a nurse or doctor.
Cauterisation – this procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. A local anaesthetic is sprayed in the nostril, first to numb the inside of your nose.
Reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.
Foreign body removal is encouraged if this is the cause of the nose bleed. Surgical repair of a broken nose or correction of a deviated septum, if this is the cause of the nosebleed.
Ligation – in this procedure in which the culprit blood vessel is tied off to stop the bleeding.
When blowing your nose (especially when you have a cold) do so gently into a soft tissue. Don’t blow forcefully or pick your nose.
Your doctor may recommend a cool-mist humidifier to moisten your indoor air.
Keep the inside of your nose moist with saline (salt water) nasal spray or gel or dab petroleum jelly or antibiotic ointment gently around the opening of the nostrils.
Wear protective athletic equipment when playing sports that could cause injury to the nose. An occasional nosebleed may make you worry, but there is no need to panic.
Now you know what to do.
Always be medically guided.
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