Home Accidents and Emergencies: Nosebleeds in Children, Adults, and Pregnant Women

Nosebleed, medically known as epistaxis, is common and frightening as it starts spontaneously in an otherwise healthy individual. Though nose bleeding can be mild and clears without much effort, it can be a herald of underlying medical conditions. In Bridging the Health Gap, we shall look at nosebleeds in children, adults, and pregnant women, causes of nosebleeds in children, possible underlying causes of nose bleeding in adults and pregnant women, home management, and when to seek advanced medical attention.

Nosebleeds in Children

Nosebleed is common in children aged between 2 to 10 years. Though startling, most nosebleeds in children are mild and clear within a short time. To a mother or an adult caring for the child, a nosebleed can be scary, but with appropriate knowledge, you can support and administer first aid confidently.

Causes of nosebleeds in children

Most nosebleeds in children originate from the anterior part of the nose due to the rapture of the tiny blood vessels or from a broken septum. Posterior nosebleeds in children emanate from the back part of the nose. Though not very common, posterior nosebleeds signify a more severe injury to the face or the nose.

Common triggers of nosebleeds in children

Most nosebleeds in children occur without provocation, but some factors are known to increase their likelihood;

• The transition from warm and temperate to hot and dry weather is the most frequent trigger of nosebleeds.
• Inhaling dry air from indoor house warming or extreme hot climatic conditions leads to dehydration and drying up of nasal mucus membrane that gets irritated and scratchy.
• Children who are fond of picking their nostrils can provoke a nose bleed. Nose picking damages the inner lining of the nose and tears into blood capillaries, the tinny blood vessels leading to nosebleeds.
• Allergy due to dust, pollen, or animals is a cause of dryness of the mucus membrane leading to scratching the nose that causes bruises and busting of blood vessels.
• Respiratory tract infection. It is most common during cold seasons when weather changes cause an increase in colds, flu, and sneezing.
• Foreign object in the nose. Children are inquisitive and can insert playthings into the nose. Nosebleeds can occur as they struggle to dislodge foreign objects.

Nosebleeds in adults

Nosebleeds are common in elderly adults over 50 years of age and can highlight an underlying medical condition. Just as in children, the nosebleed can originate from the anterior part of the nose when blood vessels are ruptured or from a broken septum. On the other hand, a posterior nosebleed occurs from a blow to the head, face, nose, or medical diseases that cause strain and rupture of blood vessels.  

Triggers of nosebleeds in adults

Nosebleeds in adults can occur due to the normal aging process due to thinning of the mucus  membrane that is easily bruised from aggressive rubbing, sneezing, or blowing the nose. However, the following conditions increase the risk of nosebleeds among adults and can point to more severe health conditions;

• Allergic inflammation of nasal tissues. Allergic symptoms of sneezing, coughing, and nose-blowing break tinny blood vessels inside the nose.
• High altitude; going high up reduces the amount of oxygen, causing drying of the nasal tissues, cracking, and triggering a nosebleed.
• Hypertension; increase in blood pressure may cause the small blood vessels inside the nose to dilated further and tear.
• Blood-thinning medication. People with blood clotting disorders use anticoagulants like warfarin, heparin, or an anti-inflammatory such as aspirin.
• Low platelet counts; Platelets (thrombocytes) are part of blood cells that aids blood clotting. Low platelets increase the risks of bruising even after a minor injury. If tissues inside the nose are hurt, a nosebleed can occur.
• Blood diseases like hemophilia and Leukemia.
• Liver disease: Evidence indicates a correlation between liver diseases and low platelets count. The liver is responsible for regulating circulating platelets and the destruction of aged platelets.  
• Tumors at the base of the head and growths in the nasal cavity can put pressure on surrounding structures, a risk that can cause nose bleeding.
• Drugs of leisure such as cocaine sniffed through the nose cause dryness, bruises, and cracks that cause blood vessels to break and bleed.
• Nutritional deficiency. Lack of nutrients like vitamin A, C, K, B-6, B-12, and D involved in blood coagulation or integrity of blood vessels and mucus membranes easily cause dryness, cracking, and bruises.

Nosebleeds in pregnant women

The physiology of pregnancy increases the blood volume by as much as 50%. This increase in blood volume adds pressure and can lead to spontaneous rupture of the tinny blood vessels in the nose. It is normal, and studies show that one in every five pregnant women suffers episodes of nosebleeds that are inconsequential. However, nosebleeds in pregnancy can be a concern when;

• Steps to control nose bleeding have not succeeded, and the nosebleed remains persistent for over 20 minutes.
• A pregnant woman has high blood pressure. High blood pressure causes the bursting of tinny blood vessels in the nostrils leading to nosebleeds. It can also signify worsening of blood pressure.
• Nosebleed is accompanied by blurring of vision. It can indicate a more serious medical condition in pregnancy like pre-eclampsia (a condition in pregnancy characterized by high blood pressure and protein in urine) that requires urgent attention.
• Nose bleed occurs together with severe headache, can indicate an increased blood pressure.

Management of nosebleeds at home

As we have seen, any form of nosebleed is scary. Be calm. Following these steps will help control the nosebleed, and no further consultation is required;

• Reassure the person, act calmly to inspire confidence. 
• Let the person sit on a chair. The rationale here is to raise the head above the heart level. This position relieves blood pressure and reduces the blood flow from the nose.
• Support the person to lean forward slightly so that the blood does not flow to the mouth. It can provoke vomiting and block the airway.
• Pinch the soft front part of the nose firmly and tell the person to breathe through the mouth. Continue with this external pressure for about 20 minutes to allow the blood to clot and stop the nosebleed.
• You can also apply a cold icepack at the ridge of the nose or the forehead to constrict the blood vessels.
• When the nosebleed stops, allow the person to rest and avoid strenuous activity for a while.

Remember that during and after a nosebleed, the person should;

• Not lean backward. Leaning back allows the blood to flow to the throat or the abdomen and may obscure the amount of blood lost during a nose bleed.
• Not lie flat on the back. Lying on the back drips down the throat to the abdomen and can cause vomiting.
• Not blow the nose immediately nose bleeding stops. It prevents hurting further the blood vessels that can trigger another episode of nose bleeding.
• Avoid strenuous physical activities for some time after a nosebleed to prevent raising the blood pressure and trigger a nosebleed.
• Avoid smoking. Tobacco smoke causes the mucus membrane and the lining of the nose to dry, cake, and flaky and can trigger a nosebleed.
• Not blow the nose too hard as it can cause the delicate blood vessels to burst and lead to another nosebleed.

Prevention of Nosebleed

Children, adults, and pregnant women with nosebleeds can prevent the frequency of nosebleeds and amount of blood flows by practicing and adopting healthy lifestyles like;

• Avoid breathing dry air. Dry air causes crusting and flacking of the nasal mucus membranes leading to bursting on fine blood vessels that increases risks of nosebleeds. Apply some petroleum jelly inside the nose to prevent dryness.
• Raise the humidity in the room. During dry seasons, it is wise to raise the moisture in the room. Simple methods like boiling water, opening showers or cooking without the lid release moisture and humidity.
• Embrace nose-picking etiquette. Use a tissue whenever the urge to pick the nose presents and rub the inside of the nose gently.
• Blow the nose gently. When you have a running or stuffed nostril, blow the nose gently to avoid hurting the inner membranes and possibly starting a nosebleed,
• Avoid excessive air drying. Fans and air conditioning blow excessively dry air. Breathing dry air drains the humidity from the inside of the nose. The dryness and flacking can lead to nosebleeds.
• Avoid very intensive physical workouts. It leads to dehydration, dried and crusty nose precursor to nose bleed. Ensure that if you have to undertake the physical activity, stay hydrated.

When to seek medical attention for nosebleeds

Though most nosebleeds are not a cause of alarm, there are instances when medical consultation and treatment are required. Seek emergency medical care when;

• The nosebleed is prolonged. Severe nose bleeding that lasts for more than 20 minutes after following all first aid steps.
• The blood flow causes vomiting. It can be a sign of a severe injury to the face or head.
• Recurrent nosebleeds. Do not assume recurrent and severe nosebleeds. It can signify a medical condition, growth of the tumor in the nose or at the base of the head.
• Irregular heartbeat, fainting, and dizziness are symptoms of circulatory compromise due to excessive blood loss.
• Difficulty breathing. Difficulty breathing may be an indication of underlying heart or lung diseases.

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