Nose – the nozzle of the face – is one of the prominent attractions of the face. It functions as passage, filter and humidifier of the air entering into it. It also helps in smelling the odour which also enhances taste. The nose is a very sensitive part since it has rich source of blood supply and sensitive nerve endings. Most of the blood vessels (arteries and veins), which supply the brain form the plexus/junction at the base of the nose. So any bleeding or infection arising in this bloody tissue can reflect in the brain’s blood supply and its activities. So, a bloody nose is a danger area of the face. Any hit or bleed from here should be attended to immediately with caution.
The nose is covered internally with mucous membrane which will always remain moist with secretions of glands and flow of lachrymation into the nose from both eyes (tears – which is a continuous process of washing the eyes to keep them moist). The action of the nose usually gets altered with environmental factors i.e. temperature, high altitudes, humidity, etc. The blood supply to the nose is mainly from the branches of the internal and external carotid arteries. “Little area” of the nose (i.e. in the middle part of the nose) is the most vulnerable part for nose bleeding, where branches of internal and external carotid arteries get anastomosed with each other. Often the precursor of bleeding from here is nose picking, blowing the nose or trauma.
Bleeding from the nose is medically termed as ‘Epistaxis’. It may be an indicator of weakened mucosa or septum or an inner disease. Epistaxis should be considered as a symptom of a disease and not as a disease itself. Bleeding from nose can occur suddenly, threatening life and making everyone anxious and restless. Bleeding can occur from nose either through nasal openings or into the pharynx. Nosebleeds mostly involve one nostril, but occasionally it can occur from both nostrils. If one nostril is blocked with clot formation, the blood may spill over through the other nostril or into the throat (backside of the nose).
Incidence – Epistaxis is more common in children than adults. Males have higher incidences than females in all ages. The reason behind it may be correlated with sportive games, violence and tension. Epistaxis is a common symptom faced in childhood even without any cause. But in the case of adults, there will mostly be a causative factor for every bleed.
Type of bleed
Epistaxis/nose bleed can occur from either the front or back of the nose. Bleeding from the front is very common and easy to control. Bleeding from the back is somewhat dangerous and often difficult to control, since it will be more profuse. Also, bleeding from arteries is more difficult to control than bleeding from veins.
Causes for nose bleed are many. They may be due to:
Injury which is caused from a blow, accidents, diving, insertion of foreign substances, nose picking and blowing the nose. The nose may also get injured from environment i.e. dryness due to low humidity and thermal variations, pressure changes due to hypertension and high altitudes, irritation from chemicals like acid fumes, smoke, etc., or from strain like coughing, sneezing, etc.
Diseased conditions like
- Nasal problems – Polyps, adenoids, tumours, deviated nasal septum, sinusitis,
allergic rhinitis, cold, etc. In all these conditions, there will be congestion and pressure which initiates bleeding.
Systemic – Cancer, bleeding and clotting disorders, deficiency of coagulation factors, liver disorders, kidney disorders, arterial or capillary diseases, diabetes and heart disorders.
Nutritional and physiological – Vitamin C & K deficiency will lead to bleeding disorders. Pregnancy and hormonal changes can also cause nose bleed occasionally.
Medications – Continuous usage of blood thinners and pain killers and Aspirin
In case of nose bleeding, children should be treated more for adenoids and elderly people more for cancer and hypertension.
Diagnosis – Even though no one goes for diagnosis immediately for a nose bleed, for ruling out any serious, deep-seated disease and to avoid its recurrences, diagnosis is a must. The following tests are essential for that.
Locate the bleeding spot – i.e. from membrane or septum or polyps, etc.
- Tc, Dc, Esr, Hb%
- Coagulation factors & serum prothrombin time
- Bleeding time and clotting time
- Urea and creatinine to rule out kidney cause
X-ray – para nasal sinuses
CT scan or MRI
- Picking the nose
- Blowing the nose vigorously
- Strong smelling irritants and sneezing
- Smoking and drinking
Sporting activities which have the risk of being hit on the nose
- Filters while traveling and working with chemicals
- Room humidifier when room is with dry air in winter or in cold places where room heater is used often.
- Nasal spray to moisten the nose when it feels dry and irritated
- Blood pressure with diet, salt restriction, exercise and medication
- Medication, especially blood thinners, pain killers and low dose Aspirin
- Nasal infection at the early stage itself
- Bleeding by compression or pinching firmly at the earliest
Continuous nose bleed and draining back may lead to high risk due to airway obstruction, blood loss, blood entry into the lungs, etc.
Safety management – Patient needs patience in these circumstances or else controlling the bleeding will be tough. Usually, bleeding will get arrested within 10-15 minutes.
Don’t lie down since it will increase the bleeding with high pressure due to the same level of the heart
Avoid blowing your nose
Sit down and relax with firmly pinched (closed) nose for about 10-15 minutes
Lean forward to avoid blood entry into the throat
Breath orally in a relaxed manner
Don’t worry or get tensed since the bleeding will stop automatically with the natural coagulation mechanism of blood
Don’t pack guaze or cloth yourself to avoid bleeding, since it mostly absorbs the blood rather than arrest it. Tight packing by expertise may be necessary to arrest bleeding. Compression of the veins is more important, so pinching the nose should be the first and essential reaction.
Apply ice, if necessary, to promote clot formation at the earliest
If you feel the bleeding continues and also into or from the back part of the nose, then it is better to go to the hospital without delay since it may require vasoconstrictors to stop the bleeding. Also, blood entry into the throat from the back part of the nose may make one gasp for breath.
General treatment – If self-management fails, get hospitalised quickly to avoid severe blood loss. Usually, drugs are not given in Allopathy for avoiding recurrences unless there is a causative factor. But most of the time the causative factor cannot be found. So, one has to wait for recurrences to investigate further. Externally, nasal (tight) packs with vasoconstrictors are often followed to arrest uncontrollable bleeding. If this also fails, then ligation (tie) or cauterisation of the arteries (burn with laser) will be attempted by ENT (ear, nose and throat) unit to arrest the bleeding. These procedures, even though successful in stopping recurrent bleeding, can cause disturbances in the sense of smell.
Burning the bleeding spot may be sometimes like sealing the bursting point of the balloon rather than reducing the inflating blow. A chain of reactions may follow if we don’t treat it according to the cause. The probability of recurrence can’t be predicted by any doctor. Some women may have recurring/repeated nose bleeds with regular periodicity as menses. This type of bleeding is called vicarious menstruation. Also some person’s headache will be relieved by nose bleeding (congestive headache). These types of patients can be surely benefit from Homeopathy. Nose bleed can be either cured or managed according to the disease with Homeopathy.
Since Homeopathy treatment is patient-oriented (not disease oriented),
it gives importance to every feeling of the patient and aggravating factors. It can help reduce/stop bleeding by strengthening the nasal mucous membranes, blood vessel walls and by reducing congestion. It can also avoid allergic reaction in the nose by raising the power of immunity. One should be aware that nose bleed is not a serious or fatal issue if one has initiated management as early as possible and provided treatment to avoid recurrences. Homeopathic treatment can give permanent relief to nose bleed with out any side-effects.
Homeopathic medicines commonly used in cases of epistaxis/nose bleed are Acid nit, Apis mel, Arg Nit, Belladonna, Bryonia, Causticum, China, Hepar sulph, Hydrastis, Kali bich, Lycopodium, Millefolium, Nat mur, Nux Vom, Phosphorus, Pulsatilla, Silicea, Sulphur, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011 (Mob)
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)