NOSE – Nose bleed
Epistaxis
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
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.
Blood analysis
·
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
Endoscopy
CT scan or MRI
PREVENTION
Avoid
·
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
Use
·
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
Control
·
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
Complications
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.
Homeopathic approach
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.
For new hope
Dr. S. Chidambaranathan, BHMS, MD
(Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001, India
Tel: +91-984-319-1011 (Mob / Whatsapp)
Clinic : +91-452-233-8833
Web : https://drcheena.in | https://drcheena.org
Youtube : https://www.youtube.com/@DrChidambaranathanhomeopathy
E-mail: drcheena@gmail.com
(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.)