Frequent nosebleeds & related diseases

A nosebleed (epistaxis) is defined as bleeding from the blood vessels in the nose. Nosebleeds are common due to the location of the nose on the face and the large amount of blood vessels in the nose. Most often, they can be treated at home. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose. Such nosebleeds may be harder to control.

It is advised to always report frequent and close episodes of nosebleeds to an otolaryngologist. In fact, only a specialist can properly assess whether it is a predisposition often occurring in children (bleeding diathesis) or in relation to a different problem. The specialist will then decide how to take appropriate action.

“In almost all cases, it is a problem related to the fragility of the capillaries present in the front of the nose” – says Dr. Luca Malvezzi, specialist at the Unit of Otolaryngology at Humanitas. The blood flow will stop by simply bending the head forward and closing the nostrils with your fingers. In rare cases, it can be a sign of malformations or other diseases, however apart from these cases, it should be underestimated.”

Frequent nosebleeds

“We must establish the repeatability of the phenomenon. The patient’s age, his/her health condition and whether nosebleeds are a common problem among other family members must be taken into consideration -says Dr. Malvezzi. Once the more severe cases have been discarded, the patient can proceed on a different path.
In most cases, it is sufficient enough to take measures to reduce the vulnerability of the capillaries. This can be done by avoiding excessively dry environments, limiting domestic chores or seeing a doctor to determine whether the mucosa is dry or cracked. The patient will be advised to apply emollient creams regularly to the inner walls of the nostrils in order to restore the protective layer of the capillaries. Only in cases when it is extremely necessary, cauterization may be required. Cauterization is a technique that uses heat to weaken the varicose veins in order to stop the bleeding.”

It is important to contact a doctor immediately if:

• A child under two years old has a nosebleed
• Bleeding continues for longer than 20 minutes
• You are having difficulty breathing
• You have lost a lot of blood

Could bleeding from the nose indicate a more severe condition?

It is important to be aware when the specialist identifies characteristics apart from simple capillary fragility. “There are conditions in which bleeding from the nose or nosebleeds are very abundant and repetitive. The cause may be due to generally inherited congenital malformations, such astelangiectasia, (Hereditary hemorrhagic telangiectasia (HHT), and also known as Osler-Weber-Rendu syndrome. This condition is characterized by small arteriovenous malformations that expose continuous bleeding. The first step towards identifying the problem is seeing an otolaryngologist. The otolaryngologist will perform certain tests and look for more severe malformations that can affect vital organs such as the liver, lungs and brain. They will not cauterize the varicose vein but rather send the patient to a specialized center for disease management. The same happens if you suspect the presence of a tumor in the nasal area and paranasal sinuses, which requires radiological investigations” concludes the specialist.

“Other cases, although even more rare, involve larger blood vessels such as the sphenopalatine artery. It is important to be aware that taking certain medications can also cause bleeding from the nose. “Adults and elderly patients who are taking anticoagulants or antiplatelet drugs – says Dr. Malvezzi – are naturally more susceptible to rhinoplasty if their mucosa shows signs of vulnerability due to aging.”

How to prevent nosebleeds

A few recommendations for preventing nosebleeds include the following: 

• Blow your nose gently
• Keep your home humidified
• Wear a head guard during strenuous activities in which the nose or hear could get injured
• Follow the instructions that come with nasal congestants
• Breathe in moist air (ex: in the shower) if your nose becomes very dry