Bleeding from the nose or epistaxis is a very troublesome problem. It is not only painful but causes much anxiety to the sufferer as well. There are many common causes for nose bleed, but the most common one observed is dryness of nasal mucosa (inner lining of the nose). This is a very delicate structure, very rich in blood supply. Due to excess dryness of the nasal mucosa, there may be disruption of the inner lining resulting in bleeding. Dryness causes intense itching inside the nose because of which people tend to scratch or prick the nose. This induces trauma due to the finger or finger nails which leads to bleeding. The resultant nose bleed is mostly restricted to the blood capillaries, i.e. the smallest branches of the blood vessels. If multiple capillaries are involved it can be massive, otherwise it is in the form of small drops only. High blood pressure can lead to epistaxis, as the high pressure within the arteries causes their rupture. Rupture of small blood vessels will cause mild bleeding but rupture of a bigger vessel leads to severe bleeding. Bleeding disorders due to deficiency of platelets or clotting factors can manifest as nose bleed. Malignancy of the blood components like leukemia can also result in epistaxis. Drugs like aspirin induce bleeding from different sites including nose as a side effect. Depending on the cause, a person may have a single episode or multiple episodes of bleeding. Repeated epistaxis is a cause for chronic anemia and its attendant complications due to the frequent blood loss. It can also lead to sepsis as blood forms a rich medium for bacteria to grow. Massive, uncontrolled hemorrhage from the nose can even be fatal. Bleeding from the nose is frightening. It is suggested that as soon as bleeding starts from the nose, one should pinch the nose tight holding both nostrils and flex the neck backwards for few moments.. This usually stops the bleeding. Packing the nose tight internally with adrenaline soaked or even plain cotton packs is also useful to stop bleeding. If these measures fail to control the epistaxis, there are medicines available in tablet or injection form which aid in clotting of blood. In those cases where bleeding occurs due to dryness of the nasal mucosa, it is advisable to keep the nose well lubricated internally to prevent epistaxis. This can be achieved by applying vaseline, glycerin, oil or any other harmless lubricating substance inside the nose. The lubricating substance used should be applied gently with a clean finger without causing any trauma, at least 3 to 4 times every day. This will prevent epistaxis occurring due to aridity of the nasal mucosa. Drinking plenty of water keeps the body well hydrated and prevents dryness of all parts of the body including nasal mucosa. Pricking the nose with fingers should be avoided as it leads to epistaxis as well as infections in the nose. Those suffering from high blood pressure should keep the blood pressure controlled with diet restrictions and medicines. People who have a tendency to bleed after taking medicines like aspirin should avoid these medicines. While taking a prescription for any other problem, the doctor should be informed about this problem. If a person has repeated epistaxis after all these precautions, he needs to be investigated to find the root of the problem and treat it. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital
