Frequent epistaxis: what are the causes?

L ‘epistaxis or rhinorrhagia, that is nosebleeds, is a common occurrence of all ages. The blood lost on these occasions always seems to be very plentiful, so we are often alerted to go to the emergency room. In fact, in the vast majority of cases, the amount of blood is minimal and the local causes are not worrying.

Dr. Antonio Foresti, head of the otolaryngology unit at the San Pietro Polyclinic in Ponte San Pietro, notes: “Epistaxis is generally due to:

  • to minor traumasuch as. caused by brushing the nose too hard;
  • tohabit of sticking fingers in the nosecommon in children;
  • to infections, such as colds or rhinosinusitis, (favored in the summer by sudden temperature changes due to often excessive use of air conditioning.

However, if the problem tends to recur with a certain frequency, especially in adults, it may be a sign of more serious causes and problems ”.

The causes in children and adults

In children The most common causes of nosebleeds are:

  • the trauma due to application pick your nose;
  • there dryness of the nasal mucosa.

In adultson the other hand, in addition to these factors, others, both local and general, are added: “Loss of nosebleeds is not uncommon, for example in people who use for therapeutic purposes nasal medicinesuch as corticosteroids and antihistamines.

In this case, the incidence is lower in people who direct the beam laterally to minimize the effect of these drugs on the septum.

Very abundant nosebleeds can also occur after trauma to the nasal bones or septum or a septal perforations: idiopathic or acquired, as when, for example, nasal vasoconstrictors or toxic substances such as cocaine are abused. And still in association with viral or bacterial rhinosinusitis And tumors.

In addition to these local factors, recurrent nosebleeds may be associated with general conditions such as:

  • coagulopatier (disease in blood coagulation processes);
  • use of anticoagulants for cardiovascular pathology;
  • tumors of hematological origin.

Me too’hypertension it can cause nosebleeds in accordance with hypertensive crises with subsequent rupture of a blood vessel in the nose, ”explains the specialist.

What to do when a nosebleed comes out

“The first rule to deal with the emergency is avoid tilting your head back. Although it is the most instinctive gesture, it can be dangerous because it favors inhalation of blood into the airways, ”suggests Dr. Forests.

What else can be done? “Considering that most anterior hemorrhages are self-limiting, that is, they stop on their own and do not require medical treatment, what everyone can do is so-called self-tapping maneuverswhich can be summarized as follows:

  • remain standing (or sitting) with the head straight or rather bent forward;
  • pud the nose firmlyeven if the blood comes out;
  • immediately after blowing press the nose between two fingersin a crucial way, close the nostrils;
  • stay in this position for a few minutes (from 3 to 5 of the clock!);
  • try in every way relax;
  • apply some emollient healing nasal ointment when the nose is opened again;
  • repeat the same procedure step by step if the problem was not resolved the first time “.

Do Grandma’s Remedies Work?

“The various ‘grandmother’ tools, such as putting the wrists under water, moistening the neck or forehead, and so on, follow the logic of an ancient wisdom, but they are too slow’ in reaching the goal. – emphasizes Dr. Foresti -. After the self-tamponade, however, it can be helpful placed over the nose of the ice in a small plastic bag.

The introduction of ‘hemostatic cotton’sometimes optimal in the resolution of epistaxis, but so difficult to remove, is inadvisableas well as of any absorbent material (cotton, gauze, absorbent paper, etc.) “.

When you go to the emergency room

If the nosebleed does not stop or if it stops again, it’s good to go to the emergency room. In fact, further treatment may be needed.

“Among these anterior nasal tamponade, performed by ENT (or by the emergency room doctor). Generally, a pad with non-degradable material is used, usually a hydroxylated polyvinyl acetate sponge that swells when wet. The tampon is coming removed after 48-72 hours. Insertion and removal can be uncomfortable or painful, especially if the nasal septum is deviated.

Next to these pillows there are a number of different ones absorbable or biodegradable materialswhich do not require removal and may be useful for patients with milder nosebleeds.

In case of important posterior epistaxisi.e. with blood drainage also towards the pharynx (in a sitting and correct position), the nasal tamponade becomes deeper, more complex and sometimes requires different materials (posterior nasal tamponade). In addition, in the most severe cases, a control of the bleeding in the operating room, under anesthesia.

After removing the nasal swab, it is advisable to use local antibiotic ointments or creams for emollient, healing and protective purposes.

In some cases, finally, as an alternative to tampons, it is possible to resort to cauterizationthat is, the ‘burning’ of the capillary that bleeds, through a bipolar electrocoagulation of the affected blood vessel with dedicated equipment, ”concludes Dr. Forests.

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