Update: February 2019
- External factors
- Local causes
- Common causes
- Symptoms, signs of anterior and posterior bleeding из
- First aid for nosebleeds
- When should I seek medical help urgently?
- What to do with frequent nosebleeds in children and
Among patients referring to an ENT doctor, 5–10% are individuals
жалующиеся на самопроизвольные кровотечения из nose, 20%
hospitalized for emergency reasons, most often after
Butсовое кровотечение после механического воздействия не вызывает
questions, as the reason is obvious, but usually anxiety
cause frequent repetitive bleeding for no apparent reason
both short and long, both abundant, tick and
scarce, in children and in adults.
TOровь из nose может пойти по причине нарушения целостности
стенок vessels nose или нарушения свертываемости крови. In 70-90%
случаев это происходит из vessels передних отделов nose, из задних
departments bleeding is most difficult to stop and it is very dangerous
for health because the larger vessels are damaged and its
intensity is higher.
In most cases this is due to a mucosal disorder.
shell in the Kisselbach zone in the anterior section of the nasal septum
(the size of a penny coin). Here the mucosa is thin, loose and
насыщена сосудами, как раз в этой зоне сплетения vessels даже
light damage leads to blood excretion.
Withчинами частых кровотечений из nose могут быть болезни крови,
infectious diseases (tuberculosis, syphilis, etc.), diseases
liver, kidney, rheumatism, cardiovascular manifestation
diseases. Blood may be trickled or dropped from the nostrils.
or flow down the back of the pharynx, accompanied by a decrease
давления, слабостью, dizzinessм, шумом в ушах,
Иногда кровотечение из nose можно перепутать с кровотечением из
trachea, lungs, nasopharynx, bronchi, stomach, esophagus. With носовом
blood of the usual kind, clean.
Почему идет кровь из nose: внешние факторы
External causes of spontaneous bleeding
in healthy people may be as follows:
Сухой воздух — частые носовые кровотечения у детей могут
to be with excessive dry air in the room, especially during
heating season. This causes the mucous membranes to dry.
nose, как бы склеиванию ее с мелкими сосудами, при этом сосуды
become more brittle and lose their elasticity.
Overheating of the body is one of the natural causes of a healthy
human is heat or sunstroke. Such bleeding
from overheating of the body is accompanied by weakness, fainting
состоянием, dizzinessм, шумом в ушах.
Перепады атмосферного или барометрического давления — они
occur during a sharp descent to the depth (when swimming at a depth of
divers), when climbing to a great height (pilots,
Professional intoxication or poisoning – inhalation in everyday life
or in the production of toxic fumes, aerosols, gases. Impact
radiation, electrical, chemical, thermal burns of the mucous. TO
For example, in chronic benzene poisoning, blood
blood vessels and blood-forming organs, permeability of the walls is disturbed
vessels, вызывая кровотечение из nose, десен и пр. With отравлении
phosphorus can develop acute hepatitis in combination with
Severe coughing and sneezing – this increases the pressure dramatically
в сосудах nose, приводя к их повреждению.
Withем некоторых medicines — антигистаминных
medications (see allergy medications), corticosteroids, nasal
vasoconstrictor sprays, blood thinners – aspirin,
Local causes носового кровотечения
- This is the most common cause as after car
accidents, and after industrial or domestic injuries – a fall,
bumps leading to cartilage fractures. Such bleeding
usually combined with severe edema of the damaged area and
soreness of the surrounding tissue, at the fracture of cartilage tissue or
facial bones deformity is visually noticeable.
- TOроме того, травмирование слизистой nose происходит при
operations, medical-diagnostic manipulations – puncture of the sinuses
nose, зондирование, катетеризация носовых пазух.
With развитии местных патологических состояний, когда происходит
полнокровие слизистой оболочки nose — при аденоидах у детей
(operation), sinusitis, antritis (see signs of sinusitis in
adults). Chronic rhinitis, including allergic rhinitis
are causes of bleeding, especially against the background of uncontrolled
use of vasoconstrictor nasal or hormonal drops
препаратов, которые способствуют истончению слизистой nose и
development of her atrophy.
Дистрофические изменения в слизистой оболочке nose, аномалии
development of veins, curvature of the nasal septum
TOак указано выше на фоне лечения хронических аллергических
rhinitis, with atrophic rhinitis occur dystrophic processes
in the mucous membrane, contributing to the occurrence of nasal
bleeding. Causes are also abnormalities of the development of veins and
arteries (local expansion), significant nasal curvature
septum or superficial vessels of the mucous
Tumors, adenoids, nasal polyps
Frequent nasal discharge may be the only
a sign of an emerging malignant or benign
tumors in the nasal passages – tumors, nasal polyps (see
treatment of polyps contribute), a specific granuloma, adenoids (see
adenoids: symptoms, treatment), angiome.
Foreign bodies – small objects, mites,
In small children, if damaged by a finger, pencil, or
ingestion of foreign objects in the nasal cavity, as well as
inhalation of small insects or when bathing in open water
возможно проникновение клещей и других parasites в просвет vessels
or nasal mucosa. When worm infestation, for example, when in the period
Ascarid larvae migrate with blood to the lungs
nasopharynx and other organs, damaging the vessels (see roundworm:
Common causes of nasal blood
Increased vessel fragility may occur with the following
diseases and conditions:
Changes in the vessel wall
- Vasculitis (inflammation of the inner lining of blood vessels) – while
bleeding is rarely heavy, sometimes accompanied
hemorrhage in the internal organs, muscles, joints and always
accompanied by a rash. Read more on vasculitis symptoms.
- Vascular atherosclerosis (see cerebral arteriosclerosis)
may be accompanied by the appearance of blood from the nose, this disease
threatened by the development of stroke and heart attack.
- Infectious diseases – chickenpox, measles, influenza, tuberculosis
(with tuberculosis of the nasal cavity may be just periodic
blood crusts in the nose), meningococcal meningitis lead to
pathological changes in the walls of blood vessels.
- Hypovitaminosis – deficiency of vitamin C, K, as well as calcium.
With fluctuations in hormonal levels – is adolescence,
women during pregnancy, during the period of premenopause.
Blood pressure increase
A sharp increase in blood pressure may occur in
the result of physical and emotional overload on the background
diseases of the cardiovascular system and not only
pressure jump occurs rupture of the walls of the capillaries (small
vessels) in the nose:
- Hypertonic disease
- Heart defects, accompanied by increased blood pressure
- Aortic stenosis, mitral stenosis
- Chronic pyelonephritis and glomerulonephritis
- Pneumosclerosis and emphysema
- Adrenal tumors
- Overload – emotional and physical
- Bleeding disorders – this is one of
symptoms of a group of acquired or hereditary pathological
conditions and diseases involving not only nasal, but also
- Aplastic anemia or leukemia.
- When the nose is often bleeding, the cause may be
reduced levels of platelet production in the body (the so-called
- Cirrhosis of the liver
- frequent tamponade of the nasal cavity, contributing to the occurrence
атрофии слизистой и кровотечениям
- systemic lupus erythematosus
- kidney disease
- osler disease
- pulmonary emphysema
- migraine and nervous disorders
Symptoms, signs of anterior and posterior bleeding
Click to enlarge
Symptoms of nasal bleeding other than the fact of expiration
blood may be supplemented by symptoms of the underlying disease and
signs of acute blood loss:
- noise in ears
- tachycardia (heartbeat), shortness of breath
- lowering blood pressure
- itchy nose, tickling
- general weakness
- paleness of the skin (slight)
With minor bleeding, symptoms of blood loss usually do not
manifest themselves. The outflow of blood can be both outward and inward.
When blood enters the back of the oropharynx, it does not come out.
out, it can be detected by pharyngoscopy. With heavy loss
blood can develop hemorrhagic shock – thready pulse,
sharp pressure drop, tachycardia.
- At the front – the source in 90% of cases is
зона TOиссельбаха, это обширная сеть мелких кровеносных
vessels that are covered with a rather thin mucous membrane,
almost without submucosal layer. With such bleeding, usually not
there is a strong blood loss, it stops on its own and does not
threatens human life.
- At the back – large vessels are damaged, which are in deep
parts of the nasal cavity, it is dangerous for the patient and almost never
self does not stop.
To determine if the bleeding is front or back,
the patient is examined by a doctor, anterior rhinoscopy is performed
- With gastric and pulmonary bleeding, blood may flow to
nasal cavity and simulate the nasal – a doctor will see it when viewed
- In the pulmonary – blood foams and bright scarlet, with nasal
dark red, with gastric very dark, similar to coffee
- With intense nasal bleeding flowing down the back
vomiting with dark blood may occur.
To find out what is the main cause of nosebleeds,
a general examination and determination of symptoms of the main
diseases. To assess blood loss, you must pass a coagulogram.
and complete blood count.
First aid for nosebleeds
- Make an adult or child recumbent, better
just put the man and tilt his head forward.
- Apply cold on the nose for 10 minutes.
- You can drip vasoconstrictor drops (galazolin, naphthyzine,
nazivin, etc.), in their absence, hydrogen peroxide 3%, clamp
nostrils with fingers.
- If this does not help, then apply a drop (or a weak solution
hydrogen peroxide) on a cotton swab (ball) and insert it into the nostril,
clinging to the nasal septum.
- If the blood from the nose flows from the right nostril – lift the right
arm up, with the left squeeze nostril, if from both,
the patient raises both hands up and the carer
presses his both nostrils.
- If these activities do not help after 15-20 minutes, then
call an ambulance.
After the bleeding stops you can not dramatically pull out
tampon, because it can damage the blood clot and go out of the nose again
blood. It will be correct to moisten it before removing the tampon.
hydrogen peroxide and only then take out.
Even after a one-time episode, especially in a child,
consult an ENT doctor for a possible reason and
prevent relapse. To prevent drying, speed up
healing and reduce the risk of re-bleeding can be 2 p / day
lubricate the nasal mucosa with petroleum jelly (ointment Neomycin, Bacitracin),
if the apartment has dry air (heating season), the child can
bury in the nose drugs with sea water – Aquamaris, Salin.
If you cannot stop the blood on your own, doctors can
conduct anemization of the nasal mucosa with ephedrine solution
or adrenaline. If after holding the front tamponade
the bleeding does not stop, then hold the back tamponade. But
usually the front tamponade helps well when the rear
bleeding from nose.
With often recurrent nasal discharge or
the ineffectiveness of tamponade is undergoing surgical treatment. With
frequent frontal bleeding is used endoscopic
cryodestruction, coagulation (cauterization), and also introduction is possible
sclerosing drugs and others
With кровотечении нельзя
- Do not throw your head back and take the recumbent
position – it increases bleeding, blood can flow into
esophagus or respiratory tract. If she gets into the stomach – this
cause nausea and vomiting, if in the respiratory tract -dushie.
- You can’t take a look at it – it will dislodge the clot that forms
may increase bleeding
- With попадании инородного тела нельзя извлекать его
on their own.
When should I seek medical help urgently?
In the following cases you can not lose time and wait
spontaneous hemostasis, and should immediately
- high blood pressure (blood pressure)
Задняя тампонадаClick to enlarge
- the patient has diabetes
- there was a nose injury
- the patient had a faint, loss of consciousness
- intense bleeding and the threat of rapid blood loss is very
- a patient has vomiting of blood, which may indicate bleeding
from the esophagus or stomach, as well as damage to the lungs (blood from
- if the patient is taking (especially a long time) NSAIDs,
heparin, aspirin or diagnosed in a child or adult
bleeding disorders (hemophilia, etc.)
- after a head injury, the blood goes through the nose and transparent flows with it
liquid, in this case there is a suspicion of a base fracture
Adults and children with severe bleeding and significant
hemorrhage is hospitalized in the hospital, in the ENT department. If a
I managed to stop him quickly at home, then the child should
show the otolaryngologist and the adult to consult too
at the doctor’s. With частых кровотечениях из nose у детей и взрослых, когда
there is no clear reason to find out;
hematologist, endocrinologist, neurologist.
Most often, blood flows from the Kisselbach area to prevent
new cases this place is cauterized. ENT doctor can
do the following:
- remove polyps, foreign body
- back or front tamponade soaked in 1% solution
feracryl, canned epsilon-aminocaproic acid
- insert a tampon with vagil or trichloroacetic acid
- coagulation in one of the modern ways: electric current,
laser, ultrasound, silver nitrate, liquid nitrogen, chromium
acid or endoscopic cryodestruction
- perhaps the introduction of an oil solution of vitamin A, sclerosing
- use hemostatic sponge
- with severe blood loss, use is indicated.
fresh frozen plasma, blood transfusion, intravenous
the introduction of hemodez, reopoliglyukina and aminocaproic acid
- if the listed methods had no effect maybe
surgical intervention – embolization of large vessels
(ligation) in the problem area of the nasal cavity
- prescription of drugs that increase blood clotting –
vitamin C, calcium chloride, calcium gluconate, Vikasol.
After nasal bleeding is not desirable to use hot
meals and drinks, you can not play sports for several days,
because it promotes a rush of blood to the head and can
provoke a repeat.
- according to the testimony reception Askorutina to strengthen the walls
- air humidification during the heating season
- good nutrition, rich in natural vitamins and
- injury prevention.