Nosebleeds, medically known as epistaxis, are a common occurrence, affecting many individuals at some point in their lives. While most nosebleeds originate from the front part of the nasal cavity and are often minor, a less common but more serious type occurs deeper within the nose. These are known as posterior nosebleeds, and they typically require specialized attention due to their location and potential for significant blood loss.
Understanding Posterior Nosebleeds
A posterior nosebleed originates from blood vessels located deep within the nasal cavity, specifically towards the back of the nose near the throat. This differs from anterior nosebleeds, which are much more common and occur from delicate blood vessels in the front part of the septum, the wall dividing the nostrils. Bleeding in a posterior nosebleed often involves larger blood vessels, such as branches of the sphenopalatine or ethmoidal arteries. The blood flow is heavier and tends to drain down the back of the throat, even when an individual is sitting upright. This flow pattern makes it difficult to assess the actual amount of blood loss.
Why Self-Healing is Unlikely
Posterior nosebleeds rarely resolve on their own due to several anatomical and physiological factors. The blood vessels involved are larger and carry a greater volume of blood compared to those in the front of the nose. This increased blood flow makes it challenging for the body’s natural clotting mechanisms to effectively seal the damaged vessel. Unlike anterior nosebleeds that can often be controlled by applying direct pressure to the nostrils, the deep location of a posterior bleed makes it inaccessible for this kind of external compression.
When blood continuously flows down the back of the throat, it prevents the formation of a stable clot at the bleeding site. Factors like older age, high blood pressure, and blood-thinning medications can hinder natural healing. Individuals with underlying bleeding disorders or recent nasal/sinus surgery may also experience more persistent bleeding. The persistent nature of posterior nosebleeds means they can lead to substantial blood loss if not medically addressed.
When to Seek Immediate Medical Attention
It is important to recognize signs that warrant immediate medical attention for a posterior nosebleed for safety. Seek professional help if the bleeding is heavy and continuous, especially if you feel or taste blood flowing down the back of your throat. Bleeding that persists for more than 15 to 20 minutes, despite attempts at initial self-care measures, indicates a need for medical evaluation.
Other concerning symptoms include difficulty breathing, dizziness, weakness, or pale skin, which can signal significant blood loss. If a nosebleed occurs after a head or facial injury, seek immediate medical care. Additionally, if you are taking blood-thinning medications or have a known blood-clotting disorder, any persistent nosebleed should prompt a medical visit.
Professional Management Options
When a posterior nosebleed does not resolve on its own, healthcare professionals employ various interventions to stop the bleeding. One common approach is nasal packing, where specialized sponges, gauze, or inflatable balloons are inserted into the nasal cavity to apply pressure directly to the bleeding vessels. These packing materials are designed to remain in place for a period, allowing the blood to clot.
Another method is cauterization, which involves using a chemical substance, such as silver nitrate, or an electrical current to seal the bleeding blood vessels. In cases where packing and cauterization are insufficient, more advanced procedures may be necessary.
Embolization is a minimally invasive technique that involves blocking the bleeding vessels from the inside using a catheter. For recurrent or severe cases, surgical ligation, which involves tying off the specific blood vessels supplying the nose, such as the sphenopalatine artery, may be performed. Adjustments to medications, particularly blood thinners, may also be part of the treatment plan.