Epistaxis, the medical term for a nosebleed, is a common occurrence. While the majority of these events are minor and originate from the front of the nose, some bleeds are more serious. This more severe type, known as a posterior nosebleed, originates from deeper within the nasal cavity and requires a distinct approach to management and treatment.
What Defines a Posterior Nosebleed
A posterior nosebleed arises from blood vessels located in the back part of the nasal cavity, near the throat. This anatomical location involves larger arteries, meaning the bleeding tends to be more profuse and challenging to control than a typical nosebleed. The sheer volume of blood flow often leads to a heavy flow from both nostrils.
The most telling sign is the direction of the blood flow, which frequently runs backward down the throat. This backward drainage can cause the individual to taste or swallow blood, potentially leading to nausea or vomiting. Because the source of the bleeding is so far back, applying manual pressure to the soft part of the nose, the standard first aid, is often ineffective. These bleeds are serious and generally require medical attention.
Underlying Causes and Risk Factors
The causes of posterior nosebleeds are often related to systemic health conditions or significant trauma. Uncontrolled high blood pressure is one of the most common factors, as elevated pressure can cause the deeper, larger blood vessels in the nasal cavity to rupture. Aging is also a factor, as adults between the ages of 45 and 80 are more likely to experience this type of bleed.
Underlying clotting disorders, such as hemophilia or von Willebrand disease, increase the risk because the blood cannot form a stable clot. Medications that interfere with blood clotting, including blood thinners and anti-inflammatory drugs, are also a risk factor for persistent bleeding. Other contributing factors include advanced arteriosclerosis, complications following nasal surgery, and severe trauma to the head or face.
Immediate Management Steps
The immediate steps for managing a suspected posterior nosebleed differ from routine first aid and focus on safety and preparing for medical assistance. Remain calm and sit upright to lower the blood pressure in the nasal veins, which can help slow the bleeding. Lean slightly forward, not backward, to prevent blood from draining into the throat and causing choking or stomach irritation.
While waiting for professional help, pinch the soft part of the nose firmly with the thumb and index finger for at least 10 to 15 minutes without releasing the pressure. Applying a cold compress to the bridge of the nose or the back of the neck may also help by causing local blood vessels to constrict. If the bleeding is heavy, felt in the throat, or persists beyond 20 minutes despite these measures, seek emergency medical attention. Do not attempt to pack the nose with gauze or tissues at home, as this can worsen the situation by dislodging clots.
Professional Medical Intervention
Once a person with a posterior nosebleed arrives at a medical facility, the professional intervention is focused on localizing the source and applying direct, sustained pressure. The most common initial treatment is nasal packing, which involves inserting specialized materials, often a gauze or an inflatable balloon catheter, deep into the nasal cavity. This packing provides the necessary internal pressure to compress the bleeding vessel, and it typically remains in place for 48 to 72 hours.
If the bleeding site is visible and accessible, the physician may attempt cauterization, a procedure that seals the ruptured vessel using a chemical agent like silver nitrate or an electrical current. Patients with posterior packing are generally admitted to the hospital for close monitoring. In rare cases of uncontrollable or recurrent severe bleeding, more advanced procedures like arterial ligation, which involves surgically tying off the blood vessel supplying the area, or embolization, which blocks the vessel using injected material, may be necessary.