Epistaxis

Epistaxis or nasal haemorrhage or nose bleed is characterised by haemorrhage from the nose, usually due to rupture of small vessels overlying the anterior part of the cartilaginous nasal septum. It is very common feature of of the childhood and a varied etiology ranging from traumatic to serious blood dyscrasias. The common site of the nose bleeding is the anterior part of the nasal septum approximately 1 cm above the nasal orifices. The mucosa of the nasal conchae or other parts of the nose is less likely to bleed. Bleeding is usually of sudden onset without any apparent cause and very often it ceases spontaneously through some times it may go on for a long time draining the patient of blood, slowing down the pulse rate and causing constitutional debility and fainting. The blood may be either of bright red colour or clotted, coagulated or dark, black or fluid or pale or stringy.
Causes
Numerous causes are assigned to Epistaxis, but most frequent cause in children is nasal trauma including blow on the nose, picking the nose, injuries to the nasal mucosa or removal of hard, crusts, general congestion caused by adenoids, foreign bodies violent exertion and from colds and other infections. Besides, atherosclerosis, disease of the heart, kidneys, liver, etc, also produce copious haemorrhage. Yet other causes of Epistaxis may be bleeding polypus, bronchitis, whooping cough, pernicious anaemia, leukemia, acute infectious fevers, influenza,  malaria, and high blood pressure. Some of the rare causes may be mountaineering, aeroplane journey and poisoning by some drugs especially quinine and salicylates. In New born infants a recurrent nasal discharge, which is blood stained should arouse suspicious of nasal diphtheria,  foreign bodies or congenital syphilis.
Constitutional causes
The children of psoric and tubercular constitution suffer from nasal haemorrhage more frequently of other than Constitutions. In tubercular children, Nasal haemorrhage are profuse, bright red, difficult to arrest and are ameliorated by cold applications. Over heating and violent exercises will often trigger off the haemorrhage. The children will have a haemorrhage from the nose on the slightest provocation, that is blowing the nose, a slight blow, or washing the face, etc. In this constitution, Epistaxis often proves to be beneficial as it ameliorated headaches, vertigoes and congestion to the brain and head
Effects
The Epistaxis in infants and young children may result in swallowing of blood which may consequently result in haematemesis ( vomiting of blood)
Preventive Children who are given to the attacks of Epistaxis should avoid violent exercise and other exertions. They should avoid exposure to hot sun which may cause congestion of head and lead to Epistaxis. Some of the conditions like nasal polypi, adenoids, whooping cough, nasal catarrhal, anaemia and fever should be treated properly with due regards to the Constitution of the child to avoid recurrence of Epistaxis.

The child should be put in the bed with his head propped high or two or three pillows and his nasal wings should be pressed to the septum to stop the bleeding. Child should be asked to hold the hands as high above the head as possible. Cold application to any part of the head constricts the bleeding vessels and helps to stop bleeding.
Homoeopathic therapeutics.
Aconite useful for violent bleeding in plethoric patients as a result of over heating or due to rush of blood to the head. This remedy is especially useful when Epistaxis is associated with headache or with cough.. Ammonium carb  this remedy is useful in Epistaxis coming on after washing face in cold water, in morning. Bleeding may also occur after eating, after blowing the nose or during headache.
Arnica This is one of the important remedies for Epistaxis caused by a blow, fall or any external injury. The nose may feel hot and bleeding bright or dark or pale colour. Epistaxis during whooping cough or typhoid fever is also covered by this remedy.
Belladonna  Epistaxis from congestion to head with flushed face injected eyes and throbbing in temples. The blood is bright red or clotted, coagulated or dark black and usually comes on at night. This remedy is also useful in case of infants when the nasal discharge is blood strained.
Bryonia Epistaxis in the morning after rising particularly at 3/4 o'clock in the morning. In young girls, frequent bleeding of nose when menses should appear, this remedy will be of particular use.
Carbo veg  Daily attacks of Epistaxis with pale face before and after attack is highly indicative of this remedy. The Epistaxis usually comes in the morning when the child is still in the bed or at night. The bleeding is periodic in nature and persistent and greatly debilitates the child.
China Useful in debilitated children who have frequent and long attacks of Nasal haemorrhage with great pallor of face and coldness, convulsions and twitching. Habitual and easy bleeding from nose even with slightest touch is successfully cured by this remedy..
Croc  The Nasal haemorrhage is accompanied by cold sweat on forehead in hot weather or in diphtheria and is usually of persistent nature. Better in open air.
Crotalus horridus Epistaxis with black and stringy blood ozaena and occurring after eruptive fevers or syphilis. As this remedy causes blood decomposition and haemorrhage, the children showing general tendency to hemorrhagic diathesis are especially benefited by this remedy. The Epistaxis from the blowing the nose or during whooping cough or typhoid fever is also relieved by this remedy.
Ferrum phos This is one of the important remedies for Epistaxis when the blood is bright red and comes out in the form of a steady flow. Bleeding from blowing the nose, during fever and during headache or cough is often relived by this remedy.
Hamamlis  This is one of the often used remedies for Epistaxis when bleeding is profuse with tightness in bridge of nose. The nature of bleeding is characterised by passive, venous flow and the blood is non coagulated. This remedy is also useful in frequent oozing of dark fluid and in haemorrhagic tendency.
Ipeca  when the bleeding is bright red or clotted and coagulated. Epistaxis in whooping cough and diphtheria is also relived by this remedy. Epistaxis accompanied by nausea and dyspnoea often calls for this remedy.
Lachesis Blood containing flakes of decomposed blood looking like charred straw after drying. This remedy is useful in Epistaxis during hot weather and during typhoid fever.
Millefolium One of the characteristic symptoms of this remedy is piercing pain from eyes to the root of nose.
Phosphorus This remedy is especially useful in tall and slim girls approaching puberty, who suffer from vicarious menstruation ( Epistaxis from suppressed menstruation) . Chronic Epistaxis with small haemorrhages, handkerchief is always bloody. Nasal haemorrhage due to bleeding polypi. The bleeding usually comes in morning or in evening. The haemorrhage may come suddenly on touch and due to strong odours or sound. Better by cold application, open air and lying on right side.
Pulsatilla Useful in young girls suffering from vicarious menstruation.
Bleeding may occur during evening or at night and may be aggravated by blowing the nose especially in the morning and with hard coughing. The Pulsatilla patient often suffers from nasal haemorrhage after being wet and by sitting in a warm stuffy room. The blood is often black and clotted. Epistaxis in sensitive, gentle weepy children will often call for this remedy.
Sulphur Children given to repeated attacks of Epistaxis are specially benefited by this remedy. Sulphur being a strong anti psoric often helps children of psoric constitution who have bright red lips and red and scabby nasal alae. Epistaxis due to dry scabs forming in the nose which when dislodge cause bleeding. Also haemorrhage due to nasal polypi and adenoids.
Tub Children tubercular constitution are benefited by this remedy. Bleeding occuring on slighted provocation namely on touch, blowing the nose, washing the face, as well as over heating and exercise often calls for this remedy on constitutional plane.
Some case
An 11 years old boy was brought to me by his worried mother of recurrent nasal haemorrhage. The child was robust and in good health and often complained of headache especially in the morning after arising. The mother reported that the child had frequent attacks of nose bleeding, mainly in hot weather and from blow and sudden touch. The blood was usually of dark colour and was profuse. The child was more liable to Nasal haemorrhage when he suffered from headache. On further interrogation, it was learnt that the bleeding was generally profuse and more from the left nostril which was slightly better after lying on the right side. Based on the above symptoms the boy was administered Lachesis 0/12 potency (50 millisimal scale)  in repeated doses for 3 days. After about a month, the mother reported that the frequency and the intensity of bleeding had greatly reduced. To the great joy and the amazement of the mother, the child had no headache during this period which was otherwise of frequent occurrence. Lachesis 0/18 was administered in frequent doses which completely cured the boy of all the troubles stated above..
Case 2
A 14 old girl suffered from Epistaxis with profuse and bright red blood without any apparent cause. She stated that during hard study particularly in the days of examination,  she had frequent attacks of Epistaxis. The girl was menstruating regularly and normally. Further interrogation did not reveal any significant symptoms as the bleeding was reported to occur any time during day or night, during any season and under any condition. But going deep into the family history of the child it was learnt that her grand father had died of tuberculosis and her father usually suffered from bouts of loose coughing. Based on the family history Tuberculinum 1m was administered followed by occasional doses of Millefolium whenever the attack came, which cured her permanently.