Nosebleed

(Epistaxis; Bloody Nose)

Nosebleed – Definition

Nosebleed refers to blood flowing from the nose or nasal passage. There are two types of nosebleeds:

• Anterior nosebleed — blood coming from the front of the nose, usually the semi-rigid walls that separate the two nostrils (most common type of nosebleed)
• Posterior nosebleed — bleeding starts deep within the nose; often more difficult to treat and more severe than an anterior nosebleed

Nosebleed – Causes

Causes include:

• Irritating or breaking to the lining of the nose
• Injuring the nasal tissue, which occurs more easily when nasal structure is not normal or the passages are inflamed due to a cold or allergies
• Having very dry nasal tissue
• Picking or bumping the nose
• Forcefully blowing or rubbing the nose
• Having clot from a previous nosebleed becoming disturbed or dislodged
• Placing a foreign object in the nose
• Having a tumor in the nose and/or sinuses

Nosebleed – Risk Factors

Factors that may increase the risk of nosebleeds include:

• Irregularity in the structure of the nose
• Abnormalities of the blood vessels in the nose (angiomas)
• Dry climate
• Dry, heated indoor air
• Allergies
• Colds
• Sinusitis
• Diseases (eg, sarcoidosis, lupus)
• Cocaine use
• Bleeding or clotting disorders
• Anticoagulant (blood-thinning) drugs, including aspirin
• Very high high blood pressure

Nosebleed – Symptoms

Nosebleed symptoms depend on where in the nose the bleeding begins, for example:

• Anterior nosebleed — produces blood flow from one nostril when sitting or standing; blood may pass down the throat if you are coughing or tipping your head back
• Posterior nosebleed — causes bleeding down the back of the mouth and throat; blood may flow from the nostril if you lean forward

When Should I Call My Doctor?

Call your doctor if:

• There is a lot of blood.
• The bleeding will not stop.
• The bleeding is caused by an injury.
• You experience frequent nosebleeds.

Nosebleed – Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam.

Your doctor may want to do certain tests, such as:

• Sinus x-rays — to identify abnormalities or a mass in the nasal region
• Endoscopy — to examine nasal tissues
• Blood tests — to check for anemia, low blood platelets, or clotting problems

Nosebleed – Treatment

Most anterior nosebleeds stop without medical care within 15 minutes. Posterior nosebleeds usually are more serious and need medical care. Treatment may include sealing off the blood vessel that is bleeding.

Self-Care

1. Stay calm.
2. Sit up and lean forward.
3. Pinch the soft parts of your nose together and hold for at least five minutes without releasing pressure.
4. Once the bleeding stops, do not pick or blow your nose.
5. Avoid straining, bending, or lifting.
6. If the bleeding starts again, reapply pressure for ten minutes.

Medical Intervention

For an anterior nosebleed, the doctor will place a compress soaked in a medicine that constricts or shrinks the blood vessel and reduces the pain. Pressure will be applied by pinching the nostrils together. The doctor may pack the area with gauze. In more severe cases, the doctor may cauterize, or seal off, a blood vessel that does not clot on its own.

A posterior nosebleed may require packing the nostril or inserting and inflating a special balloon that applies pressure on the area. If all medical attempts to control bleeding fail, surgery may be needed.

If you are diagnosed with a nosebleed, follow your doctor’s instructions.

Nosebleed – Prevention

To reduce the chance of getting a nosebleed:

• Lubricate dry nasal passages near the front of the nose. Place a small dab of lubricating cream or ointment on your fingertip. Apply the lubricant to the inside of the nose. You may do this at bedtime or up to three times during the day. Polysporin and petroleum jelly (eg, Vaseline) are examples of lubricants that may be used.
• Use a saline nasal spray to help keep nasal passages moist. Be sure that the nose spray does not contain medicines, such as phenylephrine or oxymetazoline. These types of medicines should be used for only a few consecutive days.
• Do not pick your nose. Cut children’s fingernails short to discourage picking.
• Humidify the air, especially in bedrooms.