Nose Bleeding

Treatment

How to stop a nosebleed

  • Remain calm.
  • Sit up straight and lean slightly forward.
  • Lean your head forward. Tilting your head back will only cause you to swallow the blood.
  • Pinch the nostrils together and apply direct pressure with the thumb and index finger for approximately 10 minutes. The time it to make sure the nostrils are not released earlier.
  • Spit out any blood in the mouth. Swallowing blood may cause vomiting.
  • This technique will stop the majority of simple nosebleeds.

A nosebleed simply means that blood is coming out of the inside of the nose. Nosebleeds are one of the most common problems treated in an Emergency Department.

Overview

  • Nosebleeds (epistaxis, nose bleed, nosebleed) can be dramatic and frightening. Fortunately, most nosebleeds are not serious and usually can be managed at home, although sometimes medical intervention may be necessary.
  • Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose).
    • Anterior nosebleeds make up most nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum, where a network of vessels converge (Kiesselbach plexus). Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a health care practitioner.
    • Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).
  • Nosebleeds tend to occur more often during winter months and in dry, cold climates. They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.

What Causes Nosebleeds?

Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:

  • exposure to warm, dry air for prolonged periods of time,
  • nasal and sinus infections,
  • allergic rhinitis,
  • nasal foreign body
  • vigorous nose blowing,
  • nasal surgery,
  • deviated or perforated nasal septum, and
  • cocaine use.

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

  • Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.
  • Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.
  • Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.
  • Vascular malformations in the nose and nasal tumors are rare causes of nosebleeds.
  • High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure.