Definition and Facts about Nosebleed
- 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 Is a Nosebleed?
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.
What Are Other Nosebleed Symptoms?
Bleeding usually occurs only from one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well. Blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood.
Signs of excessive blood loss include:
- confusion, and
Excessive blood loss from nosebleeds does not often occur.
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 (object stuck in the nose),
- 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.
Are Nosebleeds Serious?
With proper treatment, the vast majority of people recover from nosebleeds with no long-term effects. A minority of individuals may experience severe bleeding, which can rarely be life-threatening.
What If My Infant or Child Has a Nosebleed?
Nosebleeds in children can be an anxiety-provoking event, both for the parent and the child. However, most nosebleeds in children are self-limiting and benign, and can typically be managed at home. As in adults, most nosebleeds in children originate in the front part of the nose.
Nosebleeds in children usually occur between 2 to 10 years of age. Nosebleeds in infants, however, are unusual and require further evaluation by a healthcare professional. Although most nosebleeds in children are spontaneous and occur infrequently, some children may experience more frequent, recurrent nosebleeds.
What Are the Causes Nosebleeds in Children? What Is the Treatment?
The most common cause of nosebleeds in children is from minor trauma, typically from nose picking. Other common causes of nosebleeds in a child include:
- Direct trauma to the nose
- Upper respiratory infections
- Foreign body in the nose
- Allergic rhinitis
- Exposure to warm, dry air
- Nasal medications (for example, corticosteroids)
Less common causes of nosebleeds in children include vascular malformations, leukemia, nasal tumors, and various blood clotting abnormalities. An accidental ingestion of blood-thinning medication, for example, warfarin (Coumadin, Janotven) also is a rare cause of nosebleeds in children.
The treatment for nosebleeds in children is similar to that of adults (see Treatment section). The prognosis in children is generally excellent; however, nosebleeds caused by serious underlying medical conditions vary.
How Can I Stop a Nosebleed at Home?
A small amount of bleeding from a nosebleed requires little intervention. For example, if a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue, one should avoid forceful nose blowing, sneezing, and nose picking. This is usually enough to keep the bleeding from getting worse.
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. 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.
What to do after the bleeding has stopped
- Once the bleeding has stopped, try to prevent any further irritation to the nose, such as sneezing, nose blowing, or straining for 24 hours.
- Ice packs do not help nosebleeds.
- Exposure to dry air, such as in a heated home in the winter, can contribute to the problem. Adding moisture to the air with a humidifier or vaporizer will help keep the nose from drying out and triggering more bleeding. Another option is to place a pan filled with water near a heat source, such as a radiator, which allows the water to evaporate and adds moisture to the air.
- Nasal saline sprays or other lubricating ointments or gels also may be useful to promote tissue healing and keeps the nasal passages moist.