Epistaxis or Nosebleeds

The nose has rich vascular supply and because its location i.e. it protrudes from our face, it is more prone to injury or trauma leading to nosebleeds or bloody nose or epistaxis. The bleeding may be mild or severe. In dry climates or winter season where the air is dry due to heaters at home, the nasal membranes get dry and crack resulting in bleeding from the nose. People who are taking blood thinners such as warfarin (Coumadin), aspirin or any other anti-inflammatory medication are more prone to nosebleeds. In these patients, even the slightest impact to the nose causes profuse nosebleeds. Nosebleeds also commonly occur after an impact or trauma to the nose or face. It may be accompanied with a fracture or they can occur after minor injuries. Sometimes nosebleeds can occur spontaneously without any trauma. Majority of the nosebleeds can be stopped at home with conservative measures.

Epistaxis or Nosebleeds

Symptoms of Epistaxis or Nosebleeds

  • Bleeding occurs from either one or both the nostrils.
  • The flow of the blood can be mild to severe.
  • The duration of bleeding may last for a few seconds to 10 minutes or even more.
  • The blood may travel down to the throat causing nausea.

Serious Symptoms of Epistaxis or Nosebleeds

  • If the bleeding is profuse and cannot be stopped.
  • If the blood loss is huge.
  • If the patient is feeling weak or faint
  • If there is trauma to the face with nosebleed.
  • Blurry vision or loss of consciousness.
  • If there is fever or headache with nosebleed.

Causes of Epistaxis or Nosebleeds

  • Impact or trauma to the nose resulting in rupture of the small blood vessels in the nose. If the impact is severe, then the nose should be examined for a fracture so that the airways are not blocked.
  • Nosebleeds can also occur if a person blows the nose very hard or has a habit of picking the nose. This causes damage to the small blood vessels present in the walls of the nose causing minor nose bleeds.
  • Nose bleeds can also occur spontaneously, without any impact/trauma to the face.
  • Flu/ cold.
  • Hay fever.
  • Sinusitis.
  • High altitudes.
  • Snorting recreational drugs.
  • Infection.
  • Hypertension.
  • Allergic and non-allergic rhinitis.
  • Alcohol abuse.
  • Use of blood thinners.
  • Tumors in the nose
  • Hormonal changes during pregnancy

Treatment of Epistaxis or Nosebleeds

  • Pinch the soft parts of the nose located below the bony part of the nose.
  • Patient should be made to sit down with the head tilted forwards in order to prevent the blood from travelling down to the sinuses and throat.
  • Do not breathe through nose, but breathe through the mouth.
  • Continue pinching the nose for at least 20 minutes while checking the bleeding every 5 minutes.
  • Keep your head above the heart level. Do not put your head between your legs or lie flat.
  • Ice application to the nose and face helps in reducing the bleeding and pain.
  • Medical attention should be sought immediately if the bleeding doesn't stop after 20 minutes and is heavy.
  • After the bleeding subsides, do not touch the nose, do not blow the nose, and avoid quick movements of the head for at least 12 hours after the bleeding has stopped.
  • If patient suffers from spontaneous nosebleeds without any trauma to the nose, then medical attention should be sought.
  • If the conservative measures do not help in stopping the nosebleeds then the doctor may use nasal packs to stop them.

Prevention of Epistaxis or Nosebleeds

  • After an episode of nosebleed, rest with your head elevated at 30 to 45 degrees.
  • Avoid blowing your nose or putting anything in it. When sneezing, open your mouth to enable the air to escape from the mouth instead of the nose.
  • Avoid straining during bowel movements. Include lot of fiber in your diet and use a stool softener such as docusate.
  • Avoid straining or bending down to lift anything heavy.
  • Keep your head higher than the level of your heart.
  • Do not smoke.
  • Do not consume any hot liquids for at least 24 hours after an episode of nosebleed. Take a soft and cool diet.
  • Avoid taking blood thinners such as aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or warfarin (Coumadin). Please consult your doctor before stopping these medicines.
  • A lubricating ointment can be used inside the nose prescribed by a doctor.
  • If there is re-bleeding, you can clear the clots by sniffing in forcefully. Nasal decongestant sprays such as Afrin or Neo-Synephrine may provide temporary relief. These sprays can be addictive and should be avoided if the patient suffers from hypertension.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: February 9, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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