Epistaxis

What is Epistaxis?

Epistaxis also called acute hemorrhage or nose bleed is a medical condition in which bleeding occurs from the nasal cavity of the nostril. Nose bleed can occur due to a trauma to the nose, due to accident, or injury to the interior of the nose from pricking. Nosebleed or epistaxis can be classified according to their site of origination as anterior and posterior. Anterior nosebleed is common and does not require medical attention, while posterior nosebleed is rare and requires immediate medical care. Epistaxis is common in children and older people.

Causes

The major factors that cause epistaxis or nose bleeding are broadly categorized under local (fracture due to a sharp blow, or nose-picking, etc.) and general factors. Nosebleed generally starts from just inside the entrance of the nostril, on the middle harder part of nasal septum. Blood vessels of this region being fragile, rupture easily and begin to bleed. The factors causing nosebleed possibly are:

• Structural or anatomical deformities like hereditary hemorrhage.

• Nasal sprays and prolonged usage of nasal steroids (particularly prolonged or improper use of nasal steroids).

• Middle ear barotrauma due to sudden change of pressure.

• Surgery such as functional endoscopic sinus surgery.

• Exposure to warm, dry air for prolonged periods of time.

• Allergic rhinitis.

• Deviated or perforated nasal septum.

• Cocaine use.

• Infectious disease (cold) or high blood pressure.

• Connective tissue disease.

• Certain drugs like aspirin, warfarin, isotretinoin, desmopressin, etc.

• Pregnancy (rare, due to hypertension and hormonal changes).

• Vascular disorders.

• Vitamin C and vitamin K deficiency.

Symptoms

Bleeding usually starts from one nostril. In case of heavy bleeding, it may fill up both the nostrils and overflow the nasopharynx. In certain cases, blood may drip back from the nose through the throat to stomach. A person is likely to vomit in such a condition. The common signs of excessive nosebleed are:

• Excess blood loss may cause dizziness and fainting, confusion, loss of alertness and light-headedness. However, the condition is rare.

• Bleeding from other body parts like teeth, gums, nostrils, etc. indicate inability of blood to clot.

• Additional bleeding from other parts of the body, such as bleeding gums when brushing teeth, blood in urine or bowel movements, or easy bruising also indicate an inability of the blood to clot.

Risks

The following are the risks of epistaxis:

• Re-bleeding.

• Running nose.

• Swelling and numbing.

• Bruising face.

• Anemia.

• Nose deformity.

Prevention

The following precautions and measures can help prevent nose bleed:

• Give away the habit of nose-picking.

• Always blow your nose gently.

• Do not smoke.

• Use of a humidifier in winters when the indoor climate is dry.

• Using a saline nasal spray to keep inside of the nose moisturized.

• Avoid any facial trauma by wearing seatbelt or shoulder harness while driving, and using headgears when playing sports.

How to treat a nosebleed

Treatment for nosebleeds will vary depending on the type and cause of the nosebleed. Read on to find out about treatments for different nosebleeds.

Anterior nosebleed

If you have an anterior nosebleed, you bleed from the front of your nose, usually a nostril. You can try to treat an anterior nosebleed at home. While sitting up, squeeze the soft part of your nose.

Make sure that your nostrils are fully closed. Keep your nostrils closed for 10 minutes, lean forward slightly, and breathe through your mouth.

Don’t lie down when trying to stop a nosebleed. Lying down can result in swallowing blood and can irritate your stomach. Release your nostrils after 10 minutes and check to see if the bleeding has stopped. Repeat these steps if bleeding continues.

You can also apply a cold compress over the bridge of your nose or use a nasal spray decongestant to close off the small blood vessels.

See your doctor immediately if you’re unable to stop a nosebleed on your own. You might have a posterior nosebleed that requires more invasive treatment.

Posterior nosebleed

If you have a posterior nosebleed, you bleed from the back of your nose. The blood also tends to flow from the back of your nose down your throat. Posterior nosebleeds are less common and often more serious than anterior nosebleeds.

Posterior nosebleeds shouldn’t be treated at home. Contact your doctor immediately or go to the emergency room (ER) if you think you have a posterior nosebleed.

Nosebleeds caused by foreign objects

If a foreign object is the cause, your doctor can remove the object.

Cauterization

A medical technique called cauterization can also stop persistent or frequent nosebleeds. This involves your doctor burning the blood vessels in your nose with either a heating device or silver nitrate, a compound used to remove tissue.

Your doctor may pack your nose with cotton, gauze, or foam. They may also use a balloon catheter to apply pressure to your blood vessels and stop the bleeding.