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Nosebleed

Nosebleed

Alternate Names

  • epistaxis

Definition

A nosebleed is usually caused by a damaged blood vessel that leaks blood. Nosebleeds can affect all ages, but they are twice as common in children as in adults.

What is going on in the body?

When the blood vessels in the nose are damaged, they can bleed. Bleeding is most often limited to one nostril. If there is severe trauma to the nose, both nostrils may bleed.

Risks

What are the causes and risks of the condition?

Several possible causes of a nosebleed are as follows:
  • trauma or injury to the nose, which is the most common cause
  • nasal or sinus infection
  • excessive nose-blowing
  • uncontrolled high blood pressure
  • bleeding or clotting problem
  • tumor
  • cocaine use
  • the use of topical nasal steroid medicines
  • dry mucous membranes in the nose due to low humidity

Prevention

What can be done to prevent the condition?

A person should do the following to help prevent a nosebleed:
  • Avoid cocaine use.
  • Avoid excessive nose-blowing.
  • Avoid picking the nose.
  • Avoid trauma, if possible.
  • Get treatment for underlying causes such as high blood pressure.
  • Limit the use of topical nasal steroids or nose sprays.
  • Use a cool-mist humidifier to add moisture to the air.

Diagnosed

How is the condition diagnosed?

Nosebleeds are easily diagnosed when the person reports bleeding from the nose or when blood is seen coming from the nose during an examination.

Long Term Effects

What are the long-term effects of the condition?

Excessive blood loss can cause anemia, or a low red blood cell count. Repeated nosebleeds can be socially embarrassing.

Other Risks

What are the risks to others?

Nosebleeds are not contagious and pose no risk to others.

Treatments

What are the treatments for the condition?

First aid for a nosebleed includes the following steps:
    • Keep the person calm. Have the person breathe slowly through the mouth.
    • Direct the person to either sit or stand upright and lean forward slightly. This helps prevent blood from going down the back of the throat, causing blockage. This will also help slow blood flow from the veins of the nose.
    • Stop blood flow by pinching the nose with the thumb and index finger while breathing through the mouth. It is important to apply this direct pressure for 5 to 10 minutes. Often this is successful in stopping the bleeding.
    • Apply cold compresses to the nose to help reduce swelling and also slow down bleeding.
    • If the person's nose continues to bleed 15 minutes after changing the person's position and applying direct pressure and cool compresses, get medical help.
For a mild nosebleed, pinching the nose may be all that is needed to stop the bleeding. A person who has repeated nosebleeds or a nosebleed that doesn't stop needs further treatment.
A healthcare provider will examine the inside of the nose to find the source of the bleeding to figure out the best way to stop the bleeding. Sometimes, the provider may have to pack the nose with gauze or cotton to stop the bleeding. If the nosebleed is due to simple trauma, this is often all the treatment that is needed.
When the packing is removed, the bleeding has usually stopped. If packing the nose doesn't stop the bleeding, topical anesthesia and topical medicine to shrink blood vessels may be given.
Next, the doctor looks into the nose. If the healthcare provider can see the broken blood vessel, it can be cauterized by applying a heat or electrical probe to stop the bleeding.
Sometimes the source of the bleeding cannot be seen easily. In these cases, a special tube is inserted into the nose to let the provider see better. The vessel can be cauterized through the tube if needed.
If the cause of the nosebleed is a bleeding or clotting problem, sometimes transfusions or medications can stop the problem. If the cause is a tumor, surgery to remove the tumor may be required.

Side Effects

What are the side effects of the treatments?

Medications used to treat a nosebleed may cause stomach upset or allergic reactions. Transfusions may cause an allergic reaction or rarely, an infection. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

After Treatment

What happens after treatment for the condition?

If the nosebleed stops, no further treatment is required and the person can go back to his or her regular activities. Recurrent nosebleeds or bleeding due to underlying problems may require further treatment.

Monitor

How is the condition monitored?

No monitoring is required unless nosebleeds are frequent or do not respond to treatment. Any new or worsening symptom should be reported to the healthcare provider.

Sources

Otolaryngology Head and Neck Surgery, 1998, Cummings et al.

Instructions for Patients. Fifth edition 1994, Griffith, H. Winter.

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