Nosebleed (Epistaxis)

The nose carries blood vessels close to its surface, with no muscle around them, so they bleed for many reasons. The weather, a blow, a foreign body and blowing the nose hard all cause bleeding. Sometimes a nosebleed is the first sign of another illness.

Two kinds of nosebleed

Nosebleeds are divided into front and back bleeds.

The vessels that feed the nose run about 1 cm from the nostril, so bleeding from local causes is called a front nosebleed. Simple measures usually stop it.

Bleeding from the vessels further back can be a sign of serious illness. A back nosebleed runs out of the nose, and it also runs down into the back of the nose and the throat.

Local causes

• A blow to the nose or the face
• A broken nose
• A foreign body pushed into the nose
• Picking the nose
• A crooked septum
• Upper airway infections
• Wiping the nose hard
• Contact with chemicals
• Blowing the nose forcefully
• Dry air

Causes in the body

• Heart and blood vessel disease
• High blood pressure
• Diabetes
• Clotting disorders
• Vitamin K deficiency
• Liver disease
• Cancer of the sinuses, the back of the nose and the nose
• Alcohol use
• Pregnancy
• Hormonal causes

Nosebleeds in children

Nosebleeds happen most between the ages of 2 and 10, and they are usually not frightening. Picking the nose hard and pushing a foreign body into it irritate the lining. In cold, dry weather the small vessels crack, and a runny nose during an upper airway infection also causes bleeding.

Nosebleeds in pregnancy

Later in pregnancy the amount of blood rises, for the health of the mother and the baby. The rise puts pressure on the vessels in the lining of the nose and bleeding follows. Local causes trigger it as well. A nosebleed during pregnancy harms neither the mother nor the baby.

When to see a doctor

Signs that come with a nosebleed can point to another illness underneath. See a doctor as soon as possible if

• the bleeding does not stop, or it keeps coming back
• you bleed from other places as well as the nose
• you take blood thinning medicine
• you bruise even after a light knock
• you feel faint, or you faint
• you have difficulty breathing
• you have a high fever or a rash
• you have a condition such as liver disease or haemophilia
• you are being treated for leukaemia

The doctor finds the source of the bleeding with blood counts, a CT scan, endoscopy and X-rays. If you take medicines, they can be changed, depending on the cause of the bleeding.

How to stop a front nosebleed

1. Stay calm.
2. Sit upright and lean your head slightly forward, so that you do not swallow blood.
3. Spit out any blood in your mouth.
4. Pinch the nostrils between your index fingers for 10 minutes.
5. Do not let go before the 10 minutes are up.

Do this whether one side or both sides are bleeding.

After the bleeding stops, clean the nose with a salt water spray so that it does not start again. Do not use force when you clean it, and do not sneeze or blow your nose hard. Avoid heavy activity and hot baths for a while, to stop the bleeding returning.