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Nosebleed
(Epistaxis)

Definition:
Nosebleed refers to blood flowing from the nose or nasal passage. There are two types of nosebleeds:

Anterior Nosebleed – blood coming from the front of the nose, usually the semi-rigid walls that separate the two nostrils. This is the most common type of nosebleed.

Posterior Nosebleed – bleeding starts deep within the nose. It is often more difficult to treat and more severe than an anterior nosebleed.

Causes:
Causes include:

  • Irritation or breakage to the lining of the nose
  • Injury to the nasal tissue, which occurs more easily when nasal structure is not normal or the passages are inflamed due to a cold or allergies
  • Exceptionally dry nasal tissue
  • Picking or bumping the nose
  • Forceful blowing or rubbing the nose
  • A clot from a previous nosebleed becoming disturbed or dislodged
  • A foreign object placed in the nose
  • Tumors of the nose and/or sinuses
  • Hypertension (high blood pressure)
  • Use of aspirin or other blood thinning (anticoagulant) medications
  • Other causes of tendency to excessive bleeding including hemophilia
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for nosebleed include:
  • Irregularity in the structure of the nose
  • Abnormalities of the blood vessels in the nose (angiomas)
  • Dry climate
  • Winter, with dry, heated indoor air
  • Allergies
  • Colds
  • Sinusitis
  • Infections including:
    • Chicken pox
    • Malaria
    • Influenza
    • Scarlet fever
    • Typhoid fever
  • Diseases including:
    • Sarcoidosis
    • Wegener's granulomatosis
  • Childhood and advanced age
  • Cocaine use
  • Lupus
  • Bleeding or clotting disorders including those due to:
    • Leukemia
    • Liver disease
    • Aplastic anemia
    • Low platelet counts
    • Hemophilia
    • Cancer treatment
  • Anticoagulant (blood-thinning) drugs, including aspirin
  • High blood pressure
Symptoms:
Nosebleed symptoms differ, depending on where in the nose the bleeding begins.

Anterior Nosebleed – produces blood flow from one nostril when the patient sits or stands. Blood may pass down the throat if the person is coughing or blowing the nose.

Posterior Nosebleed – causes bleeding down the back of the mouth and throat. When the patient leans forward, the blood may flow from the nostril. Blood flow may be fast or slow.

Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. Your pulse and blood pressure will be taken carefully, because severe bleeding can cause these to become dangerously low.

Tests may include:

Sinus X-rays – to identify abnormalities or a mass in the nasal region

Endoscopy – using a thin, lighted tube to examine nasal tissues not visible from the front of the nose

Blood Tests – to check for anemia, low blood platelets, or clotting problems

Treatment:
Most anterior nosebleeds stop without medical care within 30 minutes. Posterior nosebleeds usually are more serious and need medical care. Go to your doctor if there is a lot of blood, if the bleeding will not stop, or if you experience nosebleeds often. Treatment may include sealing off the blood vessel that is bleeding.

Self-Care
  1. Stay calm.
  2. Sit up and lean forward.
  3. Pinch the soft parts of your nose together and hold for ten minutes without releasing pressure.
  4. You may want to place a cotton ball soaked with a decongestant spray, like Afrin or Neo-Synephrine, in the nostril before pinching.
  5. Place a bag of crushed ice, wrapped in a cloth, or a cold washcloth on the nose and cheeks.
  6. Once the bleeding stops, do not pick or blow your nose.
  7. Avoid straining, bending or lifting.
  8. Sit up and if the bleeding starts up again, try to remove clots.
  9. Spray a nasal decongestant four times into each nostril, before pinching and holding.
Medical Intervention
For an anterior nosebleed, the doctor will place a compress soaked in a medication that constricts or shrinks the blood vessel and reduces the pain. Pressure will be applied by pinching the nostrils together. The doctor may pack the area with gauze. In the more severe cases, the doctor may cauterize, or seal off, a blood vessel that does not clot on its own.

A posterior nosebleed may require inserting and inflating a special balloon that applies pressure on the area. If all medical attempts to control bleeding fail, surgery may be needed.

Prevention:
To reduce the chance of getting a nosebleed:
  • Lubricate dry nasal passages near the front of the nose. Place a small dab of lubricating cream or ointment on your fingertip. Apply the lubricant to the inside of the nose. You may do this at bedtime or up to three times during the day. Polysporin, zinc oxide, and Vaseline are examples of lubricants that may be used.
  • Use a saline nasal spray to help keep nasal passages moist. Be sure that the nose spray does not contain medications such as phenylephrine or oxymetazoline, or that such medications are used for only a few consecutive days.
  • Do not pick your nose.
  • Humidify the air, especially in bedrooms.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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