Epistaxis: Overview, Symptoms, Diagnosis, Causes and Treatment
Contents
Overview OF Epistaxis
Epistaxis is bleeding from the nose. It can range from a trickle to a heavy flow, and from a minor annoyance to, rarely, life-threatening bleeding.
Most nosebleeds come from a network of small blood vessels at the front of the nasal septum, the wall between the two sides of the nose. Less common but often more severe are posterior nosebleeds, which come from larger vessels deep in the back of the nose.
Posterior nosebleeds are more common in older adults and in people with hardened arteries, bleeding disorders or recent nose or sinus surgery. The inside of the nose is lined with moist, delicate tissue (mucosa) with many blood vessels near the surface. Even minor scratches, dryness or irritation can make these vessels bleed.
Most nosebleeds are not serious and stop with steady pressure and a little patience. Severe bleeding usually comes from an artery at the back of the nose. That blood often runs down the back of the throat, and it can also flow from both nostrils.
In many cases of heavy bleeding, the person has another health problem, such as high blood pressure or a bleeding disorder, or takes a blood-thinning medicine that slows clotting. Dry air, work exposures and some drugs can also make nosebleeds more likely.
Symptoms of Epistaxis
Bleeding usually begins from one nostril. Heavy bleeding can fill both sides of the nose and run into the back of the throat. Swallowed blood can upset the stomach and cause vomiting. Signs that need medical attention include:
- Dizziness, fainting, confusion or weakness from blood loss. This is rare.
- Bleeding from other places, such as the gums, may point to a problem with blood clotting.
- Bleeding gums while brushing teeth, blood in urine or stools, or easy bruising also suggest a clotting problem.
Diagnosis of Epistaxis
In otherwise healthy people, most mild nosebleeds from the front of the nose can be treated at home. If bleeding is severe or doesn't stop with first aid, see a doctor right away.
The doctor will review your health history and current medicines. They will ask how much blood you have lost, often estimated from how long you bled and how many tissues or towels you soaked.
Next, the doctor examines your nose to find where the bleeding is coming from. If needed, they may use a thin lighted tube called an endoscope. Blood tests can check for clotting problems.
Causes Of Epistaxis
Nosebleeds most often start inside the front of the nose, on the septum. The blood vessels there are fragile and break easily. Common causes and risk factors include:
- Nose picking or blowing the nose too hard.
- Injury to the nose or face.
- Dry air, especially from indoor heating.
- Prolonged or incorrect use of nasal sprays, including steroid sprays.
- Barotrauma due to sudden changes in air pressure.
- Surgeries such as functional endoscopic sinus surgery.
- Allergic rhinitis and colds.
- A deviated or perforated nasal septum.
- Cocaine use.
- Bleeding disorders and blood vessel disorders, such as hereditary hemorrhagic telangiectasia.
- Some medicines such as aspirin, warfarin and other blood thinners, or isotretinoin, which dries the lining of the nose.
- Pregnancy (due to hormonal changes and increased blood volume).
- Vitamin C and Vitamin K deficiency (rare).
High blood pressure can make a nosebleed harder to stop, though it is not usually the direct cause.
Prevention and treatment for epistaxis
To stop a nosebleed, sit down, lean forward, and pinch the soft part of your nose closed for a full 10 minutes while breathing through your mouth. Don't tilt your head back or lie down.
Get emergency care if bleeding doesn't stop after 20 minutes, is heavy, started after a head injury, or makes it hard to breathe. Doctors may use a decongestant spray, cautery, nasal packing or, rarely, procedures to close off the bleeding artery.
To help prevent nosebleeds:
- Avoid picking your nose.
- Always blow your nose gently.
- Do not smoke.
- Use a humidifier in winter when the indoor air is dry.
- Use a saline nasal spray or gel to keep the inside of the nose moist.
- Avoid facial injuries by wearing a seatbelt while driving and headgear while playing contact sports.
Prognosis
With pressure and patience, almost all nosebleeds from the front of the nose stop with simple first aid. Most of the less common, more severe nosebleeds that need a doctor can be controlled with packing, cautery or other treatments.
People who bleed heavily, have several medical problems or take blood thinners may need hospital care. See a doctor if you get nosebleeds often.
HP Thoughts: Colds and flu can dry and irritate the inside of your nose. Here are some remedies to help you battle the flu: Natural Remedies For Flu.
Conclusion
Epistaxis is bleeding from the nose. Most nosebleeds come from fragile vessels at the front of the septum and stop with first aid: sit up, lean forward and pinch the soft part of the nose for 10 minutes.
Less common posterior nosebleeds can be heavier and need medical care. Preventing dryness, blowing your nose gently and avoiding nose picking lower the chance of nosebleeds.
