Nosebleed (Epistaxis)

Nosebleed Overview

Nosebleeds (epistaxis, nose bleed) can be dramatic and frightening. Fortunately, most nosebleeds are not serious and usually can be managed at home, although sometimes medical intervention may be necessary. Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose).

• Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum, where a network of vessels converge (Kiesselbach plexus). Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a health care practitioner.

• Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).

One out of every seven people will develop a nosebleed at some time in their lives. Nosebleeds tend to occur more often during winter months and in dry, cold climates. They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.

Topic Overview

Most nosebleeds are not usually serious and can be stopped with home treatment. Most nosebleeds occur in the front of the nose (anterior epistaxis) and involve only one nostril. Some blood may drain down the back of the nose into the throat. Many things may make a nosebleed more likely.

• Changes in the environment. For example:
  • Cold, dry climates; low humidity
  • High altitude
  • Chemical fumes
  • Smoke
• Injury to the nose. For example:
  • Hitting or bumping the nose
  • Blowing or picking the nose
  • Piercing the nose
  • An object in the nose. This is more common in children, who may put things up their noses, but may be found in adults, especially after an automobile accident, when a piece of glass may have entered the nose.
• Medical problems. For example:
  • An abnormal structure inside the nose, such as nasal polyps or a deviated nasal septum
  • Colds, allergies, or sinus infections
  • High blood pressure
  • Kidney disease
  • Liver disease
  • Blood clotting disorders, such as hemophilia, leukemia, thrombocytopenia, or von Willebrand's disease
  • Abnormal blood vessels in the nose, such as with Osler-Weber-Rendu syndrome. This syndrome is passed in families (inherited). The abnormal blood vessels make it hard to control a nosebleed.
• Medicines. For example:
  • Those that affect blood clotting, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), clopidogrel (Plavix), or nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Cold and allergy medicines
  • Oxygen
  • Nasal inhalers, such as Afrin
  • Steroid nasal sprays
• Nasal abuse of illegal drugs, such as cocaine and amphetamines

A less common but more serious type of nosebleed starts in the back of the nose (posterior epistaxis) and often involves both nostrils. Large amounts of blood may run down the back of the throat. Posterior epistaxis occurs more often in older adults because of other health conditions they may have. Medical treatment will be needed to control the bleeding from posterior epistaxis.