Epistaxis is the medical word for a nosebleed. Many factors contribute to epistaxis including medications (especially those which thin blood), dry climate, medical conditions, and manual manipulation (nose picking or sticking other objects in the nose). The nasal passages have blood vessels which lie very close to the surface of the nasal mucosa. Risk factors for nosebleed include being either young or old, having high blood pressure, and certain medications. The two types of nosebleeds are named based on their location, anterior and posterior. Anterior nosebleeds usually come from a relatively superficial set of blood vessels called Kisselbach’s plexus. Posterior nosebleeds come from a larger artery called the sphenopalatine artery which may cause them to bleed more briskly and, in combination with the deeper location, be more difficult to stop. Posterior nosebleeds are more likely to bleed from both nostrils a well as from the mouth. Posterior epistaxis is more likely to be difficult to stop and to require intervention.
Bleeding from the nose, bleeding from the mouth, coughing up blood, vomiting blood
The diagnosis of nosebleed is made based on the history and physical examination. If your nosebleed does not stop with pressure or packing, you may need a scope in your nose to both look in and stop the bleeding. Your doctor or the emergency room may also check several blood tests like your blood counts, your platelet level and some tests that measure how well your blood clots called the prothrombin time and partial thomboplastin time.
In order to stop the bleeding, you may try topinch the fleshy part of the nose. This pressure needs to be given for at least five minutes but can be given for up to twenty. You should tip your head forward as well to prevent the blood from going down your throat and blocking your airway. If your bleeding will not stop, a doctor in the emergency room may place a lot of cotton in your nose to absorb the blood and apply pressure, but you shouldn’t try this yourself at home. Sometimes either a doctor in the emergency room or an Ear, Nose and Throat (ENT) doctor will apply a vasoconstrictive (blood vessel shrinking) medication to attempt to stop bleeding. Alternatively, your doctor may place a special mesh in your nasal passages to help clot your blood. If these treatments do not stop the bleeding in your nose, an ENT doctor to look in the nose and do a procedure called cautery which involves numbing the mucosa in the nose followed by a light chemical or electrical burning of the bleeding vessel to stop the bleeding. If bleeding does not stop after these interventions, it is considered a surgical emergency. You will need to have a scope of your nose (a thin tube with a camera at the end) to do a ligation (tying off) of the artery causing the bleeding. Also, if your bleeding is due to another issue, like low platelets, the underlying condition may need to be treated to stop the bleeding. To prevent future episodes of bleeding, you should always try to keep foreign objects out of your nose, including your fingers. If your bleeding stops, but you have frequent nose bleeds, your doctor may recommend that you see an ENT doctor to cauterize your superficial blood vessels in your nose to prevent easy bleeding. If you chronically have episodes of bleeding, you may keep your nose moist with saline spray or Vaseline rubbed lightly on the inside of the nosril. If your blood counts become low (anemia), you also may need iron supplements to help your body replace the iron lost through bleeding.
