Epistaxis is also known as a nosebleed. The nasal passages are lined with a rich supply of blood vessels situated in proximity to the surface. Due to the location of the blood vessels in the lining of the nose, they can easily be injured and subsequently bleed. Typically, since the lining of the nose is so richly supplied with blood vessels, even the smallest irritation can cause an episode of epistaxis. Generally, nosebleeds tend to appear more severe than they really are.
Some common causes of epistaxis are dry indoor air and head or chest colds. Generally, dry heated air dries out the membranes of the nose which may cause them to crack. When delicate mucus membranes of the nasal lining crack, they may begin to bleed. Head and chest colds may also contribute to epistaxis because of continuous irritation of sneezing, nose blowing and coughing. In addition, allergies can cause the nose to bleed the same way a cold can. Rarely, high blood pressure can cause the nose to bleed.
Occasionally, epistaxis may be caused by certain medications. Typically, anti-inflammatory medications as well as prescription blood thinners can cause the nose to bleed. In addition to medications, a condition known as a deviated septum may contribute to epistaxis. Deviated septum refers to an abnormality in the shape of the septum that divides both sides of the nose. Rhinoplasty, or nasal surgery can usually correct this condition.
Generally, epistaxis treatment can be performed at home. Staying calm is important in the treatment of a nose bleed. While remaining calm, the individual should sit down and slightly lean his body and head forward. Leaning forward may prevent blood from running down the throat. When blood trickles down the throat, it may cause nausea, vomiting, and sometimes, diarrhea. In addition to leaning forward, pinching together the soft portion of the nose for five minutes may halt the bleeding.
After the episode of bleeding has stopped, bending over and lifting heavy objects should be avoided for a few days. In addition, blowing or rubbing the nose should be discouraged for several days as well. The nose should be left alone because the clot that forms from the bleeding may become dislodged and precipitate the bleeding all over again.
Although most cases of epistaxis are not serious, sometimes emergency care may be needed. If bleeding persists after continuous pressure has been applied for 20 minutes, medical treatment is warranted. Additionally, if the blood loss is becoming rapid and copious, or if the blood loss is related to an injury, emergency treatment should be sought. Most importantly, if the individual feels faint or weak from the blood loss, he should seek immediate emergency intervention.
Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:
exposure to warm, dry air for prolonged periods of time,
nasal and sinus infections,
allergic rhinitis,
nasal foreign body (object stuck in the nose),
vigorous nose blowing,
nasal surgery,
deviated or perforated nasal septum, and
cocaine use.
Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.
Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.
Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.
Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.
Vascular malformations in the nose and nasal tumors are rare causes of nosebleeds.
High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure.
Treatment for epistaxis aims to control bleeding and treat the underlying cause. You may have any of the following:
Medicines: Caregivers may directly apply medicines to your nose to relieve congestion, decrease pain, and stop bleeding. Other medicines may also be given to treat the cause of your nosebleed. These may include medicines for high blood pressure, bleeding problems, and kidney and liver diseases.
Nasal packing: Caregivers may pack your nose with gauze (bandage) strips to control bleeding and prevent infection. These strips are moistened (wet) with salt solution or antibiotic ointment. A balloon device or rubber tube may also need to be placed at the back of your nose. This may be left in place until the bleeding has stopped.
Cautery: This uses an electrical device or a chemical, such as silver nitrate, to seal the injured blood vessels.
Embolization: A special substance will be injected into the bleeding vessel. This blocking agent will stop the blood flow.
Laser therapy: Laser therapy uses intense light to destroy abnormal blood vessels that cause the bleeding.
Surgery: You may need surgery to tie an artery if the bleeding does not stop. Surgery may also be needed to correct a deformity or fix damaged tissues in the nose. Blood clots in the nose may also be removed to prevent infection. Injury to the other parts of the nose, nerves, or blood vessels may also be treated with surgery.
You may do the following when your nose bleeds:
Lean forward to keep blood from going down the back of your throat, and breathe through your mouth.
Pinch the lower soft part of your nose tightly using your thumb and index finger for 5 to 20 minutes.
While pinching your nose, apply ice to the bridge of your nose to slow down the bleeding.
After pinching your nose, release it to check if there is still bleeding. If your nose is still bleeding, repeat pinching your nose and applying ice.
Seek emergency medical help if your nose bleeding does not stop.