Nosebleeds (epistaxis)
Where does the blood in a nosebleed come from?
The blood usually comes from a blood vessel located in the front of the nasal septum (nasal partition) or further back in the nasal cavity.What can cause a nosebleed?
- Picking the nose.
- A blow to the nose or damage to the mucous membrane.
- A cold or flu.
- A nasal allergy.
- Dry mucous membranes in the nose due to a stuffy indoor atmosphere.
- Hypertension (high blood pressure) - rarely.
- Certain kinds of medication; for instance, products that reduce the viscosity of the blood (such as aspirin (eg Micropyrin)and non-steroidal anti-inflammatory drugs).
- Exposure to chemicals that may irritate the mucous membranes.
- Deviation of the nasal (septum).
Most nosebleeds occur for no obvious reason.
Other rare causes of nosebleeds
- Blood diseases such as leukaemia or haemophilia.
- Tumours in the nasal cavity.
- Osler's disease.
Danger signals in a severe nosebleed
- Heavy bleeding.
- Palpitation, shortness of breath and turning pale.
- Swallowing large amounts of blood, which will cause you to vomit.
How to avoid nosebleeds
- Avoid damaging the nose and excessive nose-picking.
- Seek medical treatment for any disease causing the nosebleeds.
- Get a humidifier if you live in a dry climate or at high altitude.
What to do if you get a nosebleed
- Sit in an upright position with your head bent forward.
- Hold the tip of your nose for five minutes while breathing through the mouth.
- If the bleeding stops and then returns, hold your nose for 8 to 10 minutes. This will allow time for the blood to clot.
- Applying an ice-pack to your nose may help.
Good advice
- Do not blow your nose for the next 12 hours after the bleeding has stopped. This will help the dried blood to remain in place.
- Do not swallow the blood. It can cause you to become nauseous and vomit, or could conceal a greater blood loss.
- If you frequently suffer from nosebleeds you should seek help from your doctor.
The most likely development
- The bleeding usually stops if you follow the above instructions.
- Heavy bleeding may require hospital treatment and, in rare cases, a blood transfusion.
How is heavy bleeding treated and what kind of medication can be given?
Contact your doctor if the advice described above does not help stop the bleeding.
Initially, the doctor will try to stop the bleeding by using something that will make the blood vessels contract.
When the bleeding has stopped, the doctor may choose to cauterise the source of the bleeding with a chemical to prevent it bleeding again.
If the bleeding fails to stop, it may be necessary to put a pack in the nose.
In rare cases, an operation may be necessary to tie off the blood vessel that supplies the bleeding area.
If the bleeding is caused by another disease, such as increased blood pressure, it is very important to seek treatment to avoid recurrence of nosebleeds.
Nosebleeds can be very intermittent, and between bleeds it may be very difficult to determine their source. If this occurs it is best to ensure that the nose is inspected during a bleed, which might mean needing to be assessed 'out of hours' by the on-call GP or local casualty unit.
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