Epistaxis (nosebleeds): Types, Causes, Symptoms & Treatment

Epistaxis is a medical term used for nosebleeds. Meaning a loss of blood from the tissue that lines the inside of your nose. This can occur in one or both nostrils. Usually, it only affects one nostril.

Nose bleeding are common. They may be scary, but they rarely indicate a serious medical problem. The nose contains many blood vessels, which are located close to the surface in the front and back of the nose. They’re very fragile and bleed easily.

Nosebleeds are common in adults and children between the ages of 3 and 10. About 60% of people will have at least one nosebleed in their lifetime. Only about 10% of cases are severe enough to require medical treatment.

Symptoms of epistaxis

Nosebleed main symptom is blood coming out from the nose. This bleeding can vary in severity and can come out of one or both nostrils. Posterior nosebleeds are more likely to cause bleeding in both nostrils.

If your nosebleeds occurs while lying down, you will typically feel liquid in the back of your throat before the blood comes from the nose.

Types of epistaxis

The two main types of nosebleeds depend on the site where the bleeding occurs, which include:

• Anterior nosebleed. If you have an anterior nosebleed, you bleed from the front of your nose, usually a nostril. Capillaries and small blood vessels in the front area of your nose are fragile and can easily break and bleed. This is the most common type of epistaxis and usually isn’t serious. These nosebleeds are more common in children. You can usually treat these nosebleeds at home.
• Posterior nosebleed. If you have a posterior nosebleed, you bleed from the back of your nose. The blood also tends to flow from the back of your nose down your throat. Posterior nosebleeds are less common and often more serious than anterior nosebleeds. A bleed in larger blood vessels in the back part of your nose near your throat causes this type. It can result in heavy bleeding, which may flow down the back of your throat. You may need medical attention right away for this type of nosebleed. This type is more common in adults.

You can also read about symptoms and types of paralysis.

Causes of epistaxis

Several things can trigger a nosebleed. The most common causes of epistaxis is dry air, either from having the heat on in winter or being in a hot, low-humidity climate.

Other causes of nosebleeds include:

• Allergies. Allergic and nonallergic rhinitis (inflammation of your nasal lining).
• Infections. Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing and nose blowing.
• Blood-thinning medications. Drugs such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin and others.
• Recreational drugs. Cocaine and other drugs you inhale through your nose.
• Chemical irritants. Chemicals in cleaning supplies, chemical fumes at workplaces and other strong odors.
• Deviated septum. An abnormal shape of the wall that separates the two sides of your nose.
• Nasal sprays. Frequent use of nasal sprays and medications to treat an itchy, stuffy or runny nose. Medications like antihistamines and decongestants can dry out your nasal membranes.
• High altitudes. The air is thinner (lack of oxygen) and drier as the altitude increases.

Less common causes of epistaxis include:

• Bleeding disorders, such as hemophilia or von Willebrand disease.
• High blood pressure.
• Atherosclerosis.
• Alcohol use.
• Facial and nasal surgery.
• Nasal tumors.
• Nasal polyps.
• Immune thrombocytopenia.
• Leukemia.
• Pregnancy.
• Hereditary hemorrhagic telangiectasia.

How to stop a nosebleeds (epistaxis)

The following are the certain things you can do to help stop your nose from bleeding. This include:

• Sit down and pinch the soft parts of the nose firmly, breathing through the mouth.
• Lean forward to prevent blood from draining into the sinuses and throat, which can result in inhaling the blood or gagging.
• Sit upright so that the head is higher than the heart. This reduces blood pressure and slows further bleeding.
• Continue putting pressure on the nose, leaning forward, and sitting upright for 10–15 minutes so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is necessary.

You should seek a medical attention immediately if:

• You experience frequent nosebleeds
• You have sustained an injury to the head
• You are taking blood-thinning medications
• You bleeding lasts more than 10–15 minutes
• You experience heart palpitations

You can also read about causes of syncope (fainting).

Prevention of epistaxis

The following are the tips that can help you prevent nosebleeds from happening. This will lower your chances of experiencing a nosebleed:

• Don’t pick your nose. Also, don’t blow or rub it too hard. If your child is getting nosebleeds, keep their fingernails short and discourage them from picking their nose.
• Keep the inside of your nose moist. Dryness can cause nosebleeds. Use a cotton swab to gently smear a thin layer petroleum jelly in your nostrils three times a day, including before you go to sleep. You can also use an antibiotic ointment like Bacitracin or Polysporin.
• Use a saline nasal product. Spraying it in your nostrils helps keep the inside of your nose moist.
• Use a humidifier. Your nostrils might be dry because the air in your house is dry.
• Don’t use cold and allergy medications too often. These can dry out your nose. In some cases, certain medications can cause nosebleeds or make them worse. You may need to discuss your medications with your doctor. But keep taking them unless your doctor tells you to stop.
• Don’t smoke. Smoking can irritate the inside of your nose and dry it out.

Diagnosis of epistaxis

To diagnose the cause of a nosebleed, your healthcare provider will ask about your condition and perform a physical examination.

Your provider will ask about:

• How often you get them.
• Length (in minutes) of your nosebleed.
• If the bleed involved one or both nostrils.
• Approximate amount of blood that was lost.

Your provider will also ask about:

• Your family history, including any history of blood disorders.
• Your use of alcohol and/or any recreational drugs in which you sniffed the drug up your nose.
• Medications you’re taking, including over-the-counter blood-thinning medications such as aspirin, and drugs for colds and allergies.

The following are the tests that can be used to identify the cause of your epistaxis. These include:

• nasal endoscopy
• partial thromboplastin time (PTT), which is a blood test that checks how long it takes for your blood to clot
• complete blood count (CBC), which is a blood test to check for blood disorders
• X-ray of the face and nose
• CT scan of the nose

You can also read about prevention and diagnosis of asthma.

Treatment of epistaxis

The treatment of nose bleeding depends on the cause. Options include:

• Nasal packing. Your healthcare provider will insert gauze, special nasal sponges or foam, or an inflatable latex balloon into your nose to create pressure at the site of the bleed. Your provider may want to leave the material in place for 24 to 48 hours before removing it.
• Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. Your provider will spray a local anesthetic in your nostril first to numb the inside of your nose.
• Medication adjustments/new prescriptions. Reducing or stopping the amount of blood-thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary. Your provider may prescribe Tranexamic, a medication to help blood clot.
• Foreign body removal. If the cause of the nosebleed is a foreign object, your provider will remove it.
• Ligation. In this procedure, your provider will tie off the culprit blood vessel to stop the bleeding.
• Surgery. Surgical repair of a broken nose or correction of a deviated septum (septoplasty) if this is the cause of the nosebleed.

Epistaxis (nosebleeds) that occur higher on your septum or deeper in your nose may be harder to control. However, nosebleeds are rarely fatal. They account for 4 out of every 2.4 million deaths in the United States. Always seek a medical emergency when you find it difficult to control your nosebleeds.

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