NOSEBLEED (Epistaxis)

General Information

DEFINITION--Bleeding from the nose.

BODY PARTS INVOLVED--Blood vessels (arteries and veins) in the nose. Nosebleeds occur close to the nose opening or deeper in the nose.

SEX OR AGE MOST AFFECTED--All ages, but twice as common in children as adults.

SIGNS & SYMPTOMS

• Blood oozing from the nostril. If the nosebleed is close to the nostril, the blood is bright red. If the nosebleed is deeper in the nose, the blood may be bright or dark.
• Lightheadedness from heavy blood loss.
• Rapid heartbeat, shortness of breath and pallor (with significant blood loss only).
• Black stool from swallowed blood.

> Injury to the nose or nasal polyps--

even simple injury caused by picking the nose.

• Nasal or sinus infection.
• A foreign body in the nose.
• Scarlet fever, malaria or typhoid fever.
• Dry mucous membranes in the nose from any cause, such as low humidity.
• Atherosclerosis; high blood pressure.
• Bleeding tendencies associated with alcoholism, aplastic anemia, leukemia, thrombocytopenia or liver disease.

RISK INCREASES WITH

• Any disorder listed as a cause.
• Hodgkin's disease; scurvy; rheumatic fever.
• Blood disorders, including leukemia and hemophilia.
• Use of certain drugs, such as anticoagulants, aspirin, or prolonged use of nose drops.
• Exposure to irritating chemicals.
• High altitude or dry climate.
• Dry air in airplanes or air conditioned buildings.

HOW TO PREVENT

• Avoid injury if possible.
• Obtain treatment for the underlying cause.
• Humidify the air if you live in a dry climate or at high altitude.
• Avoid picking at nose or vigorous nose blowing.
• Avoid aspirin if you have frequent nosebleeds.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory blood studies.

APPROPRIATE HEALTH CAR

• Self-care (see General Measures).
• Doctor's treatment.
• Surgery (for severe bleeding only) to tie off the artery feeding the bleeding area.

POSSIBLE COMPLICATIONS--Bleeding severe enough to require transfusion (rare).

PROBABLE OUTCOME--Symptoms can be controlled with treatment. Severe bleeding requires hospitalization and usually is caused by an underlying disorder, such as liver disease, blood disease or hypertension. In these cases, the underlying disorder should be treated also.

How To Treat

GENERAL MEASURES-- Self-care:

• Sit up with your head bent forward.
• Clamp your nose closed with your fingers for 5 uninterrupted minutes. During this time, breathe through your mouth. If blood is coming from one nostril, press firmly on that nostril.
• If bleeding stops and recurs, repeat, but pinch your nose firmly on both sides for 8 to 10 minutes. Holding your nose tightly closed allows the blood to clot and seal the damaged blood vessels.
• You may apply cold compresses at the same time.
• Don't blow your nose for 12 hours after bleeding stops to avoid dislodging blood clot.
• Don't swallow blood. It may upset your stomach or make you "gag," causing you to inhale blood.
• Don't talk (also to avoid gagging). Medical or emergency-room treatment:
• If self-care is unsuccessful. Gauze packing may be inserted to absorb blood, stop dripping and exert pressure on the ruptured blood vessels.
• Continued or recurrent bleeding may require cauterization (See Glossary).

MEDICATION--Your doctor may prescribe drugs to treat any underlying serious disorder.

ACTIVITY--Resume your normal activities as soon as symptoms improve.

DIET--No special diet.

Call Your Doctor If

• You have a nosebleed that won't stop with self-care described above.
• After the nosebleed, you become nauseous or vomit.
• After the nose has been packed, your temperature rises to 101F (38.3C) or higher.