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What Are Nosebleeds?

Epistaxis, or a nosebleed, is the common event of blood draining from the nose. Most people have at least one nosebleed during their lifetime. They are twice as common in children compared with adults. Most stop with direct pressure on the nose, but some may need medical care.

What Causes Nosebleeds?

A break in blood vessels in the nose, such as from an injury (blow to the nose) causes a nosebleed. Other causes include chemicals, infections, abnormal blood vessels in the nose, and diseases such as high blood pressure or bleeding disorders. The most common cause is dry nasal passages from dry air, especially in winter.

What Are the Symptoms of Nosebleeds?

Symptoms include bleeding from one or both nostrils and bleeding down the back of the throat with spitting, coughing, or vomiting of blood.

Prolonged or recurrent nosebleeds may cause anemia.

After a big nosebleed, dark or tarry bowel movements mean that a large amount of blood was swallowed.

How Are Nosebleeds Diagnosed?

The health care provider will diagnose the nosebleed from a physical examination. Blood work may be done if a large amount of blood was lost or a blood disorder may be causing the nosebleed.

How Are Nosebleeds Treated?

The first treatment is direct pressure. Grasp the nose firmly between the thumb and forefinger and squeeze it for 10 to 30 minutes without stopping.

Putting an ice pack on the neck or bridge of the nose may help slow blood flow. Leaning forward to spit out blood instead of letting it run down the throat and be swallowed may help prevent vomiting. Using salt water nasal sprays and humidifying the air may help dryness.

Sometimes, packing the nose with absorbent gauze may be needed. The health care provider may also cauterize the bleeding site. Some elderly people can have a slowed pulse rate or blood pressure abnormalities from packing and may in some cases need hospitalization.

DOs and DON’Ts in Managing Nosebleeds:

  • DO control your blood pressure. High blood pressure may contribute to nosebleeds.
  • DO avoid aspirin products if you get many nosebleeds. They may slow clotting.
  • DO humidify air in your home and if possible at work, put a little petroleum jelly inside the nostrils, and use a scarf or cloth mask in cold, dry air. Salt water nasal sprays may also help stop nosebleeds caused by dryness.
  • DO avoid chemicals or dusts or wear a filter mask. Your health care provider may prescribe a steroid nasal spray if you have infections or allergies.
  • DO call your health care provider if blood gushes from your nose or you vomit repeatedly from swallowed blood.
  • DO call your health care provider if you cannot control the bleeding or you have repeated nosebleeds in one day.
  • DO call your health care provider if you know that high blood pressure or bleeding problems (hemophilia, leukemia) are causing nosebleeds.
  • DO call your health care provider if you take aspirin or blood thinners (warfarin, dabigatran, apixaban, and rivaroxaban).
  • DO call your health care provider if you have a temperature higher than 102° F, especially if your nose was packed or cauterized.
  • DON’T blow your nose hard or pick at any clots, which may restart the nosebleed.

Contact the following sources:

  • American College of Emergency Physicians
    Tel: (800) 798-1822
  • American Academy of Otolaryngology—Head and Neck Surgery
    Tel: (703) 836-4444

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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