Nosebleeds are a fairly common occurrence and the vast majority represent just a minor nuisance. They tend to be frightening because they can be profuse and dramatic but only rarely are they life-threatening. They can occur at any age but are most common under age 10 and over age 50.

Nosebleeds can be divided into two types: anterior and posterior. Anterior epistaxis represents about 90% of nosebleeds and tend to be easier to manage. With an anterior nosebleed the blood will tend to come out the front of the nose. Bleeding that is more profuse and going down the back of the throat is more likely to be posterior.

The nasal mucous membranes warm and humidify air as it passes through the nose. To accomplish this, the nose has a very rich vascular supply. There is a collection of blood vessels on the anterior septum called Kiesselbach’s plexus where the vast majority of nosebleeds occur. Often, there is no obvious cause for the bleeding and it may seem very random. Some factors that may cause bleeding include dry air, trauma either from an injury or from picking the nose, chemical irritants, nasal septal deformities, allergies, upper respiratory infections, medications such as aspirin and other anti-coagulants, and medical illnesses such as hypertension and vascular disease.

Most nosebleeds can be managed at home. Humidifying the air and applying nasal saline sprays may help preventively. Avoid hard nose blowing and picking the nose. Avoid hot and spicy foods and hot showers and avoid aspirin and other anti-coagulants unless medically necessary. If bleeding occurs, sit down and lean forward and relax. Pinch the nose firmly on the soft part of the nose so that pressure is applied against the septum. Apply ice or cold cloths to the nose. Pinch the nose for 5 minutes watching the clock. If it is still bleeding then pinch the nose for another 10-15 minutes. If bleeding continues then medical attention may be necessary. Topical over-the-counter nasal sprays containing oxymetazoline or phenylephrine may help to decrease bleeding.

If bleeding persists or recurs or is severe then medical attention may be necessary. Anterior bleeding can sometimes be managed with chemical cauterization using silver nitrate. Occasionally, persistent bleeding will require nasal packing and, more rarely, surgical management or embolization.

Posted by R. Glen Medders, MD