Nose Bleeds (Epistaxis)

Nose Bleeds (Epistaxis)

Nose bleeds can occur after a nose injury (post-traumatic), or for no apparent reason (spontaneous) .

Spontaneous nose bleeds are very common, particularly in young children and older adults.

Children often have nasal inflammation (rhinitis) and increased vascularity (prominent blood vessels) in this area as a result. Furthermore, young children are more likely to sustain trauma to the nose, often by picking their noses! Nosebleeds in children tend to occur frequently, but usually settle down with pressure after a few minutes.

In contrast, older people tend to have nosebleeds that don’t occur as frequently, but can be quite severe when they do. Older people are more likely to need to be admitted to hospital to have their noses cauterised or packed with a dressing.

The older patient’s nasal lining tends to be is quite dry and the blood vessles are more ‘brittle’. Combined with the increased likelihood that they are on blood thinning medication, and may have high blood pressure, the nose bleeds can be quite severe.

How to stop a nosebleed at home The most important thing to do when a nose bleed starts is not to panic! Of course, this is much easier said than done.

Firstly, as with bleeding from anywhere else, the first thing to do is to try and compress the region. For the nose, compression should be applied to the soft part of the nose just below the nasal bones. This area is just below and to the side of the bridge of the nose.

Secondly, get a bag of ice (or frozen veg, if that’s all you have to hand), and place it over your forehead. The aim of this is to try and make the blood vessels to constrict (narrow), hopefully reducing the amount of blood getting to the nose.

Lastly, bend forward to make sure that any blood that goes into the throat can be expelled through the mouth rather than swallowing it. The natural tendency is to look up and lean back. Expelling the blood through the mouth makes it less likely that blood can accidentally pass into your lungs and make you cough. Swallowing a large amount of blood into the stomach can also make one feel quite nauseated.

What to do if it doesn’t stop

This is a much more likely situation in older adults than younger children. In short, if you have any concern about the amount you’ve been bleeding or how long you’ve been bleeding, make your way to the Emergency department as soon as possible, by calling an ambulance if necessary.

The Emergency department doctors will usually manage the bleeding in the first instance, and may need to carry out blood tests and put up a drip. You may then be referred to the on call ENT team, and be admitted for a day or so. Rarely, a longer stay in hospital may be required. Occasionally, a surgical procedure may need to be carried out.

A detailed description of Epistaxis can be found here.