Nosebleed - symptom

Definition:

Bleeding from the nose.

Alternative Names:

Epistaxis; Bleeding from the nose

Considerations:

An abundant supply of tiny blood vessels makes the nose particularly vulnerable to bleeding.

Air moving through the nose can dry and irritate the mucous membranes. This forms crusts which bleed when removed by rubbing, picking, or blowing the nose.

The large majority of nosebleeds are associated with minor injuries to the nose or with common colds.

Nosebleeds occur more frequently in the winter when viruses are common and heated indoor air dries out the nostrils. A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds.

Common Causes:

Nose picking
Trauma (such as a broken nose) or irritation
Vigorous nose blowing
In children, a foreign body lodged in the nose
Allergic rhinitis
Repeated sneezing
Upper respiratory infection (see specific respiratory diseases)
Barotrauma
Chemical irritants
Drugs (such as anticoagulants or anti-inflammatories)
Facial and nasal surgery

Home Care:

Sit down and simply squeeze the soft portion of the nose between the fingers for about 5 minutes. Lean forward to avoid swallowing the blood and breath through your mouth. Almost all nose bleeds can be controlled this way if sufficient time is allowed for the bleeding to stop.

Cold compresses or ice applied across the bridge of the nose may help.

Avoid packing the nose with gauze.

Use of a humidifier, vaseline, and nasal saline spray can prevent nosebleeds, especially during the winter months.

Call your health care provider if:

A nosebleed occurs after an injury to the head -- it may indicate a skull fracture (X-rays should be taken no matter how trivial the blow seemed to be at the time).
There are repeated nosebleeds, particularly if they are becoming more frequent and if they are not associated with a cold or other minor irritation.

What to expect at your health care provider's office:

A history will be obtained and a physical examination performed. In some situations, the patient may be monitored for signs and symptoms of hypovolemic shock.

Medical history questions documenting nosebleeds may include:

Quality
- Do the nosebleeds involve bleeding a large amount?
- Do the nosebleeds stop readily (with pressure to the nostrils)?
Time pattern
- Did they begin recently?
- Do the occur frequently or repeatedly (recurrent)?
- Has a tendency to have nosebleeds been present lifelong?
- Has it only occurred for the past few weeks or months?
  - How long?
- Are nosebleeds only occasional?
Other
- What other symptoms are also present?
- Is there blood in the stools?
- Are you vomiting blood?
- Is there easy bruising or bleeding?
- Is there petechiae (pinpoint red or purplish spots in the skin)?
- Are you on blood thinners (Coumadin) or aspirin?

Diagnostic tests that may be performed include:

Complete blood count
Partial thromboplastin time measurements
Prothrombin (PT)
X-rays of the skull
Nasal endoscopy (examination of the nose using a camera)

Treatment is usually tailored to the cause of nose bleed:

Cauterization using heat or silver nitrate sticks
Reducing the amount of blood thinners or stopping Asprin
Controlling the Blood pressure
Reducing a broken nose or removing a foreign body
Nasal packing

After seeing your health care provider:
You may want to add a diagnosis related to nosebleeds to your personal medical record. You may be referred to an ENT specialist to diagnose and treat the condition.

Review Date: 1/21/2002
Reviewed By: Ashutosh Kacker, M.D., Department of Otolaryngology, New York Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network.

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