Epistaxis is the medical term for a nosebleed. It is a common condition noticed when blood drains from the nostrils. Most nosebleeds stop spontaneously and are benign. Sometimes nosebleeds are severe and become a threat to life, particularity in older patients who take blood thinners or those who have cardiovascular disease.
Most nosebleeds are not serious and are caused when small vessels on the septum of the nose are damaged and break as a result of dryness of the mucus membranes. More severe bleeding may be caused by larger vessels deep within the nose. For these patients, urgent treatment may be required for profuse and unstoppable bleeding.
For simple episodes of bleeding, application of pressure by pinching the soft part of the nasal tip for 5 to 8 minutes often stops the bleeding. It is best to tilt the head forward to minimize the amount of blood swallowed as blood irritates the stomach and often causes nausea. If bleeding does not stop with pressure, packing the nostril with tissue or a small cotton ball soaked in Afrin (oxymetazoline or phenylephrine available at any pharmacy) may be used. Other products are available that promote coagulation and include NasalCEASE. These are a calcium alginate mesh or swabs that are inserted in the nasal cavity to accelerate coagulation. If these techniques are ineffective medical care may be required.
When a patient is treated for epistaxis, the cause of the bleeding should be identified rather than use of a pack or another method. A complete exam of the head and neck is standard as some patients have other abnormalities of their noses and sometimes an endoscope is used to examine deep inside the nose. Problems such as fragile blood vessels, infection, trauma, mucus membrane lesions, septal deviation, tumors, polyps, and foreign bodes may exist.
Once the bleeding site is known it is common to remove blood from the nose and then apply Afrin to constrict the blood vessel and an anesthetic to numb the area. The vessel may be cauterized with a chemical called silver nitrate or with electricity or a pack may be placed. If bleeding continues which is common in patients with blood disorders or in those who take blood thinning agents, a pack may be required. Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated by surgical intervention.
Application of a topical antibiotic ointment to the nasal mucosa has been shown to be an effective treatment for recurrent epistaxis. Nosebleeds are rarely dangerous unless prolonged and recurrent but nevertheless they should not be underestimated particularly in posterior nosebleeds because large volumes of blood may be swallowed and thus blood loss underestimated. The elderly and those with co-existing morbidities such as disorders of blood clotting or heart disease should be closely monitored. For those with recurrent nosebleeds anemia may result.