Nosebleed (Epistaxis)

Nosebleeds (also called epistaxis) can occur easily because of the location of the nose
and the close-to-the-surface location of blood vessels in the lining of your nose. Most
nosebleeds can be handled at home, but certain symptoms should be checked by a
physician.
What is a nosebleed?
Simply put, a nosebleed is the loss of blood from the tissue that lines the inside of your
nose.
Nosebleeds (also called epistaxis) are common. Some 60% of people will have at least
one nosebleed in their lifetime. The location of the nose in the middle of the face and
the large number of blood vessels close to the surface in the lining of your nose make it
an easy target for injury and nosebleeds.

Are nosebleeds serious?

Although seeing blood coming out of your noise can be alarming, most nosebleeds are
not serious and can be managed at home. Some, however, should be checked by your
doctor. For instance, if you have frequent nosebleeds, see your doctor. This could be an
early sign of other medical problems that needs to be investigated. A few nosebleeds
start in the back of the nose. These nosebleeds usually involve large blood vessels,
result in heavy bleeding and can be dangerous. You will need medical attention for this
type of bleed, especially if the bleeding occurs after an injury and the bleeding hasn’t
stopped after 20 minutes of applying direct pressure to your nose. (Read on to learn the
steps for how to stop a nosebleed.)
Are there different kinds of nosebleeds?
Yes. Nosebleeds are described by the site of the bleed. There are two main types and
one is more serious than the other.
An anterior nosebleed starts in the front of the nose on the lower part of the wall that
separates the two sides of the nose (called the septum). Capillaries and small blood
vessels in this front area of the nose are fragile and can easily break and bleed. This is
the most common type of nosebleed and is usually not serious. These nosebleeds are
more common in children and are usually able to be treated at home.
A posterior nosebleed occurs deep inside the nose. This nosebleed is caused by a
bleed in larger blood vessels in the back part of the nose near the throat. This can be a
more serious nosebleed than an anterior nosebleed. It can result in heavy bleeding,
which may flow down the back of the throat. You may need medical attention right away
for this type of nosebleed. This type of nosebleed is more common in adults.
Who gets nosebleeds?
Anyone can get a nosebleed. Most people will have at least one in their lifetime.
However, there are people who are more likely to have a nosebleed. They include:
  Children between ages two and 10. Dry air, colds, allergies and sticking fingers
and objects into their nose make children more prone to nosebleeds.
 Adults between ages 45 and 65. Blood may take longer to clot in mid-life and
older adults. They are also more likely to be taking blood thinning drugs (such as
daily aspirin use), have high blood pressure, atherosclerosis (hardening of the
walls of arteries) or a bleeding disorder.
 Pregnant women. Blood vessels in the nose expand while pregnant, which puts
more pressure on the delicate blood vessels in the lining of the nose.
 People who take blood-thinning drugs, such as aspirin or warfarin.
 People who have blood clotting disorders, such as hemophilia or von Willebrand
disease.
What causes nosebleeds?
Nosebleeds have many causes. Fortunately, most are not serious.
The most common cause of nosebleeds is dry air. Dry air can be caused by hot, low-
humidity climates or heated indoor air. Both environments cause the nasal membrane
(the delicate tissue inside your nose) to dry out and become crusty or cracked and more
likely to bleed when rubbed or picked or when blowing your nose.
Other common causes of nosebleeds include:
 Nose picking.
 Colds (upper respiratory infections) and sinusitis, especially episodes that cause
repeated sneezing, coughing and nose blowing.
 Blowing your nose with force.
 Inserting an object into your nose.
 Injury to the nose and/or face.
 Allergic and non-allergic rhinitis (inflammation of the nasal lining).
 Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin,
and others).
 Cocaine and other drugs inhaled through the nose.
 Chemical irritants (chemicals in cleaning supplies, chemical fumes at the
workplace, other strong odors).
 High altitudes. The air is thinner (lack of oxygen) and drier as the altitude
increases.
 Deviated septum (an abnormal shape of the wall that separates the two sides of
the nose).
 Frequent use of nasal sprays and medications to treat itchy, runny or stuffy nose.
These medications – antihistamines and decongestants – can dry out the nasal
membranes.