Symptom Information: Nose Bleed

Symptom:

Nose bleed (Other names: Epistaxis, nasal haemorrhage).

General Description:

Nosebleeds involve bleeding from the inside of your nose.   Nosebleeds can originate from the front of the nose or from the back of the nose. Bleeding typically will be seen from only one nostril. If the bleeding is heavy, blood can fill up the affected nostril and overflow into the nasopharynx, this is the area inside the nose where the two nostrils converge.   This can then lead to blood flow from the other nostril as well. Nose bleeds can sometime cause blood to drip into the back of the throat.  Blood can then accumulate into the stomach, causing you to spit up or vomit blood (hemoptysis).

If the blood loss is significant enough it can cause dizziness, weakness, confusion, and fainting.

• From the front of the nose. This type of nosebleed is seen in more than 90% of all nosebleeds. The blood vessels in the nasal septum usually cause the bleeding. This occurs where a network of blood vessels converge called the “Kiesselbach plexus”.  Anterior (from the front) nosebleeds are usually easy to control and treatments be done at home or by a health care practitioner.
• From the back of the nose. These nosebleeds are much less common than from the front of the nose. They are more often seen in elderly people. It is an artery in the back part of the nose that the bleeding usually originates from.  This type of nosebleed is more complicated and often  necessitates admission to the hospital where it can be management by an ear, nose, and throat specialist.

Causes:

Some causes of nose bleeds are:

• Dryness (often caused by indoor heat in the winter) - this is the most common cause
• Nose picking - Together with dryness nose picking occurs more often when mucus in the nose is dry and crusty.
• Injuries
• Colds
• Very vigorous nose blowing
• Allergies
• Cocaine use
• Foreign object in the nose – Small children may stick small objects up the nose
• Atherosclerosis (which is the hardening of the arteries)
• Polyps
• Nasal and sinus infections
• Nasal surgery
• Deviated or perforated septum
• High blood pressure and blood clotting disorders
• Drugs that interfere with blood clotting, such as aspirin.
• Liver disease
• Sometimes, the cause of nosebleeds can't be determined.

Risk factors:

• Local irritation
• Injury to the face  
• Medications/supplements, including aspirin 

How you can help your doctor:

Before your consultation with you doctor, think about the following questions they may ask you.

• Describe the frequency and length of time you have nosebleeds - Frequent nosebleeds are those that occur more than once a week.

• When was your last time you had nosebleed?
• How long do your nosebleeds usually last?
• Have you swallowed blood during your nose bleed?
• Have you vomited any blood?
• Do you have any other symptoms when the nose bleed occurs?
• What do you think may be causing your nosebleeds?
• Have you had a nose injury recently?
• What home treatments have you tried to stop the nosebleeds? Did they help?
• What nonprescription medicines have you used to help stop nosebleeds? Did they help?
• What prescription and nonprescription medicines (not related to your nosebleeds) do you take?
• Do you have a family history of bleeding problems?

When is it an emergency?

• Involves a greater than expected amount of blood
• Makes it difficult for you to breathe
• Does not stop after 30 minutes even with compression
• Occurs after an injury, such as a car accident or serious blow to the face.

Do not drive yourself to an emergency room if you're losing significant amounts of blood. You should call 911 or have someone drive you to seek medical attention.