Nose Bleeds (Epistaxis)

NOSE BLEEDS (EPISTAXIS)

Care and prevention

Most nose bleeds (or epistaxis) are mere nuisances; but some are quite frightening, and a few are even life threatening.  Doctors classify nose bleeds into two different types-

  1. Anterior Nose bleed: the nose bleed that comes from the front of the nose and begins with a flow of blood out of one or the other nostril if the patient is sitting up or standing
  2. Posterior Nose bleed: the nose bleed that comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting up or standing

Obviously if the patient is lying down even the anterior nosebleeds seem to flow in both directions, especially if the patient is coughing of blowing his nose. Nevertheless, it is important to try to make the distinction since posterior nosebleeds are often quite severe and almost always require care from a doctor.  Posterior nose bleeds are more likely to occur in older people, persons with high blood pressure and in cases of injury to the nose or face.

Nosebleeds in children are almost always of the anterior type.  Anterior nose bleeds are common in dry climates and when the air is dry.  The dry air parches the nasal membranes so that they crust, crack and bleed.  This can be prevented if you will place a bit off lubricating cream or ointment (e.g. Vaseline, Bactroban ointment) about the size of a pea on the end of your fingertip and the rub it up the nose, especially on the middle portion (the septum).

Up to three applications a day may be needed, but usually every bedtime is enough.

Warfarin, Aspirin (or Aspirin containing products) and non-steroidal anti-inflammatories (e.g.Brufen, Voltaren) thin the blood and can cause bleeding, or cause the bleeding to persist.

If the nosebleeds persist you should see your doctor, who may recommend cautery to the blood vessel that is causing trouble.

To stop an anterior nosebleed 

If you or your child has an anterior nose bleed, you may be able to care for it yourself by taking the following steps:

  1. Pinch the soft (lower) parts of the nose together between your thumb and index finger.
  2. Hold it for 5 minutes (timed by the clock)
  3. Keep head higher than the level of the heart – sit up or lie with head elevated.
  4. Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks
  5. Sucking ice is also useful

To prevent re-bleeding after bleeding has stopped:

  1. Do not pick or blow nose (sniffing is all right)
  2. Do not strain or bend down to lift anything heavy
  3. Keep head higher than the level of the heart

If re-bleeding occurs:

Clear nose of all blood clots by sniffing forcefully

  • Spray nose four times on both sides with decongestant nasal spray (such as Drixine or Otrivine)
  • Pinch the soft parts of the nose together between your thumb and two fingers for five minutes (to stop an anterior nose bleed)
  • Call your doctor if these measures fail.

When to call the doctor or go to the Accident and Emergency:

  • IF bleeding cannot be stopped or keeps reappearing within a short period of time
  • IF bleeding is rapid or if blood loss is large
  • IF you feel weak or faint, presumably from blood loss
  • IF bleeding begins by going down the back of the throat rather than the front of the nose

YOUR CONSULTATION

If your nose bleeds are severe and/or recurrent, please call 031 201 3118 for an appointment.

A complete history will be taken, and a thorough examination of the nasal passages will be performed (including nasal endoscopy). Further management will depend on the site and cause of the nose bleed, and will be in keeping with best ENT specialist practice guidelines.