Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

Epistaxis is a nosebleed. Rupture of blood vessels somewhere in your nose causes a nosebleed. This may result from an injury such as a blow to the nose. Other causes include chemical irritants, infections, or abnormalities of the blood vessels of the nose. Diseases such as elevated blood pressure or bleeding abnormalities may cause a nosebleed. The most common cause is excessive drying of the nasal passages from dry air, especially in the winter. Most individuals will have at least one nosebleed during their lives. They are twice as common in children. Most resolve with direct pressure on the nose, although some may need further medical intervention such as packing or cautery.

Living With Your Diagnosis
The signs and symptoms of epistaxis include bleeding from one or both nostrils. There also may be bleeding down the back of the throat with spitting of blood, coughing of blood, or vomiting of blood. Swallowed blood irritates the stomach, frequently causing vomiting. Most nosebleeds do not result in sufficient blood loss to cause significant problems. However, a very prolonged, vigorous nosebleed may result in anemia. If you have had a significant nosebleed recently, you may notice dark or tarry bowel movements; these indicate that you have swallowed a significant amount of blood.

The first-line treatment for epistaxis is direct pressure. Grasp the nose firmly between the thumb and forefinger and squeeze it for 10–30 minutes without releasing the nose or peeking. Some feel that placing an ice pack on the neck or on the bridge of the nose may be helpful in slowing the blood flow to the nose. Lean forward so that any blood running down the throat may be spit out rather than swallowed. This may help prevent vomiting. If this is not successful, it may be necessary to pack the nose. Your doctor will pack absorbent gauze into the nose so as to place pressure on the bleeding site. It may be necessary to cauterize the bleeding site. The main side effects of packing are discomfort and the inability to breathe through your nose. Complications include an increased risk of sinus infection with packing. In some elderly individuals, slowed pulse rate or decreased blood pressure can be a result of packing, and your doctor may recommend hospitalization for close monitoring of the elderly individual. With cautery, there is a risk of perforation of the septum, the tissue that separates one nostril from the other.

The DOs
If your nosebleed is caused by elevated blood pressure, you should work with your doctor to get your blood pressure under good control. If you are prone to nosebleeds, you should probably avoid aspirin products because they may slow clotting. Humidification of the air in your home and, if possible, at work may prevent nosebleeds caused by dry air. Other useful treatments may include placing a small amount of petroleum jelly inside the opening of the nostril to protect it from drying. A scarf or cloth mask may be helpful if you must be out in cold, dry air. Salt water nasal sprays may be helpful. If irritating chemicals or dusts are a problem, avoidance or a filter-type mask may help. Your doctor may prescribe a steroid nasal spray if infections or allergies are a problem.

The DON’Ts
If bleeding is stopped by direct pressure, it is important not to blow the nose vigorously or to pick at any clots, because this may restart the bleeding. If you find that you are prone to nosebleeds, you should try to avoid factors that cause them. Decongestant nasal sprays can be a problem, and you should discuss their use with your doctor. Dry air and picking of the nose cause the majority of nosebleeds. Avoiding both of these situations will help prevent nosebleeds.
When to Call Your Doctor
You should call your doctor if your nose is gushing or if you are having repeated episodes of vomiting from swallowed blood. You need medical attention if applying direct pressure to your nose for 30 minutes does not control the bleeding. Also, call your doctor if you are having more than three or four nosebleeds a day. You should call your doctor if you know that your nosebleeds are caused by elevated blood pressure or a bleeding problem such as hemophilia or leukemia. You should call if you are on blood thinners such as heparin or coumadin. You should call your doctor if you have a temperature of greater than 102°F, especially if your nose was packed or cauterized.