Epi-What’s-is?

Nosebleeds (epistaxis) will occur in up to sixty percent of all individuals.  Episodes are more common in children less than ten years old and then peak again after age fifty.  Fortunately, most cases are minor and self-limited, not needing medical attention.  

The nose is obviously separated into two sides, being divided by the septum.  There are many blood vessels on the septum that come together in the front part of the nose, giving us an area that can be prone to bleeding.  This is the region where most nosebleeds will occur.  Fortunately, bleeding here is easier to treat.  Bleeding in the back part of the nose, however, is harder to identify and treat.  

The most common cause of nosebleeds is epistaxis digitorum (nose picking).  Other common causes include irritation of the nasal lining from allergies, irritants such as cigarette smoke and dry air, particularly in the winter months.  Infections in the sinuses can also cause bleeding.  Aspirin, which is commonly taken to thin the blood, may lead to easy bleeding.  Another medicinal cause is nasal sprays, both over-the-counter and prescription.

Uncontrolled high blood pressure will occasionally cause nosebleeds.  This is presumably due to the high pressure in the capillaries.  Other less common causes include disorders of blood clotting, liver disease, and cancers.

Since most bleeds occur in the front part of the nose, where the nose is flexible, they are easily treated with direct pressure.   Squeezing the nostrils continuously for at least five minutes will stop most bleeds.  Tilt the head forward to prevent pooling of blood back in the throat.  This could lead to nausea or airway obstruction.  If bleeding doesn’t stop after five minutes’ pressure, squeeze again for up to 15 to 20 minutes.  A nasal decongestant sprayed on a wad of cotton and placed into the bleeding nostril may aid in stopping the bleeding.

If bleeding persists despite these measures, you should see your doctor.  Prescription medicine may need to be applied to the nasal lining in order to constrict the blood vessels.  Visible bleeding blood vessels can often be cauterized either with chemicals or electricity (cautery).  In more severe cases or in cases where the bleeding is not easily visible, gauze packing is inserted to control the bleeding.

In individuals who are prone to nosebleeds, some general measures can be instituted to prevent recurrences.  Increase the humidity in your home with a humidifier, especially during dry months.  Nasal saline (salt water) sprays and petroleum jelly can be put just inside the nostril on the septum to keep your nose from drying out.  If you have allergies or chronic sinus problems, getting these properly controlled can reduce nosebleeds.  The same is true of high blood pressure.  Very frequent and difficult to control nosebleeds should be evaluated more extensively by your physician.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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