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Nosebleeds (Epistaxis)

What are nosebleeds (epistaxis)?

Epistaxis is the medical term for bleeding from the nose.

Anyone can have a nosebleed, but they are slightly more common in men than women. They tend to affect the elderly and are also very common in children, with over half of children between the ages of 6-15 years old having regular nosebleeds.

They can happen anytime and usually happen unexpectedly but are more likely to occur in the morning or late evening.

What are the causes of nosebleeds?

It is believed that nosebleeds are caused by a broken fragile blood vessel in the nose, which could be caused by a minor injury or an infection.

The risk of nosebleeds is also increased by:

  • High blood pressure
  • Drinking a lot of alcohol
  • Anti-thrombotic medication such as aspirin, warfarin, clopidogrel and apixaban. These are often prescribed to patients with heart disease and affect the way blood clots. If you are taking one of these medications, speak to your doctor if you start to have nosebleeds.
  • Blood clotting problems – if you find you bleed for a long time after minor cuts or if your skin bruises easily, you should speak to your doctor as you may need blood tests to investigate how long your blood takes to clot.

In children, a minor skin infection called Staphylococcus Aureus can cause crusting inside the nose. This may be transferred to the inside of the nose by the child’s finger when they pick their nose, a common childhood habit, which can damage the nose lining and lead to nosebleeds.

How are nosebleeds treated?

Most nosebleeds are minor and can be treated without the need for seeing a doctor. Bleeding should stop following application of pressure by pinching the fleshy part of the nose  for 15 minutes. If it does stop then no further treatment is necessary, although you should avoid strenuous exercise or straining on the toilet for a few days after nosebleeds.

If you have minor bleeding that you can stop by applying pressure, but it occurs regularly, then you should consult your doctor for advice.

If bleeding does not stop after 15 minutes of applying pressure and is severe, you should see a doctor immediately.

If the cause of your nosebleeds is crusting and infection inside the nose, then your doctor can prescribe an antiseptic cream. One such cream (Naseptin) contains peanut oil so a different option (Bactroban) is used for patients with a peanut or soy allergy. These creams are effective in treating nosebleeds, particularly in children, but may need repeated treatments for several weeks at a time.

In specific circumstances, e.g. if you are taking warfarin, your nose bleed may be treated using packing, which involves putting packs of sponge or material into the nose to stop the bleeding. You may need to be admitted and stay in hospital for a few days with the packs in place, after which your doctor will discuss your warfarin prescription with you.

In most other circumstances, ‘direct’ treatment can be used, which is a very effective and non-painful procedure. An example of this is to use modern technology to find the location of the bleeding in your nose and stop it by ‘sealing it off’ using a chemical called silver nitrate. This is applied to the lining of the nose, usually after applying local anaesthetic solution.

Diathermy is another example of ‘direct’ treatment that is successful for treating nosebleeds and involves passing a very weak electric current across the affected blood vessel. This is performed using a small telescope, which allows your consultant to find the damaged blood vessel and stop the bleeding and is usually carried out under local anaesthetic.

In uncommon cases, the above may not be successful and surgery may be required. Many different options are available, and they are quite complicated. Your consultant will explain these in detail and help you to decide which is the best procedure for you. Some examples include:

  • Using telescopes and diathermy to stop bleeding from deep within your nose
  • Sphenopalatine artery ligation – sealing off the main blood vessel in your nose which is located behind your cheek. This, again, uses telescopes and avoids the need to cut the skin around your nose.
  • Embolisation – passing small guidewires along a blood vessel from your leg up into your nose and using fine mesh or glue to seal the blood vessels.

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