Alternate Names: Epistaxis; Bleeding from the nose

Considerations: An abundant supply of tiny blood vessels makes the nose particularly vulnerable to bleeding.

Air moving through the nose can dry and irritate the mucous membranes. This forms crusts which bleed when removed by rubbing, picking, or blowing the nose.

The large majority of nosebleeds are associated with minor injuries to the nose or with common colds.

Nosebleeds occur more frequently in the winter when viruses are common and heated indoor air dries out the nostrils. A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds.

Common Causes:

• nose picking
• trauma (such as a broken nose) or irritation
• vigorous nose blowing
• in children, a foreign body lodged in the nose
• allergic rhinitis
• repeated sneezing
• upper respiratory infection (see specific respiratory diseases)
• barotrauma
• chemical irritants
• drugs (such as anticoagulants or anti-inflammatories)
• facial and nasal surgery

Home Care: Sit down and simply squeeze the soft portion of the nose between the fingers for about 5 minutes. Almost all nose bleeds can be controlled this way if sufficient time is allowed for the bleeding to stop.

Cold compresses or ice applied across the bridge of the nose may help.

Avoid packing the nose with gauze.

Call If:

• a nosebleed occurs after an injury to the head it may indicate a skull fracture (X-rays should be taken no matter how trivial the blow seemed to be at the time).
• there are repeated nosebleeds, particularly if they are becoming more frequent and if they are not associated with a cold or other minor irritation.

What To Expect: A history will be obtained and a physical examination performed. In some situations, the patient may be monitored for signs and symptoms of hypovolemic shock.

Medical history questions documenting nosebleeds may include:

• quality
  • Do the nosebleeds involve bleeding a large amount?
  • Do the nosebleeds stop readily (with pressure to the nostrils)?
• time pattern
  • Did they begin recently?
  • Do the occur frequently or repeatedly (recurrent)?
  • Has a tendency to have nosebleeds been present lifelong?
  • Has it only occurred for the past few weeks or months?
    • How long?
  • Are nosebleeds only occasional?
• other
  • What other symptoms are also present?
  • Is there blood in the stools?
  • Are you vomiting blood?
  • Is there easy bruising or bleeding?
  • Is there petechiae (pinpoint red or purplish spots in the skin)?

• complete blood count
• partial thromboplastin time measurements
• prothrombin (PT)
• X-rays of the skull