Nosebleed (epistaxis)

Overview

The blood vessels in the nose are located close to the surface and can burst easily. The mucous membrane of the nose can be irritated and inflamed, or can be accidentally injured. Other causes for a nosebleed include high blood pressure and a tendency to bleed as well as tumours. The first measure is to squeeze the nostrils together while sitting with the head bent forward. Blood shouldn't be swallowed.

Symptoms

• Bleeding from one or both nostrils

Causes and treatment

Causes

Nature of blood vessels in the nose

• Dense network of small blood vessels (particularly in the front section)
• Relatively close to the surface
• Can burst easily

Local causes

• Irritated or inflamed nasal mucosa
  • Dry, cold air
  • Cold, allergies
  • Long-standing use of nasal spray
  • Irritants (chemicals, e.g. chlorine)
  • Nose picking, heavy nose blowing
• Trauma/accident
  • Blow to or falling on the nose
  • Fracture of central facial bones
  • Foreign body in the nose (often happens with small children: pea, button, peanut)
• Malformations/tumours in the nose

General causes

• High blood pressure
• Blood diseases and coagulation disorders
• Anticoagulant medication (aspirin, coumarin, etc.)
• Osler's disease (hereditary disease)

Further treatment by your doctor / in hospital

Possible tests

• Examination of nose and throat
• Blood pressure measurement
• CT scan (computed tomography), if necessary

Possible therapies

• Stop acute bleeding
  • Nasal tamponade (packing/blocking of nose)
  • Vasoconstriction (laser)
• Adjust dosage of anticoagulant medication, if necessary
• Reduce blood pressure, if necessary

What can I do myself?

• Sit with the head bent forward
• Squeeze nostrils together for 5 to 10 minutes
• Put a cold cloth on the neck
• Nasal care: nasal ointment, inhalation or irrigation with salt water
• Soften crusts with nasal ointment, carefully remove them

Very important:

• Don't swallow blood, spit it out
• Don’t plug the nose with paper tissues or cotton wool
• Don't drive yourself

When to see a doctor?

• Frequent nosebleeds
• After a blow, a fall or an accident involving the skull
• Nosebleed if you're taking anticoagulant medication
• Call emergency number 144 if:
  • Nosebleed doesn't stop within 30 minutes (children: 10 minutes)
  • Heavy bleeding

Synonyms

nosebleed, epistaxis