A nosebleed, or epistaxis, is bleeding from the blood vessels lining the nose. About nine in ten start from a cluster of fragile vessels at the front of the septum and stop with simple pressure. Bleeds from further back are less common, heavier and seen mainly in older adults.
Most nosebleeds are a nuisance and not a danger. Recurrent bleeds can usually be stopped by sealing the responsible vessel. Repeated or heavy bleeding also deserves a check of blood pressure, medicines and clotting.
Symptome
- Blood from one nostril, less often both
- Blood running down the back of the throat, especially when lying down
- Bleeds triggered by nose blowing, picking, sneezing or dry air
- Crusting and soreness just inside the nostril
- Light-headedness or pallor after a heavy bleed
- Tiredness from anaemia when bleeds are frequent
Ursachen und Risikofaktoren
Local causes include nose picking, colds and allergy, dry heated or air-conditioned air, a deviated septum, steroid nasal sprays aimed at the septum, injury, cocaine use and, rarely, tumours. General factors include blood-thinning medicines such as warfarin, the newer anticoagulants, aspirin and clopidogrel, clotting disorders such as von Willebrand disease, liver disease, heavy alcohol use and hereditary haemorrhagic telangiectasia. High blood pressure does not usually start a bleed but makes it harder to stop. In teenage boys, a one-sided blocked nose with bleeds needs a check for angiofibroma.
Wie es diagnostiziert wird
- Nasal examination: After clearing clots, the front of the septum is inspected for a prominent vessel or a raw area.
- Nasal endoscopy: A thin camera finds bleeding points further back and excludes polyps or a growth, particularly with one-sided symptoms.
- Blood tests: Blood count and clotting screen for heavy or recurrent bleeds, with anticoagulant levels where relevant.
- Blood pressure and medicine review: A check of pressure and of every tablet and supplement, since fish oil, ginkgo and anti-inflammatory painkillers all affect bleeding.
- CT or MRI: Only when a mass is suspected.
Behandlungsmöglichkeiten
- Correct first aid: Sit up, lean forward, and pinch the soft part of the nose firmly for 10 to 15 minutes without letting go. Spit out blood and apply something cold to the bridge or suck ice.
- Nasal cautery: The bleeding vessel is sealed with a silver nitrate stick or electrocautery under local anaesthetic spray in the clinic. It takes a few minutes.
- Antiseptic or moisturising ointment: Applied inside the nostril for 1 to 2 weeks to heal crusting, together with saline spray and a humidifier in dry rooms.
- Nasal packing: A dissolvable or inflatable pack for bleeds that do not stop with pressure, left in for 24 to 48 hours.
- Surgical or radiological control: Endoscopic clipping of the sphenopalatine artery, or embolisation, for severe posterior bleeds that packing fails to control.
- Adjusting blood thinners: Done only with the prescribing doctor, balancing the bleeding against the reason for the medicine.
Wenn es dringend ist
Go to a local emergency department if bleeding continues after 20 minutes of firm continuous pressure, if the flow is heavy or you are swallowing large amounts of blood, if you feel faint, breathless or have chest pain, if the bleed follows a blow to the head or face, or if you take anticoagulants. A child under two with a nosebleed should be seen by a doctor.
Reisen nach Türkiye zur Behandlung
An active nosebleed is handled locally. If you have recurrent bleeds, a visit can include endoscopy and cautery in a single appointment, and septoplasty if a deviated septum is the underlying cause. After cautery avoid nose blowing, hot drinks, heavy lifting and ideally flying for a few days, since dry cabin air can restart bleeding.
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Häufig gestellte Fragen
Should I tilt my head back?
No. Blood then runs down the throat, irritates the stomach and hides how much you are losing. Lean forward and pinch the soft part of the nose.
Does cautery hurt, and does it last?
The nose is numbed first, so you feel pressure and a brief sting. It stops bleeds from that vessel in most people, though new vessels can form and need repeat treatment.
Do nosebleeds mean high blood pressure?
Not usually. Blood pressure is often raised during a bleed because of anxiety. It is still worth having it measured properly once things have settled.
My child has nosebleeds every week. Is that normal?
It is common and nearly always due to picking and crusting. Ointment for a couple of weeks often stops the cycle. Frequent heavy bleeds or easy bruising need a blood test.