Epistaxis or nose bleeding can be a scary symptom if you get it. In a few cases it can be a life-threatening medical emergency but, fortunately, the majority of nose bleeds can be treated at home.

What is epistaxis?
Epistaxis is not a medical disorder or disease but a symptom of underlying disease. This symptom has been described for many years now, as far back as Hippocrates. The nose has many blood vessels many of which lie close to the surface and can be easily traumatized resulting in a nose bleed. It is estimated that approximately 10-12% of the general population will have a nose bleed repeatedly and 60% of the population having one episode in their lifetime. Epistaxis can occur at all ages but there are two peak times between the ages 15-24 and 45-65 years affecting women and men alike.

What are the causes of epistaxis?
The most common causes of nose bleeding are dryness and nose picking. These two things work together. Nose picking occurs often when the mucus in the nose is dry and crusty. Other causes of nose bleeding include:
• Foreign body in nose
• Blunt trauma
• Sneezing
• Nasal fracture
• Infection
• Tumours
• Inhalation of tobacco, cocaine, cannabis and other drugs
• Medications
• Medical disorders like hypertension and coagulation disorders

Is epistaxis serious?
The vast majority of nose bleeds occur from the anterior two thirds (front) of the nose and resolve with self-treatment and are not serious. A few nose bleeds stem from large vessels in the back of the nose and these nose bleeds are serious and can be very dangerous. This type of nose bleed may occur after an injury and is often more common in the elderly. The individual with this type of nosebleed should seek medical attention immediately. Any nose bleed that goes on for more than 15 minutes, or if it occurs after an injury e.g. a punch in the face, should be referred for immediate medical attention.

What should I do if I get a nose bleed?
If you get a nose bleed you may try self-treatment. It is important that you sit down and lean slightly forward keeping your head above your heart. Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of the nose and the hard bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. You should breathe through your mouth while holding your nose. You should squeeze your nose for at least 5 minutes. If the bleeding persists you should hold again for ten minutes. You can also place a cold compress or an ice pack across the bridge of your nose. Once there is no bleeding you should avoid bending over or blowing your nose for a while as these may start the bleeding again.

Seeking medical attention
If your nose bleeding is a result of an injury or goes on for more than 15 minutes you should see a doctor immediately. Your doctor will promptly carry out an examination and resuscitation immediately if required. The identification of the site of bleeding, control of bleeding and treatment of identifiable causes are then done. The prognosis is good but variable for epistaxis. With adequate supportive care and control of underlying medical conditions, most patients may not experience any re-bleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A few cases may require specialized care and more aggressive treatments.

Can I prevent nose bleeds?
This may be possible in some cases. The following may prove beneficial:
• Keep children’s fingernails short to discourage nose picking.
• Quit smoking. Smoking dries out your nose and also irritates it.
• Open your mouth when you sneeze!

Conclusion
Epistaxis is a common symptom that is often treated at home with gentle pressure to the nose or ice packs applied to the nasal bridge. In a few cases the nose bleeding can be very severe and serious and requires immediate medical attention. Appropriate management of epistaxis and referral to a specialist can reduce the morbidity and mortality from this common medical emergency.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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