• Dr. Dave

15 things to know about nose bleeds (Epistaxis)

Nose bleeds can be very scary as a parent. Sometimes they seem to happen out of the blue or for others they are a frequent occurrence.

Here are some important facts to know:

Epistaxis occurs in either the front of the nose (anterior) or less often the back of the nose (posterior). The front of the nose is particularly well vascularized with five different arteries meeting in an area called Kiesselbach’s plexus. The most common cause of bleeding in this area is trauma – often in the form of nose-picking. Other causes are trauma from a fall, genetics, or just bad luck.

5 things to stop a nose bleed:

1) Hold tight pressure on the soft part of the nose. If you cannot feel your fingers on the other side or if you feel hard bone – you are holding it wrong and will not stop the bleeding!

2) Use your fingers. Nose clips and other gimmicky pressure holders just don’t work as well.

3) Do not let go for at least 10 minutes straight. The first step the body uses to stop bleeding is to create a clot. This takes time to form, when we let go the clot cannot form as effectively.

4) Consider using Afrin (oxymetazoline). This is a nasal decongestant that causes constriction of blood vessels making it easier to stop the bleeding. Caution – do not use this medication for more than 3 days in a row as the nose starts to develop chemical dependence at that point.

5) Keep the head tilted forward. It is better to have the blood coming out of the nose than silently dripping down the throat. This can give feedback on whether the pressure you are holding is tight enough.

5 things to prevent nose bleeds in the future:

1) Humidification. Keep a humidifier in the bedroom at night.

2) Nasal gels such as Ayr nasal saline gel can be placed gently in the nostrils before bedtime.

3) Saline spray can be used throughout the day to keep the nose moist (especially in dryer climates).

4) If you use any nasal sprays – do not aim them at the septum (middle of the nose) as this increased the likelihood of irritation and traumatic bleeding. A good trick is to use your left hand to spray into the right nostril and the right hand to spray into the left nostril (this forces you to spray towards the eye and away from the septum).

5) Avoid nose-picking and other traumatic activities.

5 other considerations:

1) Frequent nose bleeds (recurrent epistaxis). Schedule an appointment to see your local ENT. This may be something as simple as one pesky blood vessel that keeps getting irritated. This can be easily controlled with a simple and safe in-office procedure.

2) Bleeding that just won’t stop. Go to the ER or your nearest ENT clinic. There are many more sophisticated options to stop the bleeding. If you cannot control it, get help.

3) Genetic condition. Some patients have conditions that predispose them to recurrent epistaxis such as Hereditary Hemorrhagic Telangiectasia (HHT) or others. These need special treatment considerations and an ENT expert should be consulted.

4) High blood pressure. This will not cause epistaxis, but it can make it harder to control and stop once it has started.

5) Low platelets or use of blood thinners. While these conditions will not cause someone to have nose bleeds they will make it much easier to occur and much harder to control.

Do you know someone with nose bleeds? Hit the comments with your tricks and tips or any questions you still have.


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