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EPISTAXIS - NOSE BLEEDS

What is Epistaxis ?

Epistaxis is bleeding from the nose. Often the source of the bleeding will be obvious. Sometimes the blood runs into the throat and is coughed or spat out – its origin is uncertain. In younger people, the bleeding usually comes from fragile surface blood vessels near the tip of the nose (Little’s area). The septum divides the nose into right and left sides - and should be in the middle. In orler people, the bleeding usually comes from further back and higher up in the nose. The blood vessels which bleed may be veins or arteries. The bleeding may range from very small bleeds just staining the hankerchief, to very heavy bleeding requiring admission to hospital.

How does Epistaxis occur ?

Minor injury to the nose is a common cause. This may be an injury to your nose, or may be due to nose picking. People with blocked noses blow them very hard and this may start bleeding. Infections such as the common cold make the vessels more likely to bleed. If such a cold follows nasal surgery, this may cause severe bleeding. High blood pressure or heart failure can cause nose bleeds; the former because of raised pressure in arteries, the latter because of raised pressure in veins. Abnormalities of the blood vessels in the nose are sometimes found. Hardening of the arteries is common in the elderly. Occasionally the vessel abnormality runs in families. Abnormalities of the blood clotting system may give rise to nose bleeds. Some cases are due to drugs given to stop clotting in other parts of the body (anticoagulants).

Treatment Involved for Epistaxis

Most cases of epistaxis in young people are due to bleeding from the front of the nasal septum. Even small bleeds may be quite alarming. If not much blood has been lost and there is no faintness, sitting up helps. Next apply pressure to the bleeding point by squeezing the tip of the nose firmly for five minutes. Both sides of the nose should be squeezed. Cold compresses around the nose and face are helpful: this causes the blood vessels to constrict. If you feel faint, lie down on your side with the bleeding side of your nose uppermost. However, most patients are better off sitting up. If the bleeding continues and you are lying down, then blood is swallowed. Blood in the stomach may cause vomiting. Troublesome or repeated nose bleeds from the front of the nose may be dealt with by nasal cautery. In this treatment the blood vessel which is bleeding is cauterized with a chemical or electrical cautery. This may be done under a local anaesthetic. The procedure is not very uncomfortable and can even be performed on small children if they are cooperative. If the bleeding is coming from far back or high up in the nose cautery may not be possible. To control the bleeding some form of packing of the nose may be required. When there is large blood loss you will need to be admitted to hospital. Very rarely, blood loss may be severe enough to warrant blood transfusion. Such severe epistaxis needs to be investigated to be sure that there is no other underlying cause. An x-ray of the nose and sinuses may have to wait until the bleeding has settled and packs are out. Your blood pressure and pulse rate are checked. High blood pressure may need treatment. Blood tests are done to exclude any abnormalities of the blood. Pre-existing anaemia makes blood loss more dangerous. Tests are also done to make sure the clotting mechanism is normal. If packing of the nose does not control the bleeding you may have to be taken to the operating theatre. Under an anaesthetic, a patient's nose can be carefully examined. A deviation of the septum may need to be straightened out. This operation allows a thorough examination to be performed and the nose can be packed properly. Endoscopic surgery, using very fine instruments can be used toput clipson bleeding blood vessels. If despite adequate packing bleeding continues, you may need ligation of an artery. This is an operation to tie off one of the main supply vessels to the nose. When the bleeding has been controlled the patient will be discharged and advised to avoid exertion for a week or two.

During Treatment for Epistaxis

Young people rarely have any serious complications with nose bleeds. It is the elderly who have most problems. Admission to hospital is a major event and may upset them. Epistaxis patients need to rest, and bed rest for the elderly may produce problems: skilled nursing is needed to avoid deep vein thrombosis and pressure sores. Reassurance is also very important for elderly patients, who tend to get confused in strange surroundings. Even the mildest of drugs may make the confusion worse. Heart disease increases the risk of blood loss. Transfusion may only rarely be necessary, and this carries some risks in the elderly.

If Epistaxis is Left Untreated

Repeated small bleeds over a period of time can lead to anaemia. This may result in a variety of symptoms. Tiredness and faintness in the young or heart failure or heart attacks in the elderly may occur. Rapid and severe bleeding will lead to failure of the circulation: a condition known as shock.

Effects on Family of Epistaxis

Epistaxis in the elderly can lead to serious complications and early advice and treatment is needed for a severe nose bleed. Relatives and friends have a responsibility to get these patients to hospital as quickly as possible. The patient should be kept lying down on the side and squeezing pressure applied to the end of the nose.