Epistaxis is the medical term used to describe a nosebleed, involving the loss of blood from the tissue lining the nasal cavity. The nasal passages contain a rich network of tiny, fragile blood vessels that lie close to the surface, making them highly susceptible to rupture and bleeding. Although experiencing a nosebleed can be alarming, the vast majority of episodes are benign, self-limiting, and resolve without requiring medical intervention.
Understanding the Two Types of Epistaxis
Epistaxis is categorized into two types based on the anatomical source of the bleeding: anterior and posterior. An anterior nosebleed is the most frequent type, accounting for over 90% of all cases, and is generally less serious. This bleeding originates from a complex network of vessels located on the anterior part of the nasal septum. This site is easily exposed to trauma and environmental factors, and the bleeding tends to be a steady ooze from one nostril.
A posterior nosebleed is much less common and typically more serious, occurring more frequently in older adults. This type arises from larger arteries located deeper within the nasal cavity, such as branches of the sphenopalatine artery. Blood from a posterior bleed is often profuse and may flow down the back of the throat, presenting a greater risk for complications like aspiration. Because the source is not easily visualized, a posterior bleed often requires professional medical intervention.
Common Causes and Triggers
Bleeding occurs when the delicate nasal lining is eroded, exposing and rupturing the underlying blood vessels. Local trauma is a leading cause, often involving self-induced injury from nose picking or the insertion of foreign objects, which is common in children. More forceful injuries, like a direct blow to the face, can result in more severe bleeding.
Environmental factors contribute to the rupture of these vessels, especially dry air from low-humidity climates or heated indoor spaces. This dry environment causes the nasal membrane to dry out and crack, making the vessels brittle and prone to bleeding. Certain medications interfere with clotting ability, including anticoagulants (warfarin) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Underlying systemic conditions, such as hypertension or disorders that affect blood clotting (coagulopathies), can also increase the frequency and difficulty in controlling nosebleeds.
Immediate Care and When to Seek Medical Attention
Managing a typical anterior nosebleed involves several straightforward steps to help the vessels clot and stop the flow of blood. The person should sit upright and lean slightly forward, which prevents blood from draining down the throat and causing stomach irritation or vomiting. Next, firmly pinch the soft part of the nose just above the nostrils, maintaining continuous pressure for a full 10 to 15 minutes while breathing through the mouth. Applying a cold compress to the bridge of the nose may also help constrict the blood vessels.
Knowing when to seek immediate medical attention is important. You should go to an emergency department if the bleeding does not stop after two attempts of applying pressure for 10 to 15 minutes each. Emergency care is warranted if the blood flow is extremely heavy, if the nosebleed follows a significant head or facial injury, or if you feel faint, dizzy, or lightheaded. Furthermore, any nosebleed in a person taking blood-thinning medication or someone with a known clotting disorder should be evaluated by a healthcare professional.