Nosebleeds

Though they can be quite impressive, nosebleeds are generally harmless. Young children and the elderly are most at risk for suffering from this type of haemorrhage, also known as epistaxis.

There are many blood vessels in the nose and their role is to warm and humidify the air we breathe. These vessels are located close to the surface and are therefore easily damaged. Nosebleeds, particularly in children, originate in the septum which is the partition that separates the nostrils. In rare cases, the haemorrhage can originate from deeper within the nose. This generally occurs in the elderly who have circulation problems. This type of nosebleed is more serious and is much more delicate to treat.

What causes nosebleeds?

Nosebleeds can occur for many reasons, including:

• Allergies, a cold or sinusitis
• Nasally inhaled drugs
• Very dry, cold air in winter
• Nose picking
• Head or face injury
• Coagulation disorders or taking anticoagulants
• High blood pressure
• Benign (ex. polyp) or malignant tumours

What to do in the event of a nosebleed

Firstly, do not panic! Keep the head upright, higher than the level of the heart. Tilt the head forward slightly and firmly pinch the nostrils for 5 to 10 minutes.

DO NOT tilt the head back. This is very important as the blood will flow into the throat. This will prevent coagulation and could even cause vomiting.

Then, take it easy for at least one hour and avoid blowing your nose.

When is it important to see a physician?

Certain situations require medication attention:

• If the bleeding is constant and exceeds 20 minutes
• If the bleeding is the result of an accident (fall, head injury) that may have caused a fracture
• If nosebleeds are frequent, chronic
• If you take blood thinning medication (ex. Aspirin™) or anticoagulants (ex. Coumadin™).

What are the possible treatments?

The first step, upon consulting a physician, is determining the origin of the haemorrhage. Once that is done, there are two treatment options: cautery and anterior packing.

• Cautery: Cauterization involves the use of a chemical solution, a small electrical discharge or a laser to burn the vessels responsible for the hemorrhage. This will prevent them from bleeding any further. Cauterization is used to treat those who suffer from frequent nosebleeds.
• Anterior packing: This second method is used when the haemorrhage does not stop on its own after 20 minutes. The physician inserts a wick or cotton pack that will act like a sponge and will swell when it comes into contact with blood. By swelling, the pack will exert pressure on the blood vessel which will stop the bleeding.

In more serious cases where the above mentioned methods fail to stop the bleeding, more elaborate techniques may be undertaken but require hospitalization.

How are nosebleeds prevented?

A few simple measures can be taken to help prevent nosebleeds:

• Prevent your child from putting fingers or small objects in their nose.
• Keep your child's finger nails short.
• Hydrate the nose with a saline solution based nasal spray or by applying Vaseline at the base of the nostrils.
• In winter, use a humidifier in the bedroom.