Nose Bleeds/ Epistaxis

Epistaxis is bleeding from the nose caused by damage to the blood vessels of the nasal mucosa. Most epistaxis is self-limiting and harmless, and often the cause of damage to the blood vessels is not identified. It is quite common in children and the elderly.

Local causes of damage to the blood vessels include trauma, inflammation, topical drugs (such as corticosteroids), surgery, vascular causes (such as hereditary haemorrhagic telangiectasia and Wegener’s granulomatosis), or tumours (such as squamous cell carcinoma).

More general causes of damage include hypertension, atherosclerosis, increased venous pressure from mitral stenosis, haematological disorders (such as thrombocytopenia, leukaemia, and haemophilia), environmental factors (such as temperature, humidity, or altitude), systemic drugs (such as anticoagulants and antiplatelets), and excessive alcohol consumption.

Treatment usually is first aid measures such as bending forwards and the pinching the soft fleshy bottom part of the nose for 10-15 minutes. You can apply a pack of ice at the top of the nose. Most nose bleeds settle with these measures. However if they do not settle and the bleeding is profuse you have to go to A&E.

Mr. Dhanasekar will treat minor, intermittent and recurrent nose bleeds in his clinic rooms. He will visualise the bleeding area and this sometimes might need an endoscope. He will then cauterise this area with chemical cautery after spraying the nose with a local anaesthetic. Rarely if the bleeding is from a large vessel at the back of the nose, this vessel might need clipping and it will be done under a general anaesthetic.