A nosebleed occurs when the tiny blood vessels that run near the surface of the lining of the nose become damaged and begin to hemorrhage. Bleeding can be as mild as spotting when blowing your nose, or as severe as gushing blood that requires a visit to the emergency room. Epistaxis is categorized by the location of the bleeding (front or back of the nose), and by the side (left or right). The front and back of the nose have distinct networks of blood vessels that are potentially responsible for the bleeding. Once the location of the bleed is confirmed, the potential causes and risk factors can be more accurately determined.

• Dry weather
• Injury to the nose
• Use of blood thinners (baby aspirin, Plavix, Warfarin)
• High blood pressure (Hypertension)
• Bleeding disorders
• Deviated septum
• Septal perforations
• Chronic inflammatory disorders (i.e., Hereditary Hemorrhagic Telangiectasia
• Nasal polyps
• Sinonasal tumors

1. Sit down, tilt your head forward, and do not like let the blood drain backwards. Swallowing the blood can cause you to vomit.
2. Use a washcloth or paper towel to catch the blood
3. Use your index finger and thumb to press around the soft part of the nose near where it turns into bone
4. Breathe through your mouth
5. You can use over-the-counter decongestant nasal spray such as Afrin (oxymetazoline) or Neo-Synephrine to help control the bleeding. Soaking a cotton ball with this medicine and plugging it up the nose may also help.
6. If the bleeding persists for more than 10-15 minutes, seek a nearby emergency room for control of the bleeding. Otherwise, the bleeding should slow down and stop. Afterwards, make sure not to bend over, strain too hard, or blow your nose for 2-3 days.

If you keep experiencing nosebleeds, it is important to seek a consultation to determine the cause. Many times, the problematic vessel, particularly in the front of the nose, can be easily identified in the clinic and chemically cauterized. It is important to keep the nose properly moisturized with saline sprays, vasoline, or a humidifier to prevent future injury. In rare cases, nosebleeds require surgery in the operating room, where the large blood vessels responsible for the bleeding are identified and clipped.