nosebleed

Nosebleed, or epistaxis, is bleeding from the nasal mucosa. Most occur in the anterior portion of the nasal septum near Kiesselbach's plexus and are usually self-limited. Posterior epistaxis, which originates further back in the nasal cavity or from deeper arteries, tends to be more severe and harder to treat.

Common causes include dry nasal lining, nasal trauma such as nose picking or blowing, allergic or infectious rhinitis, excessive use of nasal sprays, and medications that impair clotting (anticoagulants, antiplatelet agents). Less common causes include hypertension, alcohol or cocaine use, bleeding disorders, vascular abnormalities, tumors, and chronic sinus or nasal infections. Risk factors include dry climate, low humidity, or repeated mucosal irritation.

Symptoms involve audible or visible bleeding from one or both nostrils, often with bright red blood, while coughing or swallowing blood can occur if the bleed is significant. Lightheadedness or faintness may accompany substantial blood loss.

Diagnosis is typically clinical, based on history and anterior nasal examination. If bleeding is heavy, recurrent, or suspected to be posterior, additional evaluation such as nasal endoscopy or imaging may be needed and assessment for coagulopathy or underlying conditions may be performed.

First aid at home: sit up and lean forward slightly, pinch the soft part of the nostrils for 5–10 minutes, and breathe through the mouth. Apply a cold compress and avoid nose blowing, nose picking, or strenuous activity for several hours after bleeding stops. Medical care is needed if bleeding lasts longer than 20 minutes, recurs frequently, or is associated with weakness or shortness of breath.

Medical treatment may include nasal packing, topical vasoconstrictors, cauterization of a bleeding vessel, or, for posterior bleeds, specialized packing or ENT intervention. Prevention focuses on humidification, saline sprays, treating allergies, avoiding nasal trauma, and managing anticoagulant therapy under medical supervision.