Epistaxis is the Greek word for 'nosebleed' and it is the word doctors use to describe this common occurrence. Hippocrates recognized that placing pressure on the alae nasi, or the wing of the nose, was an effective method for controlling epistaxis. Ancient Egyptians preferred to mix the ashes of papyrus with vinegar for use in a compress, while in some areas of Nigeria, "efirin leaf," a local herb, has been passed down through the ages as a way to arrest bleeding from the nose.

In the U.S., the prevalence of nosebleeds has been reported to occur in up to 60 percent of the general population, though affected persons usually do not seek medical attention, particularly if the bleeding is minor. The condition of epistaxis has a 'bimodal' distribution, meaning that the frequency of occurrence peaks twice: around the age of 10 years and older than 50 years. Generally, males more than females find themselves with a nosebleed, and this happens more often during winter months or in climates with low humidity.

Most cases of epistaxis are minor, but in rare cases they can be a sign of some deeper cause. When massive bleeding or repeated occurrence is involved, a sufferer should seek medical care. In such cases, a doctor will assess the condition based on its origin: Is the cause of the nosebleed local or systemic?

Local Causes

Simple trauma, inflammatory reactions, anatomic deformities, and intranasal tumors are the most common local — those that affect only the nose — causes of epistaxis. Simple and direct trauma, such as a blow to the nose, often elicits immediate bleeding and thankfully this most often occurs in the under 10 population. Another common cause of nose bleeds in children, especially during the winter months, is irritation, usually by a finger or small object, to the nasal septum (the cartilage that divides left and right airways of the nose).

Another source of epistaxis, common among adults as well as children, is the improper use of topical nasal sprays; repeated trauma to the surface cells of the nasal septum from sprays consistently directed toward the same area of the nose can cause intermittent epistaxis. Simple instruction to direct the spray away from the midline septum can alleviate this problem.

Septal deflections, bony spurs, and fractures are the most common anatomic deformities that will predispose a patient to epistaxis. Intranasal masses, including aneurysms, encephaloceles, hemangiomas, and adenocarcinomas, may also give rise to nosebleeds. In particular, juvenile nasopharyngeal angiofibroma, though benign, is a locally aggressive vascular tumor that most commonly affects adolescent boys. Growing in the back of the nasal cavity, such tumors often cause one-sided nasal obstruction and recurrent bleeding.

Finally, postsurgical nosebleeds are often caused by the use of nasal cannula (a device used to deliver supplemental oxygen or airflow to a patient or person in need of respiratory help).

Systemic causes

The most common systemic — those that affect the entire physical system or body — causes of epistaxis include hypertension, aberrations in clotting ability, inherited bleeding tendencies, and vascular/cardiovascular diseases.

Although a complete understanding of the relationship between hypertension and epistaxis is frequently debated, they are associated; in cases of severe or resistant to ending epistaxis, hypertension is the most common related issue. Both medication-induced clotting aberrations and liver dysfunction are common systemic factors influencing epistaxis. Medications commonly associated with epistaxis are aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs, and warfarin. Chronic alcoholism and renal dysfunction can also cause platelet dysfunction and result in an inability to form clots.

Of the inherited bleeding disorders associated with epistaxis, the most common are hemophilia A, hemophilia B, and von Willebrand disease. Inheritance of these disorders is sex-linked; only males are affected. Finally, vascular and cardiovascular diseases such as congestive heart failure, arteriosclerosis, and collagen abnormalities may also cause nosebleeds.

Doctors manage nosebleeds through medical therapy, conservative therapy, and arterial embolization.


Most cases of epistaxis are not only minor but also manageable; they require only that you sit down, breathe through your mouth, lean back your head, and pinch the soft part of your nose. Sometimes nasal irrigation with saline or topical ointments might be necessary to create a humidified nasal environment that will prevent further episodes. If bleeding persists, a topical nasal decongestant is often used. In unusual cases, a doctor may recommend medical therapy, which involves identifying and correcting the cause directly. For instance, in the case of hypertension and other causes stemming directly from the blood, a doctor will work to correct the underlying condition, usually by prescribing medication. Once the hypertension is corrected, any newly occurring nosebleeds will in all likelihood be alleviated in the usual manner of gently pinching the nostrils.

Conservative therapy includes cautery and nasal packing. Nasal cautery is currently performed with chemicals or controlled temperature. Nasal packs may be either anterior (at the front of the nose) or posterior (at the back). Depending on where the bleeding begins or if blood slides down the back of the nose and worsens after application of an anterior pack, the first method, an additional posterior pack may be required. Posterior packs sometimes include balloon structures and Foley-type catheters.

Surgical therapy for epistaxis has largely been supplanted by the use of arterial embolization, which is performed by interventional radiologists. This relatively new technique involves performing diagnostic angiograms to assess the vascular anatomy. Brisk bleeds will show up as blushes and can be selectively embolized where the radiologist injects special materials that form a blockage to close off (occlude) the blood supply.

In conclusion, epistaxis or the common nosebleed may look frightening and may even cause a terrible mess, but most of the time it will end quickly if you sit down, breathe through your mouth, lean your head back, and pinch your nostrils. If you are still bleeding after 15 minutes or if a massive amount of blood flows, seek medical care immediately from your physician or an emergency room.

Sources: Nwaorgu OGB. Epistaxis: An Overview. Annals of Ibadan Postgraduate Medicine. 2004.

Fatakia A, Winters R, Amedee RG. Epistaxis: A Common Problem. The Ochsner Journal. 2010.

Kucik CJ, Clenney T. Source: Management of Epistaxis. American Family Physician. 2005.