​Epistaxis (Nosebleed)


Epistaxis or nosebleed as it is commonly known is a disorder of the nose, whereby you experience bleeding from inside the nose. The purpose of the nose is to warm and humidify the air we breathe in, and it is lined with many blood vessels to help fulfil this purpose. Nosebleeds occur when one of these blood vessels within the nose burst, leading to bleeding from the nose. A nose bleed may seem frightening to many, but is rarely life-threatening and stops on its own in most cases. However, frequent or severe nosebleed that does not stop after a few minutes needs to be evaluated by an ENT (Eye-Nose-Throat) specialist.

Epistaxis is more common among children and older people. Common causes of nosebleeds include dry, heated indoor air or hot, low-humidity climates which dry out the mucus membranes and nasal linings. Besides that, cold, sinusitis or allergic nasal disorders, such as rhinitis, can also cause nosebleeds as you may frequently sneeze, cough and blow your nose due to these disorders. Similarly, vigorous blowing or rubbing of the nose, injury to the nose or the face and inserting foreign objects into the nose may also cause nosebleeds by damaging the blood vessels in the nose.

Other causes of epistaxis include the use of blood-thinning medications, such aspirin, high blood pressure, allergy to certain chemical substance, such as industrial chemicals, having a deviated nasal septum, facial or nasal surgery, frequent use of nasal sprays and nasal polyps. Contrary to the common misconception, nosebleeds are not a symptom of high blood pressure, though having high blood pressure can aggravate this condition. 

There are two types of nosebleeds – anterior (front) and posterior (back). If you suffer from anterior nosebleeds, blood will drip out from the nostrils. In posterior nosebleeds, blood will drip down the throat through the nose. Anterior nosebleeds are scarier for patients, and affect children more. Posterior nosebleeds are more common among older people whose blood vessels become hardened and break.

The most obvious symptom of a nosebleed is blood oozing out of the nose. In some cases, blood may even flow down the throat. General symptoms of epistaxis are:

  • Bleeding from one nostril.

  • In case of heavy nosebleeds, blood may fill up both nostrils, eventually leading to bleeding from both nostrils.

  • Spitting or vomiting blood in cases of posterior nosebleeds when blood flows down the throat.

  • Dizziness and confusion.

  • Weakness in case of significant blood loss.

These symptoms of a nosebleed usually subside within twenty to thirty minutes. In case symptoms persist longer than that without any lessening of the blood flow, you must consult an ENT specialist at The Aga Khan University Hospital.

Nosebleeds or epistaxis, though scary, is rarely a very serious condition and bleeding usually stops on its own. However, if you experience severe bleeding, no improvement in symptoms after about 30 minutes, or severe dizziness and fainting, you must see your doctor immediately. 

You must also see a doctor if a nosebleed occurs after injury to the head or face, your breathing is affected because of it or if it occurs in a child younger than two years. If you have frequent nosebleeds, it is also important to get your symptoms assessed by an ENT specialist to diagnose the cause of repeated episodes of epistaxis.

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

The team of ENT doctors working with the Eye and ENT Service Line at The Aga Khan University Hospital use the necessary techniques in a safe and secure environment to thoroughly evaluate and diagnose our patients.

A complete medical history of your symptoms and frequency of occurrence, as well as a thorough physical examination using a lighted scope for the nose will help your doctor make a diagnosis about the cause of epistaxis for you. Imaging tests, such as CT (Computerized Tomography) scans, as well as lab tests, such as blood tests and allergy tests may also be conducted.

At-home care can be useful in stopping nosebleeds when you face one. For instance, sitting upright reduces blood pressure in your nose, discouraging bleeding from the nose. You can also blow your nose very gently to clear up clotted blood, and pinch your nose to put pressure on the particular bleeding point. You will need to breathe through the mouth to allow this. This will help the bleeding subside. Once bleeding has stopped, you must avoid bending down or blowing your nose very hard for a few hours to avoid repeated nosebleeds. You should also avoid rubbing or picking your nose for a few days.

Saline sprays, nasal decongestants and nasal ointments help nosebleeds to subside as well. In very serious cases, your ENT doctor may recommend surgery to remove nasal masses causing chronic nosebleeds. If your doctor suspects another underlying disorder which could be causing nosebleeds, you may be referred to the Laboratory Services or other specialists for the diagnosis and treatment of your underlying condition.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.




The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.