Epistaxis (or nose bleeds)


Nose bleeds are quite common. The majority of nose bleeds are idiopathic; that is to say we do not know the cause. But that is alright as long as the cause has been sought for, and importantcauses excluded.

The majority of nose bleeds occur in the front of the nose called the septum and turbinates. There are a variety of reasons for nose bleeds:

  • Nose picking habit
  • Nasal allergy that increases the inflammation of the nose
  • Distorted nasal anatomy like a deviated nasal septum
  • Surgery or major trauma to the nose
  • Tumors and growths (these do not generally cause frank nose bleeds but rather blood-stained nasal discharge)
  • Blood thinning medication usually taken for stroke prevention and hypertension

Nose bleeds are more common in extreme weather conditions and during rapid weather changes especially when the air gets both colder and drier quickly.

Trivia: Why does cold and drier air makes the nose to bleed more?


How to stop a nose bleed

Lean forward, open the mouth to breathe and apply firm pressure to the soft lower third of the nose (essentially squeeze the bottom half of the nose together so you cannot breathe through the nose at all). By doing this, you are applying firm pressure to Little’s area (the area where the little finger can touch inside the nose and where Keisselbach’s plexus of blood vessels confluence) and where the majority of nose bleeds occur.

Trivia: Why is Little’s area named as such?


By tipping your head forward and down by at least 20 degrees, blood will not run back down to the throat and make you cough and splutter. Also you will be fully aware of any continuing bleeding and the amount of blood loss.

Trivia: What anatomical reason requires us to tip the head forward by 20 degrees? Why not just sit straight?


Hold this for 20 minutes (normal blood will coagulate after 5 minutes and holding longer gives it a margin of security). If available, suck an ice cube as well.

Trivia: How does sucking ice help?



If you are taking blood-thinning drugs like Warfarin, Aspirin, Plavix, Pradaxa, etc., you will need to continue pressing for longer.

If the bleeding persists, especially down the back of the throat, then the bleeding area is most likely at the back of the nose. In this case, an Ear, Nose & Throat Specialist or hospital care should be sought immediately, as the bleeding is less likely to be controlled by your own applied pressure in the front, and may recur later. Bleeding from the back of the nose also tends to be more profuse as the bleeding points are nearer the feeding arteries with a higher pressure.

After the bleeding has been arrested, an endoscopic nasal inspection would be advised especially if this has been a recurrent event.

Bleeding vessel on the left nose

Bleeding vessel sealed in a 10-minute office procedure

After 3 weeks. No further epistaxis there after




















The information on this website is for general educational purpose only.
Readers should consult their physician before considering treatment, and should not interpret their condition solely based on the information above.