Epistaxis, more commonly known as nosebleeds, is a frequent occurrence affecting people of all ages. Studies indicate that around 60% of the population will experience at least one nosebleed in their lifetime, with a smaller percentage requiring medical intervention. Nosebleeds can be classified into two types: anterior, which originates from the front part of the nose and is more common, and posterior, which occurs deeper within the nasal cavity and is less frequent but often more severe.

Why Nosebleeds Happen
Several factors contribute to the occurrence of nosebleeds. One of the primary causes is dry air, which can lead to the drying out and cracking of the mucosa lining inside the nose. This lining is rich with blood vessels, particularly in an area known as Little’s area or Kiesselbach's plexus, where numerous small arteries converge. When the mucosa dries out and cracks, these delicate blood vessels become exposed and can easily rupture, leading to a nosebleed.

Nasal trauma is another common cause of nosebleeds. This can include anything from a minor bump to the nose to more significant injuries. Severe trauma often affects the anterior ethmoid artery, a major blood vessel that supplies the nasal cavity via the eyeball.

Additionally, tumours within the nasal cavity, although less common, can also cause nosebleeds. These growths can exert pressure on the surrounding tissues and blood vessels, leading to recurrent bleeding. While benign tumours are more common, it is essential to rule out malignancy in cases of persistent or unusual nosebleeds.

Impact of High Blood Pressure and Anticoagulants
It's a common misconception that high blood pressure directly causes nosebleeds. However, while high blood pressure does not initiate nosebleeds, it can certainly exacerbate them. Individuals with elevated blood pressure may experience more severe bleeding when a nosebleed occurs, making it harder to control. Similarly, anticoagulant medications, which are prescribed to prevent blood clots, do not cause nosebleeds. Nevertheless, they do impair the blood's ability to clot, resulting in prolonged and sometimes more intense bleeding episodes when a nosebleed does occur.

Treatment of Nosebleeds
Treating nosebleeds depends on their severity and underlying cause. For minor nosebleeds, applying direct pressure to the nostrils, leaning forward slightly to prevent swallowing blood, and sucking on ice (freezing the roof of the mouth and reducing the flow of blood to the nose there) may help stop the bleeding. For those who experience frequent or severe nosebleeds, more advanced treatments may be necessary.

One effective treatment is nasal cauterisation, which involves using a chemical or electric device to burn the bleeding blood vessel, thereby sealing it off. This procedure is often performed under local anaesthesia and is highly effective for recurrent nosebleeds originating from a specific site.

For individuals with more severe nose bleeds, surgical intervention may be required. In cases where medical treatment fails to control severe nosebleeds, arterial ligation or embolization may be considered. These procedures involve either tying off or blocking the blood vessels supplying the nasal cavity, thus reducing the risk of recurrent bleeding.

The National Institute for Health and Care Excellence (NICE) guidelines recommend a stepwise approach to the management of nosebleeds, starting with conservative measures and progressing to more invasive interventions if necessary. These guidelines emphasise the importance of identifying and addressing any underlying causes, such as nasal masses or tumours, to provide a comprehensive and effective treatment plan.

Professor Vik Veer, a leading expert in ENT surgery, can provide personalised advice and treatment options for individuals experiencing frequent or severe nosebleeds. By understanding the causes and appropriate treatments for epistaxis, patients can make informed decisions about their care and improve their quality of life.

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