Causes & management of early morning nosebleed in adult - Dr. Sreenivasa Murthy T M

In adults early morning bleeding is usually secondary to sudden increase in blood pressure, so the patient will be generally known hypertensive and taking medication or they may be hypertensive and not at all taking any medications, their first presentation would be bleeding in the nose. We can also see this in adults who are on blood finners or taking anticoagulants for various other ailments in the body. Now other age group in whom we can see early morning bleeding which usually happens between 3-5 am in elderly age or middle age man like early 60's and late 50's who have high blood pressure who are on medication, their B.P. tends o be high early in the morning 3-5 am and can start bleeding in the nose, these people can be bleeding torrentially meaning volumes exceeding 50 ml of blood. In the elders or adult age if they have bleeding we should check whether it is from the front part or the back part of the nose, in elders back part of the nose bleeds commonly arising from one of the branches from the main blood supply of the nose called sphenopalatine artery and in these patients since the blood loss can be on high volumes and torrential, they may lead to some intervention either in the form of packing initially so that they can get control over bleeding to appropriate anti-hypertensives, some rest and then removal of the pack after 24 hours. If it doesn't reoccur then control of blood pressure alone would be sufficient. Few unfortunate people tend to bleed frequently, they may bleed 3rd day, 4th day or every week to such people we offer surgical procedure endoscopic sphenopalatine artery ligation as the artery can be easily accessed through an endoscope and this can be clipped and the success rate of this surgery is very good in these patients.