Epistaxis in Sport

Epistaxis is bleeding from the nose, common in sport after a direct blow to the face in contact and collision sports such as rugby, football, boxing and martial arts, and sometimes spontaneous.

Most bleeds come from the front of the nose and stop with correct first aid: lean forward and pinch the soft part of the nose. The sport and exercise medicine (SEM) clinician controls the bleed, recognises the minority that need cautery, packing or referral, looks for a septal haematoma, and assesses for facial fracture and head injury before return to play.

Most nosebleeds arise at the front of the nasal septum from Little's area, which contains Kiesselbach's plexus. These anterior bleeds are the common type in sport, are usually visible from the front and are generally controlled by pressure.

Posterior bleeds arise further back from larger vessels around the sphenopalatine artery. They tend to bleed more heavily, run down the throat and are harder to see and control. They are more common in older, hypertensive or anticoagulated people, so more often need specialist care.

Contributing factors:

• •Direct trauma, the usual cause in sport
• •Nose picking, blowing the nose too hard, and dry or cold air
• •Anticoagulant or antiplatelet medication, or a bleeding disorder
• •High blood pressure, associated with persistent or severe bleeding rather than a proven direct cause