Nosebleeds (Epistaxis) in Cats

What Is Epistaxis (a Nosebleed) in Cats?

Epistaxis is more commonly known as a nosebleed. When a cat has a nosebleed, the bleeding can be coming from within the nostril, in the nasal cavity, or further up in the part of the throat behind the nose (nasopharynx).

In some cases, the nosebleed is caused by blood vessels in the nasal passage and sinuses breaking because of injury or pressure. If the cat has eaten rat bait or a rodent who recently ate rat bait, this can affect the cat’s blood clotting, which may also result in nosebleeds. In some cases, nosebleeds occur as tumors grow into blood vessels, causing them to break.

Nosebleeds are not common in cats. While they can be scary for pet parents, they usually aren’t immediately life-threatening for your cat. But you should definitely get them checked by a veterinarian if you're noticing any nosebleeds without a known cause.

Why Is My Cat’s Nose Bleeding?

It’s important to know that most sudden nosebleeds are not serious. However, there are some potential causes that may be more serious, and some may require immediate treatment. A cat could be suffering from a nosebleed due to:

• Trauma (such as a fall, being hit by a car, or a fight with other animals)

• Upper respiratory tract infections (URIs)

• Fungal infections in the nose

• Foreign object in the nose

• Toxins that affect clotting, such as rat poison

• Tumors in the nose

• Liver failure, which means the liver doesn’t produce enough clotting factors

• Dental disease (tooth roots are very close to the sinuses)

If your cat needs immediate attention, seek care with an emergency veterinarian.

What To Do if Your Cat’s Nose Is Bleeding

• Remain calm­. Your cat may be in tune with your anxiety, and stress can make any injuries worse and may increase bleeding.

• Use an ice pack on the bridge of the nose. Make sure to keep a cloth between the cat’s face and the ice pack. Blood vessels constrict (shrink) in the cold, which may help to slow bleeding.

• Do not put anything in the nose or give medications unless told to do so by your veterinarian. You can use tissue or a cloth to catch bleeding as it comes out, but you should not stick these items up your cat’s nose.

Seek veterinary attention right away if the bleeding doesn’t stop or if your cat:

• Is struggling to breathe

• Has obvious injuries

• Recently got into rat bait or recently ate a rodent

• Is acting oddly or inappropriate (different than usual)

Keep in mind that your cat’s nose can drain down their throat. They will likely swallow blood if the nosebleed is heavy, which might cause your cat to vomit blood clots or to have dark stool (melena) due to digested blood.

Treatment of Nosebleeds in Cats

If the cat’s nosebleed stops on its own at home, it’s still a good idea to call your veterinarian to discuss the episode and make an appointment to rule out underlying conditions.

If your cat needs immediate attention, seek care with an emergency veterinarian. Once you’re at the veterinary office, the veterinarian will do a physical examination. If your cat is still bleeding but seems otherwise healthy, the veterinarian may lightly sedate the cat to calm them, place ice on the nose, or put a small amount of epinephrine in the nose to help constrict blood vessels.

Further treatment will be based on the underlying cause. To find the cause, the veterinarian may do routine blood and urine testing, X-rays of the head, a sedated nasal examination, cultures for bacterial infections, testing for fungal infections, or computed tomography (CT) scans of the head.

Nosebleed Related to Trauma

If your cat had some sort of trauma causing the nosebleed, the veterinarian will likely focus on pain management and treating any other injuries, such as wounds or fractures. Pain management can include medications like meloxicam or buprenorphine.

Nosebleed Related to Infection or Fungus

If an upper respiratory infection is causing the nosebleed, your cat will likely have a secondary bacterial infection. Antibiotics such as doxycycline or azithromycin will be prescribed to treat the infection.

Funguses that can affect the nose, such as cryptococcosis, are usually treated for a few months with medications like fluconazole or itraconazole. For severe cases, amphotericin B may be recommended in the early stages of treatment. Surgery may be recommended to remove fungal lesions in the nose or on the bridge of the nose. In some cases, antifungals are put directly inside the nose.

Nosebleed Related to Foreign Object or Toxin

If the veterinarian thinks there is a foreign object in the nose, they may use a small scope or camera to find the object. They may also rinse out the nasal passages, while the cat has a tube in its trachea to protect the airway.

Cats who ate rat poison or possibly ate a rodent who recently ate rat bait will need to be hospitalized. Vitamin K1 will be given to prevent bleeding. Some cats who have eaten rat poison will have bleeding so severe they need blood transfusions.

Nosebleed Related to Tumor

Tumors in the nose typically need specialized care. Nasal tumors are usually diagnosed through CT scans, and a tissue sample can be used to figure out the type of tumor. In cats, the most common nasal tumor is nasal lymphoma, but nasal adenocarcinoma can also occur. Treatment options may include chemotherapy or radiation therapy. Surgical removal of the tumor is usually not successful.

Nosebleed Related to Liver Failure

Cats with liver failure that is severe enough to cause loss of clotting factors are usually very sick and do not recover. Huamne euthanasia may be recommended. If you and your veterinarian decide to pursue treatment, treatment recommendations would depend on what is causing the liver failure. Management in this case can include:

• Nutritional support (feeding tube)

• Blood transfusions

• Intravenous (IV) fluids

• Medications like maropitant citrate to reduce vomiting

• Appetite stimulants like mirtazapine

• Pain medications like buprenorphine

• Lactulose to reduce ammonia absorption (which is increased in liver failure)

• Antibiotics to kill bacteria causing infection in the liver

• Supplements like S-adenosylmethionine (SAMe) or silybin, which help support the liver

Surgical cauterization (closure of the wound) may be needed if the bleeding is recurrent or will not stop.

Although nosebleeds often take pet parents by surprise, they can usually be managed with the help of a veterinarian. If your cat is having nosebleeds, contact a veterinarian to find out if your cat’s particular case needs immediate care.