Dr. Tariq Jagnarine
Family Medicine, Endocrinology/ Diabetes
Nosebleeds are common. They may be scary, but they rarely indicate a serious medical problem. The nose contains many blood vessels, which are located close to the surface in the front and back of the nose. They’re very fragile and bleed easily. Nosebleeds are common in adults and children between the ages of 3 and 10.
There are two kinds of nosebleeds. An anterior nosebleed occurs when the blood vessels in the front of the nose break and bleed.
A posterior nosebleed occurs in the back or the deepest part of the nose. In this case, blood flows down the back of the throat. Posterior nosebleeds can be dangerous.
CAUSES OF NOSEBLEEDS
There are many causes of nosebleeds. A sudden or infrequent nosebleed is rarely serious. If persons have frequent nosebleeds, they could have a more serious problem.
• Dry air is the most common cause of nosebleeds. Living in a dry climate and using a central heating system can dry out the nasal membranes, which are tissues inside the nose.
This dryness causes crusting inside the nose. Crusting may itch or become irritated. If the nose is scratched or picked, it can bleed.
• Taking antihistamines and decongestants for allergies, colds, or sinus problems can also dry out the nasal membranes and cause nosebleeds. Frequent nose blowing is another cause of nosebleeds.
Other common causes of nosebleeds include:
• Foreign object stuck in the nose
• Chemical irritants
• Allergic reaction
• Injury to the nose
• Repeated sneezing
• Picking the nose
• Cold air
• Upper respiratory infection
• Large doses of aspirin
Other causes of nosebleeds include:
• High blood pressure
• Bleeding disorders
• Blood clotting disorders
• Cancer
Most nosebleeds don’t require medical attention. However, persons should seek medical attention if their nosebleed lasts longer than 20 minutes, or if it occurs after an injury. This may be a sign of a posterior nosebleed, which is more serious.
Injuries that might cause a nosebleed include a fall, a car accident, or a punch in the face. Nosebleeds that occur after an injury may indicate a broken nose, skull fracture, or internal bleeding.
DIAGNOSING A NOSEBLEED
If persons are seeking medical attention for a nosebleed, their doctor will conduct a physical examination to determine the cause. They’ll check the nose for signs of a foreign object. They’ll also ask questions about your medical history and current medications.
Tell doctors about any other symptoms and any recent injuries. There’s no single test to determine the cause of a nosebleed. However, doctors might use diagnostic tests to find the cause. These tests include:
• Complete blood count (CBC), which is a blood test to check for blood disorders
• Partial thromboplastin time (PTT), which is a blood test that checks how long it takes for your blood to clot
• Nasal endoscopy
• CT scan of the nose
• X-ray of the face and nose
TREATMENT
Treatment for nosebleeds will vary depending on the type and cause of the nosebleed.
• Anterior nosebleed
If persons are having an anterior nosebleed, they bleed from the front of their nose, usually the nostril. This can be treated at home. While sitting up, squeeze the soft part of the nose.
Make sure that the nostrils are fully closed. Keep the nostrils closed for 10 minutes, lean forward slightly, and breathe through the mouth.
Don’t lie down when trying to stop a nosebleed. Lying down can result in swallowing blood and can irritate the stomach. Release the nostrils after 10 minutes and check to see if the bleeding has stopped. Repeat these steps if bleeding continues.
Persons can also apply a cold compress over the bridge of their nose or use a nasal spray decongestant to close off the small blood vessels.
See a doctor immediately if persons are unable to stop a nosebleed on their own. They might have a posterior nosebleed that requires more invasive treatment.
• Posterior nosebleed
If persons have a posterior nosebleed, they bleed from the back of their nose. The blood also tends to flow from the back of their nose down their throat. Posterior nosebleeds are less common and often more serious than anterior nosebleeds.
Posterior nosebleeds shouldn’t be treated at home. Contact a doctor immediately or go to the emergency room in case of a suspected posterior nosebleed.
• Nosebleeds caused by foreign objects
If a foreign object is a cause, the doctor can remove the object.
• Cauterization
A medical technique called cauterization can also stop persistent or frequent nosebleeds. This involves the doctor burning the blood vessels in the nose with either a heating device or silver nitrate, a compound used to remove tissue.
Doctors may pack the nose with cotton, gauze, or foam. They may also use a balloon catheter to apply pressure to the blood vessels and stop the bleeding.
PREVENTION
There are several ways to prevent nosebleeds.
• Use a humidifier in your house to keep the air moist.
• Avoid picking the nose.
• Limit the intake of aspirin, which can thin the blood and contribute to nosebleeds. Discuss this with a doctor first because the benefits of taking aspirin might outweigh the risks.
• Use antihistamines and decongestants in moderation. These can dry out the nose.
1. Use a saline spray or gel to keep the nasal passages moist.
Nosebleeds are common and not usually serious. Most are anterior nosebleeds and can often be treated at home. These usually occur suddenly and don’t last long.
