Nosebleeds-Why is the nose prone to bleeding?

The nose has many blood vessels in it to help warm and humidify the air you breathe. These vessels lie close to the surface, making them easy to injure.

Are nosebleeds serious?

A few nosebleeds stem from large vessels in the back of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, atherosclerosis, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed.

You’ll need to get medical attention if a nosebleed goes on for more than 20 minutes or if it occurs after an injury (such as a fall or a punch in the face), especially if you think you may have a broken nose. A nosebleed after a fall or car accident could be a sign of internal bleeding.

Frequent nosebleeds may mean you have a more serious problem. For example, nosebleeds and bruising can be early signs of leukemia. Nosebleeds can also be a sign of a blood clotting or blood vessel disorder, or a nasal tumor (both cancerous and non-cancerous).

Causes & Risk Factors

What causes nosebleeds?

The most common causes are dryness (often caused by indoor heat in the winter) and nose picking. These 2 things work together — nose picking occurs more often when mucus in the nose is dry and crusty.

Other, less common, causes include injuries, colds, allergies or cocaine use. Children may stick small objects up the nose. Older people may have atherosclerosis (which is the hardening of the arteries), infections, high blood pressure and blood clotting disorders, or they may be taking drugs that interfere with blood clotting, such as aspirin. A rare cause of frequent nosebleeds is a disorder called hereditary hemorrhagic telangiectasia (HHT). Sometimes, the cause of nosebleeds can’t be determined.

Treatment

What should I do when I get a nosebleed?

A nosebleed can be scary to get — or see — but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will slow the bleeding. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can irritate your stomach.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don’t let go for at least 5 minutes. If it’s still bleeding, hold it again for another 5 to 10 minutes.

Once the bleeding stops, don’t do anything that may make it start again, such as bending over or blowing your nose.

See your doctor if:

• The bleeding goes on for more than 20 minutes.
• The bleeding was caused by an injury, such as a fall or something hitting your face.
• You get nosebleeds often.

What will my doctor do for a nosebleed?

Your doctor will try to find out where the bleeding is coming from in your nose. He or she will probably ask you some questions and examine your nose. If the bleeding doesn’t stop on its own or when pressure is applied, your doctor may cauterize the bleeding vessel or pack your nose to stop the bleeding.

Cauterizationinvolves using a special solution called silver nitrate or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.

Packing the noseinvolves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding.

Prevention

Tips on preventing nosebleeds

• Keep children’s fingernails short to discourage nose picking.
• Counteract the drying effects of indoor heated air by using a humidifier at night in your bedroom.
• Quit smoking. Smoking dries out your nose and also irritates it.
• Open your mouth when you sneeze.

Questions to Ask Your Doctor

• I get a lot of nosebleeds. What can I do to stop them?
• How long should I wait to call the doctor if I’m having a nosebleed?
• I’m around secondhand smoke a lot. Could that be causing my nosebleeds?
• Are nosebleeds more common in winter?
• What can I do to prevent my child from picking his/her nose?
• Could my nosebleeds be a sign of a separate disease?

Follow these instructions at home:

When you have a nosebleed:

• Sit down.
• Tilt your head a little forward.
• Follow these steps:
  • Pinch your nose with a clean towel or tissue.
  • Keep pinching your nose for 10 minutes. Do not let go.
  • After 10 minutes, let go of your nose.
  • If there is still bleeding, do these steps again. Keep doing these steps until the bleeding stops.
• Do not put things in your nose to stop the bleeding.
• Try not to lie down or put your head back.
• Use a nose spray decongestant as told by your doctor.
• Do not use petroleum jelly or mineral oil in your nose. These things can get into your lungs.

After a nosebleed:

• Try not to blow your nose or sniffle for several hours.
• Try not to strain, lift, or bend at the waist for several days.
• Use saline spray or a humidifier as told by your doctor.
• Aspirin and blood-thinning medicines make bleeding more likely. If you take these medicines, ask your doctor if you should stop taking them, or if you should change how much you take. Do not stop taking the medicine unless your doctor tells you to.

Contact a doctor if:

• You have a fever.
• You get nosebleeds often.
• You are getting nosebleeds more often than usual.
• You bruise very easily.
• You have something stuck in your nose.
• You have bleeding in your mouth.
• You throw up (vomit) or cough up brown material.
• You get a nosebleed after you start a new medicine.

Get help right away if:

• You have a nosebleed after you fall or hurt your head.
• Your nosebleed does not go away after 20 minutes.
• You feel dizzy or weak.
• You have unusual bleeding from other parts of your body.
• You have unusual bruising on other parts of your body.
• You get sweaty.
• You throw up blood.

Summary

• Nosebleeds are common. They are usually not a sign of a serious medical problem.
• When you have a nosebleed, sit down and tilt your head a little forward. Pinch your nose with a clean tissue.
• After the bleeding stops, try not to blow your nose or sniffle for several hours.