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Nose Bleeds

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Nosebleeds

In the United States, one in every seven people will develop a nosebleed some time in their lifetime.

The nose contains many blood vessels that lie on the surface of the nasal lining at the front of the nose. Since this is an active area, from breathing, nose blowing and inflammation, these vessels can easily be injured. Nosebleeds can occur at any age at any time, but are most common in children ages 2 through 10 and adults ages 50 through 80.

Nosebleeds occur more frequently during allergy season, in the winter when the weather is very dry, and when you are taking blood thinners such as aspirin or Advil.

Nosebleed Causes:

There are many different causes of nosebleeds, including:

  • Allergies
  • Infections
  • Dryness from low humidity or high elevation
  • Vigorous nose blowing or nose picking
  • Bleeding and clotting disorders
  • Nasal injury
  • Medications that thin the blood, like aspirin or coumadin

Nosebleed Symptoms:

Nosebleeds usually occur from only one nostril. If the bleeding is heavy, the blood can overflow within the nasopharynx (the area where the two nostrils merge in the back of the nose), spilling into the other nostril making it seem as though there is bleeding from both nostrils. Blood can also drip into the back of the throat or down to the stomach, causing hemoptysis (bloody mucous or vomit). Lightheaded and weakness occurs from excessive bleeding.

Nosebleed Treatments:

Acute nosebleeds respond very well to the following treatment:

  1. Spray Afrin (or an equivalent spray with oxymetazoline) in your nose immediately. This medication causes blood vessels to squeeze closed.
  2. Hold your nose on the soft part, pressing your nostrils together tightly so you must breathe out of your mouth. Do this consistently for several minutes.
  3. Your head position determines the flow of blood, so if you lay down, you may swallow blood. If you sit forward the blood will come out of your nose or mouth.
  4. When the nosebleed stops, avoid putting ANYTHING inside your nose for 2-3 days. This includes tissues or fingers.
  5. You can place a small amount of neosporin or spray Afrin in your nostrils several times a day for a few days to prevent your nose from bleeding again.

If you have active or frequent bleeding you may benefit from cauterization of the bleeding site in the office. This is done using a chemical called silver nitrate, which burns the tissue and creates a temporary seal. There are also medications and injectable substances that can be used to constrict the blood vessels or improve clotting.

Another treatment for nosebleeds is nasal packing with a large sponge or balloon. It is placed deep inside the nose and left in place for 1 to 3 days. Oral antibiotics are also given to prevent toxic shock syndrome. This method is very uncomfortable, and is only necessary in extreme cases, when other methods are not sufficient.

While the vast majority of nosebleeds are controlled with the above procedures, severe or recurrent bleeding may require surgical treatment. Surgical procedures may include radiofrequency cauterization, septoplasty, arterial ligation and embolization.

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Linda D. Dahl, MD