The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface where they can be injured and bleed. Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are. Many can be treated at home, but some do require medical care.
Common causes of nosebleeds include:
- Dry, heated, indoor air, which dries out the nasal membranes and causes them to become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
- Dry, hot, low-humidity climates, which can dry out the mucus membranes
- Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
- Vigorous nose blowing or nose picking
- The insertion of a foreign object into the nose
- Injury to the nose and/or face
- Allergic and non-allergic rhinitis (inflammation of the nasal lining)
- Use of drugs that thin the blood (aspirin, non-steroidal anti-inflammatory medications, warfarin, and others)
- High blood pressure
- Chemical irritants (e.g., cocaine, industrial chemicals, others)
- Deviated septum (an abnormal shape of the structure that separates the two sides of the nose)
- Tumors or inherited bleeding disorders (rare)
- Facial and nasal surgery
When should I seek physician or emergency care?
Seek medical care through your physician or an emergency room if:
- You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure.
- The bleeding is rapid or the blood loss is large (exceeds a coffee cupful).
- The bleeding was caused by an injury, such as a fall or other blow to the nose or face.
- You feel weak or faint.
- The blood goes down the back of your throat rather than out front through the nose even though you are sitting down with body and head leaning slightly forward. (This may indicate the rarer, but more serious, “posterior nosebleed,” which almost always requires a physician’s care. This condition occurs more frequently in older people and individuals with high blood pressure).
How might an ER doctor treat the nosebleed?
The doctor will ask you questions about your nosebleed and examine your nose to try to determine the source of the nosebleed. He or she will use a small speculum to hold the nose open and can use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but need not be painful. Occasionally x-rays or blood tests are ordered.
Treatments, depending on the cause, could include:
- Cauterization – the application of a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
- Nasal packing – the placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used.
- Medication adjustments – reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.
- Foreign body removal
- Repair of nasal fracture
- Correction of a deviated septum
Are there any steps I can take to prevent nosebleeds?
- Use a saline nasal spray or saline nose drops two to three times a day in each nostril. These products can be purchased over-the-counter or made at home. (To make the saline solution at home: mix 1 teaspoon of salt into 1 quart of tap water. Boil water for 20 minutes, cool until lukewarm.)
- Add a humidifier to your furnace or run a humidifier in your bedroom at night.
- Place water-soluble nasal gels or ointments in your nostrils with a cotton swab. Bacitracin®, Vaseline®, or Ayr Gel®are examples of over-the-counter ointments that you can use. Be sure not to insert the swab more than ¼ inch into your nose. These gels and ointments can be purchased in most pharmacies.
- Avoid blowing your nose too forcefully, but you may choose to blow your nose after using nasal saline sprays or drops.
- Sneeze through an open mouth.
- Avoid putting anything solid into your nose, including fingers and cotton applicators.
- Limit your use of medications that can increase bleeding, such as aspirin and ibuprofen. Please remember that any adjustment to medication, especially prescribed medication such as warfarin (Coumadin®), and non-steroidal anti-inflammatory drugs (NSAIDs), should only be done under your physician’s supervision.
- See your doctor if your nasal allergy symptoms are not easily controlled with over-the-counter or prescription medications.
- Quit smoking. Smoking dries out your nose and irritates it.
If you have any questions or concerns, do not hesitate to call your physician.
- American Academy of Otolaryngology—Head and Neck Surgery. Nosebleeds Accessed 2/12/2015.
- American Academy of Rhinology. Epistaxis (Nosebleeds) Accessed 2/12/2015.
- Friedman NR, Scholes MA, Yoon PJ. Ear, Nose, & Throat. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013. library.ccf.org Accessed 2/12/ 2015.
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