Nosebleeds

Most nosebleeds are not serious and can be handled fairly easily. However, some are serious and require medical attention.

Nosebleeds are more common during the winter months and in dry, cold climates. They are more common in children aged 2-10 years and in adults 50-80 years.

Causes of Nosebleeds

Most (90%) nosebleeds come from the anterior or front part of the nasal septum. The septum is the middle divider of the nose. Most anterior nosebleeds are easy to control either at home or by a doctor.

Posterior nosebleeds are uncommon and occur more frequently in the elderly. The bleeding usually comes from an artery in the back of the nose and flows down the back of the throat. These nosebleeds are often more complicated and require treatment by a doctor.

Nosebleeds are caused most commonly by trauma such as a blow to the outside of the nose or trauma to the inside of the nose, such as nose picking and vigorous noseblowing. Repeated irritation from a cold can also cause a nosebleed. High blood pressure may contribute to bleeding but is usually not the only reason for a nosebleed. Blood thinners such as aspirin, Plavix and warfarin (Coumadin) may contribute to the bleeding because of the inability of the blood to clot. Rarely, abnormal blood vessels or tumors (cancerous and non-cancerous) may cause nosebleeds.

What to do after the bleeding has stopped

• Do not pick or blow your nose for the next 24 hours.
• Do not strain, bend down or lift anything heavy.
• Elevate your head above the level of your heart (on an extra pillow)
• Use a humidifier or vaporizer if the weather is dry.

What to do if bleeding recurs

• Clear your nose of blood clots by blowing gently .
• Spray your nose with a nasal decongestant spray such as Afrin or Neo-Synephrine.
• Repeat the initial steps under “How to Treat a Nosebleed”.
• Call your doctor if bleeding persists.

When to call the doctor

• Repeated episodes of nosebleeds.
• Bleeding from areas other than the nose, such as in the urine or stool.
• Easy bruising.
• If you are taking blood-thinning medications such as aspirin or warfarin.
• If you have any underlying disease that may affect your blood clotting such as liver, kidney or blood disease (hemophilia).

When to go to the hospital

• If your bleeding recurs after a short period of time and cannot be controlled with pinching of your nose.
• If you feel dizzy, light-headed or feeling as if you are going to pass out.
• If you have a rapid heartbeat or trouble breathing.
• If you are vomiting or spitting up a large amount of blood.
• If your doctor instructs you to go to the hospital’s emergency department.

Office treatment

The doctor will examine the inside of the nose for the source of bleeding. Medications to decongest and numb the nose are applied with a cotton ball to assist with the examination. If necessary, the bleeding site is cauterized with a chemical called silver nitrate. Electrocautery or packing of the nose may be used if there is more severe or persistent bleeding. Packing ranges from gauze strips, balloon packs and synthetic sponges. Packing is usually left in the nose for 48-72 hours to allow the bleeding site to heal.

Treatment of posterior nosebleeds

Posterior nosebleeds often require treatment in the hospital. Posterior packing consisting of a balloon or synthetic material is often placed. Posterior packing is uncomfortable and usually requires admission for observation, sedative and pain medications. Posterior packing is usually left in place for 48-72 hours. If there is persistent or recurrent bleeding, surgery may be required.

What to do after you have been treated by a doctor

Avoid further irritation to the nose. Do not blow or pick your nose. Avoid strenuous activity, such as heavy lifting or exercise. Do not remove the nasal packing yourself.

Avoid medications that may affect blood clotting, such as ibuprofen, naproxen or aspirin. Acetaminophen (Tylenol) may be taken for pain, as needed. (correct a deviated nasal septum).