Nose bleeding is a very common symptom that can happen to anyone from children to the elderly. The medical term is epistaxis. One out of every seven people will develop a nosebleed at some time in their lives. Nosebleeds tend to occur more often during winter months and in dry, cold climates. They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.
Bleeding can range from a trickle to a frightening strong flow, and the consequences can range from a minor annoyance to life-threatening bleeding.
There are two types of epistaxis, based on the source of bleeding: (1) Anterior Epistaxis, (2) Posterior Epistaxis. Most nose bleeding is anterior, about 90% originating from a bridge of vessels on the nose septum, the middle part of the nose. These are easier to treat and usually will stop after some simple measures. Less common but more serious are posterior nosebleeds, where the source of bleeding is from the vessels located deeper inside the nose. The latter types of epistaxis tend to occur in patients who have pre-existing atherosclerotic vessels of bleeding disorder and have undergone nose or sinus surgery.
Some common causes of epistaxis, the first two are the most common:
- Local trauma : nose blowing, picking, blunt impact
- Dry mucosa : can be due to cold weather
- Infections : rhinitis
- Foreign bodies : especially in children, you will be amazed at what children can put up their nose
- Arteriosclerosis : in elderly
- Adverse drug reaction
Other less common causes of epistaxis:
- Systemic disorders : like in hypertension, which are usually posterior epistaxis
- Bleeding disorders
- Rendu-Osler-Weber syndrome
First thing to do when you have a nose bleed
- Pinch your nose for 10 minutes, this is the approximate time for the normal blood to clot
- Position yourself upright; avoid lying down because the blood will trickle down your throat or stomach which will cause coughing or vomiting.
When the bleeding stops, avoid:
- Using nasal saline spray.
- Avoid hard nose blowing or sneezing.
- Sneeze with the mouth open.
- Do not pick your nose.
- Avoid hot and spicy foods.
- Avoid taking hot showers.
- Avoid aspirin and other NSAIDs i.e. Ibuprofen, etc
Tell your doctor if you have been taking any medication, especially aspirin, ibuprofen or other pain medicine, heparin, warfarin, coumadin, or clopidogrel and after treatment ask if you can continue your medication or not.
Whenever there are these symptoms, see a doctor immediately
- Bleeding doesn’t stop with direct pressure
- Multiple recurrences, with no clear cause
- Using anticoagulant drugs
- Bleeding signs elsewhere such as bruises or red spots on the skin, gum bleeding, etc
- Weak, feeling faint
- Have high fever with the nose bleed
After asking about your related health history, the doctor will perform a physical examination to find the source of bleeding. Sometimes they will add a numbing agent prior to the examination. If the doctor finds that the bleeding is a posterior epistaxis, he or she might need to insert a special nose pack to stop the bleeding while investigating the cause and you might need to be admitted in hospital.
Laboratory tests are usually not needed. For severe nosebleeds, however, a blood count may be checked to assess the degree of blood loss. For individuals with blood clotting disorders or for those taking blood thinners, additional blood tests may also be ordered. If there are concerns about malignancy or other less common causes of nosebleeds, further blood tests and/or imaging studies may be considered.
With proper treatment, the vast majority of people recover from nosebleeds with no long-term effects.
The following tips may reduce your risk for developing nosebleeds.
- Use saltwater (saline) nose drops or a spray.
- Avoid forceful nose-blowing.
- Do not pick your nose or put your finger in your nose to remove crusts.
- Avoid lifting or straining after a nosebleed.
- Elevate your head on one or two pillows while sleeping.
- Apply a light coating of a moisturizing ointment, such as Vaseline, to the inside of your nose.
- Limit your use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, if you have frequent nosebleeds. Acetaminophen, such as Tylenol, may be used to relieve pain.
- Do not use nonprescription antihistamines, decongestants, or medicated nasal sprays. These medicines can help control cold and allergy symptoms, but overuse may dry the inside of the nose (mucous membranes) and cause nosebleeds.
- Keep your blood pressure under control if you have a history of high blood pressure. This will help decrease the risk of nosebleeds.
- Do not smoke. Smoking slows healing. For more information, see the topic quitting Smoking.
- Do not use illegal drugs, such as cocaine or amphetamines.
Make changes in your home
- Humidify your home, especially the bedrooms. Low humidity is a common cause of nosebleeds.
- Keep the heat low [60°F (16°C) to 64°F (18°C)] in sleeping areas. Cooler air does not dry out the nasal passages.
- Breathe moist air, such as from a shower, for a while if your nose becomes very dry. Then put a little moisturizing ointment, such as Vaseline, inside your nostrils to help prevent bleeding, but do not put anything inside your nose if your nose is bleeding. Occasional use of saline nasal sprays may also help keep nasal tissue moist.
Prevent nosebleeds in children
- Keep your child’s fingernails trimmed and discourage nose-picking.
- Caution children not to put any object in their noses.
- general practice