A nosebleed is the loss of blood from the delicate tissue that lines the inside of your nose. Nosebleeds are also called epistaxis are quite common. About 60% of people will have at least one nosebleed in their lifetime. Nose is an easy target for injury and nose bleeds because of its location in the middle of the face and the large number of blood vessels close to the surface in the lining of your nose.
Causes of nosebleeds?
Nosebleeds have various causes. Luckily, most are not serious.
The most common cause of nosebleeds is dry air. Dry air can be caused by hot, low-humidity climates or heated indoor air. Both environments cause the nasal membrane (the delicate tissue inside your nose) to dry out and become crusty or cracked and more likely to bleed when rubbed or picked or when blowing your nose.
Other common causes of nosebleeds include:
• Nose picking.
• Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing and nose blowing.
• Blowing your nose with force.
• Inserting an object into your nose.
• Injury to the nose and/or face.
• Allergic and non-allergic rhinitis (inflammation of the nasal lining).
• Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin, and others).
• Cocaine and other drugs inhaled through the nose.
• Chemical irritants (chemicals in cleaning supplies, chemical fumes at the workplace, other strong odors).
• High altitudes. The air is thinner (lack of oxygen) and drier as the altitude increases.
• Deviated septum (an abnormal shape of the wall that separates the two sides of the nose).
• Frequent use of nasal sprays and medications to treat itchy, runny or stuffy nose. These medications – antihistamines and decongestants – can dry out the nasal membranes.
Other, less common causes of nosebleeds include:
• Alcohol use.
• Bleeding disorders, such as hemophilia or von Willebrand disease or leukemia.
• High blood pressure.
• Facial and nasal surgery.
• Nasal tumors.
• Nasal polyps.
• Immune thrombocytopenia.
• Hereditary hemorrhagic telangiectasia.
Are nosebleeds serious?
Although seeing blood coming out of your nose can be alarming, most nosebleeds are not serious and can be managed at home. Some, however, should be checked by your doctor. For instance, if you have frequent nosebleeds, see your doctor. This could be an early sign of other medical problems that needs to be investigated. A few nosebleeds start in the back of the nose. These nosebleeds usually involve large blood vessels, result in heavy bleeding and can be dangerous. You will need medical attention for this type of bleed, especially if the bleeding occurs after an injury and the bleeding hasn’t stopped after 20 minutes of applying direct pressure to your nose.
Different kinds of nosebleeds
There are two main types and one is more serious than the other.
An anterior nosebleed starts in the front of the nose on the lower part of the wall that separates the two sides of the nose (called the septum). Capillaries and small blood vessels in this front area of the nose are fragile and can easily break and bleed. This is the most common type of nosebleed and is usually not serious. These nosebleeds are more common in children and are usually able to be treated at home.
A posterior nosebleed occurs deep inside the nose. This nosebleed is caused by a bleed in larger blood vessels in the back part of the nose near the throat. This can be a more serious nosebleed than an anterior nosebleed. It can result in heavy bleeding, which may flow down the back of the throat. You may need medical attention right away for this type of nosebleed. This type of nosebleed is more common in adults.
How to prevent a nosebleed?
1. Keep the lining of the nose moist
Dried-out mucus membranes from inhaling dry air or other causes can further irritate the nose and lead to nosebleeds. Keeping the membranes moist with a saline spray can help. You can use this spray about every two to three hours while you’re awake.
If you don’t like sprays, you can also try nasal gels or even petroleum jelly applied gently to the nostril.
2. Trim fingernails
Long and sharp fingernails can be enemy number one to someone who’s had a nosebleed. Sometimes, you may pick your nose without really thinking about it, such as at night while you’re sleeping. If your fingernails are excessively long or sharp, you’re more likely to have a nosebleed.
3. Use a humidifier
Humidifiers add moisture to the air, helping to keep the mucus membranes from drying out. You can use one while sleeping to prevent nosebleeds. Just be sure to clean the humidifier according to the manufacturer’s instructions, as the moisture and heat in the machine can attract bacteria and mold.
4. Wear protective equipment
If you have a history of nosebleeds and play a sport, such as basketball, where you’re more likely to experience injury, consider wearing protective equipment.
Some people wear a transparent mask over their nose that helps to absorb any potential blows and reduce the likelihood for nosebleeds and nasal injuries.
Who gets nosebleeds?
Anyone can get a nosebleed. Most people will have at least one in their lifetime. However, there are people who are more likely to have a nosebleed. They include:
• Children between ages two and 10. Dry air, colds, allergies and sticking fingers and objects into their nose make children more prone to nosebleeds.
• Adults between ages 45 and 65. Blood may take longer to clot in mid-life and older adults. They are also more likely to be taking blood thinning drugs (such as daily aspirin use), have high blood pressure, atherosclerosis (hardening of the walls of arteries) or a bleeding disorder.
• Pregnant women. Blood vessels in the nose expand while pregnant, which puts more pressure on the delicate blood vessels in the lining of the nose.
• People who take blood-thinning drugs, such as aspirin or warfarin.
• People who have blood clotting disorders, such as hemophilia or von Willebrand disease.
How do I stop a nosebleed?
Follow these steps to stop a nosebleed:
• Sit upright and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhea. (Do NOT lay flat or put your head between your legs.)
• Breathe through your mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop the bleeding.
• Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
• If you’d like, apply an ice pack to the bridge of your nose to further help constrict blood vessels (which will slow the bleeding) and provide comfort. This is not a necessary step, but you can try this if you want.
• You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then apply pressure to the nose as described above. WARNING: These topical decongestant sprays should not be used over a long period of time. Doing so can actually cause an increase in the chance of a nosebleed.
• After the bleeding stops, DO NOT bend over, strain and/or lift anything heavy. DO NOT blow or rub your nose for several days.
When should I go to the emergency room if I have a nosebleed?
Call your doctor immediately or have someone drive you to the nearest emergency room or call 911 if:
• You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure on your nose as described in the steps above.
• The bleeding is rapid or the blood loss is large (more than a cup).
• You are having difficulty breathing.
• You have vomited because you’ve swallowed a large amount of blood.
• Your nosebleed has followed a blow to your head or serious injury (fall, car accident, smash to your face or nose).
• Call your doctor soon if:
• You get nosebleeds often.
• You have symptoms of anemia (feeling weak or faint, tired, cold, short of breath, pale skin).
• You have a child under two years of age who has had a nosebleed.
• You are taking blood thinning drugs (such as aspirin or warfarin) or have a blood clotting disorder and the bleeding won’t stop.
• You get a nosebleed that seems to have occurred with the start of a new medication.
• You get nosebleeds as well as notice unusual bruising all over your body. This combination may indicate a more serious condition such as a blood clotting disorder (hemophilia or von Willebrand disease), leukemia or nasal tumor and will need to be checked by your doctor.
Diagnosing a nosebleed
If you seek medical attention for a nosebleed, your doctor will conduct a physical examination to determine a cause. They’ll check your nose for signs of a foreign object. They’ll also ask questions about your medical history and current medications.
Tell your doctor about any other symptoms you’ve and any recent injuries. There’s no single test to determine the cause of a nosebleed. However, your doctor might use diagnostic tests to find the cause. These tests include:
• Complete blood count (CBC), which is a blood test to check for blood disorders
• Partial thromboplastin time (PTT), which is a blood test that checks how long it takes for your blood to clot
• Nasal endoscopy
• CT scan of the nose
• X-ray of the face and nose
Treatments for nosebleeds
Treatments depend on the cause and could include:
• Nasal packing. Gauze, special nasal sponges or foam or an inflatable latex balloon is inserted into your nose to create pressure at the site of the bleed. The material is often left in place for 24 to 48 hours before being removed by a healthcare professional.
• Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. A local anesthetic is sprayed in the nostril first to numb the inside of your nose.
• Medication adjustments/new prescriptions. Reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary. Tranexamic (Lystedaâ), a medication to help blood clot, may be prescribed.
• Foreign body removal if this is the cause of the nose bleed.
• Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the nosebleed.
• Ligation. In this procedure, the culprit blood vessel is tied off to stop the bleeding.
Frequently Asked Questions
1- What can nosebleeds be a sign of?
Nosebleeds aren’t usually serious. However, frequent or heavy nosebleeds may indicate more serious health problems, such as high blood pressure or a blood clotting disorder, and should be checked. Excessive bleeding over a prolonged period of time can also lead to further problems such as anaemia.
2- When should I be worried about nosebleeds?
Most nosebleeds don’t require medical attention. However, you should seek medical attention if your nosebleed lasts longer than 20 minutes, or if it occurs after an injury. This may be a sign of a posterior nosebleed, which is more serious.
3- Can stress cause nose bleeds?
Headaches, sometimes triggered by stress, can result in or be accompanied by a nosebleed. If you tend to pick your nose or blow your nose frequently when you feel stressed or anxious, that could also trigger a nosebleed.
4- Are nosebleeds a sign of leukemia?
The symptoms of leukemia may be very subtle at first and include fatigue, unexplained fever, abnormal bruising, headaches, excessive bleeding (such as frequent nosebleeds), unintentional weight loss, and frequent infections, to name a few. These, however, can be due to a wide range of causes.
5- How often is too often for a nosebleed?
A nosebleed that recurs 4 times or more in a week needs medical evaluation to determine the seriousness of the problem. A nosebleed that recurs 2 to 3 times in a month may mean that a chronic condition such as allergies is causing the nosebleeds.
6- What food causes nosebleeds?
There’s research to suggest that certain foods, like chocolate and citrus fruits, seem to bring on nosebleeds. Sleeping in a room with a humidifier and avoiding allergy triggers can also work to prevent nosebleeds.
7- Are nosebleeds a sign of dehydration?
Bloody noses are common and can be caused by a variety of factors including dehydration, cold, dry air, sinusitis, allergies, blood-thinning medications, and trauma.
Nose bleeds is a medical condition that is not serious in most of the cases. However they can occur spontaneously when the nasal membranes dry out, crust, and crack, as is common in dry climates, or during the winter months when the air is dry and warm from household heaters.
Approved by: Sarah Taufiq