- The definition of a nosebleed is simply bleeding from the blood vessels in the nose. The medical term for nosebleed is epistaxis.
- Nosebleeds are common due to the location of the nose on the face, and the large amount of blood vessels in the nose.
- The most common causes of nosebleeds are drying of the nasal membranes and nose picking (digital trauma), which can be prevented with proper lubrication of the nasal passages and not picking the nose.
- Most nosebleeds can be stopped at home.
- Consult a doctor for a nosebleed if bleeding cannot be stopped, there is a large amount of blood lost, or you feel weak or faint.
- Chronic nosebleeds or persistent nosebleeds may need to be stopped with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble), or application of a topical medicine called thrombin that promotes local clotting of blood.
- A doctor may use nasal packs to stop nosebleeds when conservative measures fail.
- Do not take aspirin or other blood thinning products when you get a nosebleed (if they are doctor-prescribed, consult your doctor before stopping any medication).
What causes nosebleeds?
The nose is a part of the body rich in blood vessels (vascular) and is located in a vulnerable position protruding on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to a bloody nose if they take medications that prevent normal blood clotting (warfarin [Coumadin, Jantoven], clopidogrel [Plavix], aspirin, or any anti-inflammatory medication). In this situation, even a minor trauma could result in significant bleeding.
The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home result in drying and changes in the nose which make it more susceptible to bleeding. Nosebleeds also occur in hot, dry climates with low humidity, or when there is a change in the seasons. The following risk factors predispose people to nosebleeds:
- Trauma, including self-induced by nose picking (this is a common cause of nosebleeds in children)
- Allergic and non-allergic rhinitis
- Hypertension (high blood pressure)
- Use of blood thinning medications
- Alcohol abuse
- Less common causes of nosebleeds include tumors and inherited bleeding problems
- Hormonal changes during pregnancy may increase the risk of nosebleeds
How do you stop the common nosebleed?
Most people who develop nose bleeding can handle the problem without the need of a treatment by a health-care professional if they follow the step-by-step first aid recommendations below on how to stop a nosebleed:
- Lean forward slightly with the head tilted forward. Leaning back or tilting the head back allows the blood to run back into the sinuses and throat, and can cause gagging or inhaling of blood.
- Spit out any blood that may collect in your mouth and throat. It may cause nausea, vomiting, or diarrhea if swallowed.
- Gently, blow any blood clots out of your nose. The nosebleed may worsen slightly when you do this but this is expected.
- Pinch all the soft parts of the nose together between the thumb and index finger.
- Press firmly toward the face – compressing the pinched parts of the nose against the bones of the face. Breathe through your mouth as you do this.
- Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding.
- Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.
- Apply ice (wrapped in a towel) to nose and cheeks afterwards.
- Oxymetazoline (Afrin), phenylephrine hydrochloride (Neo-Synephrine, Neofrin), or phenylephrine-DM-guaifenesin (Duravent) nasal spray can be used short-term to help with congestion and minor bleeding if you do not have high blood pressure. However, these sprays should not be used for more than a few days at a time, as they can make congestion and nosebleeds worse.
Stuffing cotton or tissue into your nose is not recommended.
How do you prevent the nose from bleeding again?
- Go home and rest with head elevated at 30 to 45 degrees.
- Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
- Do not strain during bowel movements. Use a stool softener, for example, docusate (Colace).
- Do not strain or bend down to lift anything heavy.
- Try to keep your head higher than the level of your heart.
- Do not smoke.
- Eat a diet of soft, cool foods and beverages. No hot liquids for at least 24 hours.
- Do not take any medications that will thin the blood for example, aspirin, ibuprofen (Advil, Motrin, and others), clopidogrel bisulfate (Plavix) or warfarin (Coumadin). Do not stop taking any medications without first contacting your doctor.
- Your doctor may recommend some form of lubricating ointment for the inside of the nose.
- If re-bleeding occurs, try to clear the nose of blood clots by sniffing in forcefully. A temporary remedy such as a nasal decongestant spray, for example, Afrin or Neo-Synephrine may be helpful. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction so they are recommended for short-term use only. Do not use if the patient has high blood pressure.)
- Repeat the steps above on how to stop the common nosebleed. If bleeding persists, call the doctor and/or go to the nearest emergency department.