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Nosebleeds

Nosebleeds

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Luckily, there are not many emergencies in my field of ear, nose and throat that require me to go to an emergency room in the middle of the night.  However there is one situation that I get called to treat and that is severe uncontrolled nosebleeds.

Bleeding from the nose can be a minor irritation or can be severe enough to hospitalize a patient.  I thought I would discuss the most common causes of bleeding from someone’s nose as well as home treatment that often will prevent a trip to an emergency room.

The tissues of the nose have a very rich blood supply.  Almost everyone has had minor injuries to their nasal tissues causing a little bit of bleeding that usually stops within a few minutes.  Many children under the age of 8 have temporary nasal bleeding often associated with allergies.  Usually these will stop on their own after a few minutes.

More severe or prolonged bleeding from the nose is rare in the general population but certainly occurs especially in people over the age of 50.  Almost all bleeding, is from the nasal septum, which is the wall between the 2 nasal passages in the middle.  The nasal septum has a particularly excellent blood supply with blood coming from 3 different small arteries.  The area that bleeds is usually in the front where it is a transition zone between the dry scan of the external nose and the moister nucleus coated membrane farther back.

Nosebleeds are usually associated with cooler dry air.  Once we do get some winter here the humidity will drop, and of course we start turning on the heat in the house, which is usually very dry.  This contributes to cracking of the membranes especially in the front of the septum with tiny blood vessels opening up if they are close to the surface.

Another very large factor contributing to nasal bleeding is the use of medications which we think of as “blood thinners”.  These include prescription drugs such as Coumadin, Eliquis or Plavix but also include of course the use of aspirin.  Even so called low dose or baby aspirin of 81 mg a day is enough to contribute to nasal bleeding.

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Controlling the nosebleed at home is usually not that difficult.  If you or a family member is prone to nosebleeds I strongly recommend that you have Afrin (oxymetazoline 0.05%) nasal spray in your home medicine cabinet.  This medication acts quickly to constrict blood vessels and can often stop bleeding combined with a maneuver I will describe. If you are having bleeding from your nose that lasts more than 5 minutes, the first step is to blow your nose forcefully to remove all blood clots from the nasal passage.  We think that blood clots are helpful, but in actuality they prolong bleeding in your nose.  After blowing out as much blood as possible, spray the side that is bleeding with the Afrin, 3 or 4 sprays.  Then wait 5 minutes and repeat the process of forceful blowing and for 3-4 sprays of Afrin.  Then gently pinch the lower half of the nose together.  Lean forward but do not lay back flat, as this will just make the blood go into your throat.  Sometimes soaking a paper towel rolled up with Afrin and placing it in the bleeding side and pressing will also help.  Pinching the upper half of the nose that is hard bone does not do any good at all.

Saline nasal sprays containing moisturizers such as xylitol, (Xlear spray) are very helpful in keeping the nasal passages moist to prevent bleeding so they can be used very, very frequently.

Hopefully this information will be helpful to you in the upcoming months of cooler dry air.  Keep all your blood on the inside where it does the most good.

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