Here's what really causes them–and how to stop the bleeding.
December 08, 2017
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What is a nosebleed?
Nosebleeds can occur without warning. One minute you’re fine, the next you’re grabbing tissues to stop a bloody nose.
Everyone’s nose is full of blood vessels that can easily break and bleed. Nasal bleeding is a common problem, particularly during the winter months when dry, indoor air causes the mucous membranes of the nasal passageway to crack and crust, which can lead to bleeding.
While nosebleeds usually aren’t serious, you need to know how to manage them properly and when to seek medical attention.
The following facts can help you confidently care for your next bloody nose.
It’s estimated that one in seven Americans will have nasal bleeding, or epitaxis in medical lingo, at some point in their lifetime.
can occur at any age, but they’re more common in children ages 2 to 10 and in adults 50 to 80, says the American Academy of Otolaryngology-Head and Neck Surgery.
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What are the types of nosebleeds?
There are two types of nosebleeds: posterior and anterior. Anterior nosebleeds involve tiny blood vessels in the front of the nose. Most anterior nosebleeds can be self-treated.
Posterior nosebleeds involve bigger blood vessels deep in the nasal cavity and can be more problematic because bleeding can be profuse and difficult to stop. These nosebleeds almost always require medical intervention.
“Overall, anterior nosebleeds are much more common than posterior,” says Shaunda Rodriguez, DO, an ear, nose, and throat/head and neck surgeon with Via Christi Health in Wichita, Kansas.
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What causes nosebleeds?
Dry air can sap moisture from nasal membranes. Not only is it uncomfortable, but it cause the mucous lining of the nose to crust, crack, and bleed–sometimes without any provocation. But nosebleeds are most often due to nose picking or some other disturbance, such as an aggressive nose blow or the repeated poke of a nasal spray bottle. Inflammation due to allergies or common viruses like colds can also make the nasal lining more vulnerable to nosebleeds.
Less often, a bloody nose is the consequence of blunt trauma due to, say, a car accident or a punch. Sometimes blunt trauma causes nosebleeds when children stick small objects up their noses or when adults try to extract those items. Using certain allergy medications or illegal drugs like cocaine can cause nasal bleeding too.
In rarer cases, nosebleeds can also be caused by a genetic condition called hereditary hemorrhagic telangiectasia, a blood clotting disorder, or even cancer.
Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and prescription blood thinners like warfarin are all associated with a risk of bleeding. But you won’t get a nosebleed because you take these medicines.
“It’s just that if someone bleeds, it can become more of an issue,” Dr. Rodriguez explains, because the person’s bleeding can be “more significant.”
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How to stop a nosebleed
Many times, you can stop a bloody nose with a few simple steps at home. Here’s how:
First, stay calm: Getting worked up can worsen the bleeding. Tilt your head slightly forward, not backward–you don’t want blood rushing down the back of your throat. Using your thumb and index finger, pinch the soft, lower part of your nose. Apply just enough pressure to make your fingers blanch, Dr. Rodriguez says. Hold the pinch for five minutes. If the bleeding hasn’t let up, resume the pinch for five to 10 more minutes.
After the bleeding has stopped, you might want to try a decongestant nasal spray to tighten blood vessels in the nose. Just be sure to get your doctor’s permission first. Some people with high blood pressure and other health conditions should not use medicines that constrict blood vessels because they can raise blood pressure.
“Don’t ever shove anything up your nose,” Dr. Rodriguez cautions. “No tissue, no gauze.” You could make things worse, she says, by further irritating nasal blood vessels.
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How to prevent a nosebleed
During winter’s dry months, use an over-the-counter saline spray plus a humidifier at night to keep nasal membranes moist so they don’t crack and bleed.
Dr. Rodriguez does not recommend using petroleum jelly in the nose. In rare cases, it can travel to the lungs, causing inflammation. Instead, try over-the-counter saline gel or consult your doctor about a prescription for an antibiotic ointment, she says.
Ear, nose, and throat specialists also recommend trimming children’s fingernails to avoid a picking-related nosebleed. Doctors also advise quitting smoking; smoke dries out and irritates the nose.
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When to a physician about a nosebleed
“If you have a persistent nosebleed lasting beyond 30 minutes, you need to seek urgent care,” Dr. Rodriguez says.
Generally, posterior nosebleeds produce a lot of blood and require medical intervention. You’ll know you have one if the first thing you notice is a rush of blood down the back of your throat.
If you have a posterior nosebleed, your doctor may need to pack your nose with gauze to stop the bleeding, Dr. Rodriguez says. Physicians have the proper instruments and experience to guard against further trauma to the lining of the nose. Your doctor may also cauterize (or burn) the bleeding vessel or insert an inflatable balloon to put pressure on the vessel to stop the bleeding.
Even some anterior nosebleeds require a doctor visit if they won’t stop, and anyone with recurring bloody noses should see a physician too, Dr. Rodriguez says. A thorough examination is needed to uncover the cause of the bleeding, which could be something serious like a tumor.