Overview

Nosebleed refers to blood flowing from the nose or nasal passage.

Title
Nosebleed

Types

There are two types of nosebleeds:

  • Anterior Nosebleed – blood coming from the front of the nose, usually the semirigid walls that separate the two nostrils. This is the most common type of nosebleed.
  • Posterior Nosebleed – bleeding starts deep within the nose. It is often more difficult to treat and more severe than an anterior nosebleed.
Symptoms

Nosebleed symptoms differ, depending on where in the nose the bleeding begins.

  • Anterior Nosebleed – produces blood flow from one nostril when the patient sits or stands. Blood may pass down the throat if the person is coughing or blowing the nose.
  • Posterior Nosebleed – causes bleeding down the back of the mouth and throat. When the patient leans forward, the blood may flow from the nostril. Blood flow may be fast or slow.
Causes

Causes include:

  • Irritation or breakage to the lining of the nose
  • Injury to the nasal tissue, which occurs more easily when nasal structure is not normal or the passages are inflamed due to a cold or allergies
  • Exceptionally dry nasal tissue
  • Picking or bumping the nose
  • Forceful blowing or rubbing the nose
  • A clot from a previous nosebleed becoming disturbed or dislodged
  • A foreign object placed in the nose
  • Tumors of the nose and/or sinuses
  • Hypertension (high blood pressure)
  • Use of aspirin or other blood thinning (anticoagulant) medications
  • Other causes of tendency to excessive bleeding including hemophilia
Diagnosis

Diagnosis is based on symptoms, medical history, and a physical exam. The pulse and blood pressure will be taken carefully because severe bleeding can cause these to become dangerously low.

Tests may include sinus X-rays to identify abnormalities or a mass in the nasal region; endoscopy to examine nasal tissues not visible from the front of the nose; and blood Tests to check for anaemia, low blood platelets, or clotting problems.

Treatment

Most anterior nosebleeds stop without medical care within 30 minutes. Posterior nosebleeds usually are more serious and need medical care. Treatment may include sealing off the blood vessel that is bleeding. A posterior nosebleed may require inserting and inflating a special balloon that applies pressure on the area. If all medical attempts to control bleeding fail, surgery may be needed.

Prevention

To reduce the chance of getting a nosebleed:

  • Lubricate dry nasal passages near the front of the nose. Place a small dab of lubricating cream or ointment on your fingertip. Apply the lubricant to the inside of the nose. You may do this at bedtime or up to three times during the day. Polysporin, zinc oxide, and Vaseline are examples of lubricants that may be used.
  • Use a saline nasal spray to help keep nasal passages moist. Be sure that the nose spray does not contain medications such as phenylephrine or oxymetazoline, or that such medications are used for only a few consecutive days.
  • Do not pick your nose.
  • Humidify the air, especially in bedrooms.
Risks

Risk factors for nosebleed include:

  • Irregularity in the structure of the nose
  • Abnormalities of the blood vessels in the nose (angiomas)
  • Dry climate
  • Winter, with dry, heated indoor air
  • Allergies
  • Colds
  • Sinusitis
  • Infections including chicken pox, malaria, influenza, typhoid fever
  • Childhood and advanced age
  • Cocaine use
  • Lupus
  • Bleeding or clotting disorders including those due to leukemia, liver disease, aplastic anaemia, low platelet counts, haemophilia, cancer treatment
  • Anticoagulant (blood-thinning) drugs, including aspirin
  • High blood pressure
Self-help
  • Stay calm.
  • Sit up and lean forward.
  • Pinch the soft parts of your nose together and hold for ten minutes without releasing pressure.
  • You may want to place a cotton ball soaked with a decongestant spray in the nostril before pinching.
  • Place a bag of crushed ice, wrapped in a cloth, or a cold washcloth on the nose and cheeks.
  • Once the bleeding stops, do not pick or blow your nose.
  • Avoid straining, bending or lifting.
  • Sit up and if the bleeding starts up again, try to remove clots.
  • Spray a nasal decongestant four times into each nostril, before pinching and holding.