Taking control of nosebleeds

At least once in a lifetime, almost everyone will experience a nosebleed. They are fairly common for adults and children, especially during dry winter months.

Although rarely life threatening, nosebleeds can cause anxiety and sometimes may be difficult to control.

Why do nosebleeds occur?

Epistaxis, more commonly known as a nosebleed, occurs when a small blood vessel in the nasal septum — the partition that divides the two sides of your nose on the inside — ruptures. This can occur when something traumatizes the mucosa of the septum, like a fingernail accidentally scratching the tissue while blowing the nose.

Nosebleeds also can occur when the nasal mucosa is dry and the blood vessels are more prone to tearing. This is why people have more nosebleeds in the winter when the air inside is dry from use of fireplaces and furnaces. We call these anterior bleeds, and they usually present with brisk bleeding out of one nostril.

Less commonly, there may be a larger vessel more towards the back of the nasal cavity involved. This type of nosebleed is a posterior bleed, which tends to be more severe and often requires emergency treatment.

There are other less common causes of nosebleeds that may lead to recurring or serious bleeding. Some examples include clotting disorders, such as hemophilia, cancerous growths in the nose or sinus, disorders causing multiple abnormalities in the blood vessel, and the use of anticoagulant medications commonly prescribed for patients with heart conditions.

How you can avoid nosebleeds:

• Avoid vigorous nose-blowing and stuffing tissues or other objects into the nose.
• Discourage children from nose-picking, and keep their fingernails trimmed.
• Use over-the-counter nasal saline sprays and topical nasal moisturizing gels.
• Use a home humidifier to keep moisture in the air during winter months.
• If you smoke, consider quitting. Tobacco smoke dries out the nasal mucosa and increases the risk for nosebleeds.

Fortunately, most nosebleeds are self-limiting and require minimal treatment. By staying calm and following some simple steps, the majority of nosebleeds can be managed without the need of medical assistance.

Follow these steps if you get a nosebleed:

1. Gently blow your nose to clear any blood clots.
2. If available, spray an over-the-counter nasal decongestant 2–3 times into the side of the nose that’s bleeding.
3. Apply direct pressure to the nose by pinching the nostrils shut for 5–10 minutes. Lean slightly forward to prevent bleeding into the throat. Breathe through your mouth.
4. If the bleeding stops, avoid nose-blowing or strenuous activity for the remainder of the day, and begin a daily nasal moisturizing regiment with nasal saline or gel for a period of 1–2 weeks.
5. If the bleeding doesn’t stop, then repeat steps as necessary.
6. Seek medical attention if the bleeding doesn’t stop after 30 minutes, if you have trouble breathing, have suffered severe nasal trauma or lost a significant amount of blood and feel weak.

For more serious bleeds or frequent re-bleeding, seek medical attention with your primary health care provider or the local emergency department.

Thomas Lowry, M.D., is an otolaryngologist in Ear, Nose & Throat in Rice Lake, Wisconsin.