Nosebleeds can occur relatively easily due to the exposure of the nose and the location of the blood vessels on the surface of the nasal mucosa.
About
The role of the nose is to warm and moisten the air we breathe. The inside of the nose is covered with moist and delicate tissue (mucosa) provided with a rich network of blood vessels. When this tissue is damaged, even after a minor injury, these vessels tend to bleed. Once a blood vessel begins to bleed, the bleeding tends to recur because the clot or scar is easy to dislodge.
Nosebleeds, called epistaxis, can be a cause for concern, but usually, the situation looks worse than it actually is. In most cases, nosebleeds can be treated at home, through local pressure, but there are also cases in which specialized medical care is required.
Make an appointment with the doctor if:
- Nasal bleeding is common
- The bleeding seems to have occurred starting with the administration of a new drug.
- Hemorrhage is accompanied by bruises all over the body (This association could indicate a more severe condition and needs to be investigated by a doctor)
Cause:
- The dry, heated air inside the rooms, dries out the nasal membranes and causes cracking or the formation of crusts and bleeding when you rub or clean your nose or when you blow it (often in the winter months)
- Dry, warm climate with low humidity, which dries out the nasal membranes
- Colds (upper respiratory tract infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and blowing of the nose
- Blowing or blowing the nose forcefully
- Inserting a foreign object into the nose
- Trauma to the nose and/or face
- Allergic rhinitis and non-allergic rhinitis (inflammation of the nasal mucosa)
- The use of anticoagulant drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin, etc.)
- High blood pressure (HT)
- Irritating substances (cocaine, chemical agents, etc.)
- Deviation of the nasal septum (abnormal shape of the structure that separates the nostrils)
- Tumors or inherited coagulation disorders (rare)
- Surgical intervention on the face or nose
How do you stop a nosebleed?
At home:
- Try to be relaxed
- Breathe through the mouth
- Stand in a vertical position and lean forward a little. If you remain in a vertical position, you reduce the blood pressure in the nasal vessels and reduce subsequent bleeding. If you lean forward, you avoid swallowing blood and other nasal secretions – which you can swallow if you lean your head back and can irritate your stomach. Do not lie on your back and do not put your head between your knees
- Press the nostril. Pressing compresses the bleeding area on the nasal septum and often stops the bleeding. Use your thumb and forefinger to press both nostrils. Press the soft part of the nostrils against the hard part of the nose. Breathe through your mouth. If you press at or above the bony part of the nose, you will not compress where the bleeding occurs
- Keep pressing continuously for 5-10 minutes, before checking if the bleeding has stopped.
- If the bleeding continues, repeat the pressure for another 10 minutes. Avoid looking inside the bleeding nostril. You can first apply a puff of oxymetazoline, a nasal decongestant spray that is available from the pharmacy without a prescription
- To prevent further bleeding, do not clean or blow your nose or lean forward. Do not strain and lift heavy objects for several days after the hemorrhagic episode. During this time, keep your head higher than the level of your heart. You can gently anoint the inside of the nostrils with vaseline (with your finger or a cotton-tipped stick)
- If the bleeding continues, go to the emergency room
At the emergency room
Go to the emergency room under the following conditions:
- 15-20 minutes have passed in which you applied direct pressure and you cannot stop the bleeding
- You have repeated episodes of bleeding
- The bleeding is rapid or the blood loss is massive (exceeds a cup of coffee, approx. 250 ml)
- The bleeding was caused by trauma, such as a fall or a blow to the nose or face
- You feel weak or faint
- Blood flows into the throat, not out of the nose, even when you are sitting and the body and head are slightly bent forward (this may indicate a “posterior nosebleed”, which is rarer but more severe and requires intervention from the doctor; it occurs more frequently in the elderly or hypertensive people)
Treatment
Treatment, depending on the cause, may include:
- Cauterization. A chemical substance (silver nitrate) or hot energy (electrocautery) is applied to “weld” the bleeding blood vessel
- Nasal tamponade. Insertion of gauze strips into the nasal cavity to create pressure at the bleeding site. Alternatively, other materials that contribute to coagulation can be used
- Adaptation of medication. Reducing or stopping anticoagulants may help. In addition, medication may be needed to control blood pressure
- Removal of the foreign body
- Nasal fracture repair
- Correction of sept deviation
Prevention
- Use a saline solution, in the form of a spray or nasal drops, 2-3 times a day, in each nostril. This can be purchased without a prescription from the pharmacy or made at home like this – mix 1 teaspoon of salt with 250 ml of purchased plain water
- Use a humidifier in the house, especially in the room where you sleep
- Put water-soluble gel or ointment on a cotton-tipped stick (vaseline and bacitracin are examples of over-the-counter ointments that can be used). Make sure you don’t insert the chopstick more than 0.6 cm. inside the nose
- Avoid strong nose blowing, and it would be good to blow it after each spray of the saline solution
- Sneezed with open mouth
- Avoid inserting any object into the nose, including fingers and cotton-tipped sticks.
- Limit the use of drugs that promote bleeding, such as aspirin and ibuprofen. Do not forget that every change in the medication schedule, especially those on prescription (such as warfarin) or non-steroidal anti-inflammatory drugs, must be made on the doctor’s recommendation
- See a doctor if the symptoms of allergic rhinitis cannot be easily controlled with over-the-counter or over-the-counter medications
- Quit smoking. Smoking dries the nose and irritates it
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