Nosebleeds

Nosebleeds

Nosebleeds (epistaxis) have a variety of causes, the most common of which are nose picking and injury. The cold, dry air of winter also makes nosebleeds more likely. People who take aspirin or other drugs that interfere with the blood's ability to clot (anticoagulants) commonly develop nosebleeds. Some people get them rather often, and others rarely get them.

Bleeding usually comes from the front part of the nasal septum, which contains many blood vessels. There may be just a trickle of blood or a strong stream. Most nosebleeds are more frightening than serious. However, bleeding from the back part of the nose—which is uncommon—is more dangerous and difficult to treat.

Prevention and Treatment

Important steps to prevent nosebleeds include avoiding picking the nose, humidifying the air during the winter, and, for some people, moistening the front of the nasal septum with petroleum jelly.
Bleeding usually can be controlled at home by pinching the sides of the nose together for 5 to 10 minutes. It is important to hold the nose with a firm pinch and not let go even once until the 10 minutes is up. Other home techniques, such as ice packs to the nose, wads of tissue paper in the nostrils, and placing the head in various positions, are not as effective.

If the pinch technique does not stop the bleeding, the person should see a doctor. The doctor packs the bleeding nostril with a piece of cotton saturated with a drug that causes blood vessels in the nose to narrow (constrict), such as phenylephrine. A local anesthetic, such as lidocaine, numbs the nose so the doctor can look in the nose and find the bleeding site.

For minor bleeds, often nothing more is done. For more severe or recurring bleeding, sometimes the doctor seals (cauterizes) the bleeding source with a chemical, silver nitrate, or electrocautery (cauterization using an electrical current to produce heat). Another treatment is to place a long absorbent sponge in the nostril. The sponge swells in contact with moisture and compresses the bleeding site. The sponge is removed after 2 to 4 days. Rarely, the doctor may need to pack the entire nasal cavity on one side with a long strip of gauze. Nasal packing is usually removed after 3 or 4 days.

In some people, particularly those who are older and have narrowing of the arteries (arteriosclerosis), the bleeding source is sometimes further back in the nose (posterior nosebleed). Bleeding in this area is very difficult to stop and can be life threatening.

For a posterior nosebleed, doctors may place a specially shaped balloon in the nose and inflate it to compress the bleeding site. However, this and other types of nasal packing are very uncomfortable and interfere with the person's breathing. Therefore, people who have had this type of packing are admitted to the hospital and given oxygen and antibiotics to prevent an infection of the sinuses. Because of the discomfort and breathing risks associated with nasal packing, doctors sometimes cauterize or clip the bleeding vessel while looking in the nose through a small visualizing device (endoscope). Occasionally, doctors, guided by x-ray techniques, can pass a small catheter through the person's blood vessels to the bleeding site and inject material to block the bleeding vessel.





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