Nosebleeds

Nosebleeds are very common and are likely to occur at least once in each person’s lifetime. Though they typically aren’t painful or cause for serious concern, it’s important to take the following basic steps to stop a nosebleed:

• Sit upright in a chair and lean forward.
• Spray an over-the-counter decongestant (Afrin, oxymetazoline, “12-hour nasal spray,” etc.) to shrink the blood vessels and help slow or stop the bleeding.
• Apply pressure by pinching both sides of the ENTIRE SOFT part of the nose. Pinching the bone will not have any effect.
• Maintain pressure on the nose for at least 10-20 minutes.

If bleeding persists after pressure, or seems too heavy, call your physician’s office. In severe cases, you may need to visit an urgent care clinic or the emergency room.

It’s important to understand the underlying cause of nosebleeds to help control and prevent recurrence. Several factors can increase the risk of nosebleeds:

• Nasal dryness – caused by excessive use of nasal sprays, weather, home environment
• Inflammation – sinusitis, granulomatous disease (sarcoidosis, Wegener’s granulomatosis, rhinoscleroma, tuberculosis, syphilis)
• High blood pressure – leads to changes in blood vessel walls that cause them to bleed more easily and hinder the healing of nosebleeds
• Blood thinning medications – aspirin, plavix, lovenox, Coumadin, NSAIDs (including ibuprofen, Advil, Aleve, Celebrex, etc)
• Severe malnutrition – protein or vitamin K deficiency can cause deficiencies of clotting factors
• Trauma – self-induced from nose picking (common in young children), facial or nasal trauma, surgery
• Tumors – benign and malignant (cancer)
• Chemotherapy – decreases the body’s ability to create new platelets
• Septal abnormalities (spurs, deviations, perforations) – restricted airflow can cause local turbulence and persistent damage to the nasal lining
• Clotting disorders – suggested by family history, easy bruising, or prolonged bleeding from prior minor injuries or surgery
• Liver disease – clotting factors are produced in the liver
• Kidney disease – elevated blood urea nitrogen (BUN) is a platelet inhibitor
• Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) – an inherited disorder involving the formation of abnormal blood vessels that have very thin walls. These are easily damaged by minor trauma and tend to bleed easily.

Occasional and minor nosebleeds are nothing to worry about, but frequent nosebleeds can reduce the quality of life and negatively impact social behavior.

Elderly or anemic patients who cannot tolerate significant blood loss may need blood transfusions to address the blood loss caused by nosebleeds.

Some patients may need to undergo a nasal endoscopy to help determine the exact source of bleeding and identify contributing abnormalities, such as septal deformation, inflammation, and tumors. If bleeding occurs exclusively on one side, then the cause is not a tumor.

Management options can include any combination of moisturization, packing, and cautery. Some forms of packing are absorbable and do not have to be removed.

If these measures fail to reduce or prevent nosebleeds, patients may need to undergo a minimally invasive procedure (called a sphenopalatine artery ligation) to reduce blood supply to areas of the nose that bleed frequently.