Katie Phillips, MD
The 411 on Nosebleeds
Updated: Dec 6, 2020
Nose bleeds are incredibly common. Did you know that 60% of people will experience a nosebleed in their lifetime? Today’s post will discuss why nosebleeds occur, how to stop the bleeding and how to prevent future nosebleeds.
Why do nosebleeds occur?
As it turns out, the nose has an incredible amount of blood vessels that supply a large volume of blood to the nose. Particularly, the front of the nose, along the front of the nasal septum, has a dense network of blood vessels which are very close to the surface and can bleed easily. When the source of bleeding in a nosebleed is coming from the front of the nose, this is called an “anterior nosebleed”. Anterior nosebleeds are the most common, accounting for 90-95% of all nosebleeds. This is good news because anterior nosebleeds are easier to stop.
Anterior nosebleeds occur for several reasons. As we said above, the blood vessels are very close to the surface so any amount of mild trauma to the front of the nose (from a finger in the nose, to a rough wipe of the nose with a tissue, to other things placed in the front of the nose such as a nasal cannula for oxygen delivery) can be enough to start a nosebleed. These bleeds can also start spontaneously - especially if the nose is dry (like when the heat is turned on in the winter or after a bad cold) or a person has risk factors for easy bleeding or bruising (genetic diseases, kidney or liver disease, coagulation problems or certain medications that thin your blood such as aspirin, plavix, or coumadin).
The other category of nosebleeds is a “posterior nosebleed”, or a nosebleed where the source of the blood is from the back of the nose. People who experience posterior nosebleeds may only have blood coming down from the back of their nose and out their mouth instead of any blood coming from the front of the nose. Posterior nosebleeds may start and stop suddenly without a trigger and often produce a large amount of blood. Posterior nosebleeds can occur spontaneously or be secondary to facial or nasal trauma.
In rare cases, nosebleeds may be the result of a tumor or mass inside the nose that tends to bleed easier than healthy tissue. While this is not often the cause of nosebleeds, if you are someone who suddenly starts to experience nosebleeds over and over again without other risk factors, it is worth having an ENT look in your nose to ensure there is not a mass. Patients with nasal masses may often experience the inability to breathe from their nose or a loss of smell in addition to frequent nosebleeds.
I have a nosebleed, now how do I stop it?
First, do not panic! Of all nosebleeds, only 6% require medical attention because a person was not able to stop their nosebleed at home. The best way to stop a nosebleed is to be prepared! You will want to gather nosebleed supplies at home, especially if you have risk factors for nosebleeds (see more about risk factors in the next section). Supplies include afrin (oxymetazoline) nasal spray, Vaseline ointment, salt water nasal spray and possibly a nose clip (a specialty clip you can purchase for nosebleeds, see image below). These products are all available over the counter.
1. Lean forward and spit out blood that is coming down the back of your throat to prevent swallowing excess blood or having blood go down your airway.
2. Spray Afrin (oxymetazoline) nasal spray into your nose on the side that is bleeding (or both sides if you cannot tell which side is bleeding). You can spray a generous amount into the nose. Afrin nasal spray may not be appropriate in some heart conditions, talk to your primary care doctor about making sure Afrin is safe for you.
3.Hold your nose at the FLESHY part of your nose (not over the bony part of your nose) with firm pressure for 10 minutes. You can hold your nose or use a nose clip.
4. After 10 minutes of firm pressure, let go and check to see if you are still bleeding. If so, you can repeat the process.
5.If even with firm pressure over the fleshy part of your nose you continue to have bleeding or the bleeding does not stop despite a cycle or two of afrin nasal spray and 10 minutes of firm pressure, proceed to your local emergency room.
After your nosebleed, you will want to keep your nose moist as the lining of the nose heals. You can do this with either Vaseline or an antibiotic nasal ointment (Bactroban/Mupirocin available by prescription) and salt water nasal spray (available over the counter). You will also want to avoid trauma to the healing area and therefore should try not to pick away the clot or aggressively wipe or blow your nose for a few days after a nosebleed.
How do I prevent nosebleeds?
To prevent a nosebleed, it is first important to understand your risk factors. Risk factors include the use of blood thinners (ex. Aspirin, Plavix, Coumadin, Eliquis, Xarelto), genetic diseases that increase your risk of bleeding (hereditary hemorrhagic telangiectasia), coagulation disorders, kidney disease, liver disease, chronic use of nasal oxygen, uncontrolled high blood pressure, or even having your heat on during the winter months. If you are at high risk, you will want to use more aggressive measures to prevent nosebleeds relative to those who do not have a lot of risk factors.
One way to prevent nosebleeds, is to optimize your environment both inside and outside your nose. Pay attention to the air around you and your nose. When it is dry outside or dry inside your nose - it is important to find ways to humidify the conditions when possible. For example, sleeping with a humidifier in your room at night (especially when the heat is on) can be helpful. When your nose is dry, applying Vaseline (a pea size amount to each nostril) when you wake up and before you go to bed can be helpful. You may also want to try a salt water spray (available over the counter at most drug stores) which you can spray in your nose every 2-4 hours as you are able when awake.
You will also want to minimize trauma to your nose - especially the front part of your nasal septum where many blood vessels are located. Try to avoid picking your nose, wiping your nose aggressively or forceful blowing of your nose - especially if you are at high risk of having a nosebleed or recently had a nosebleed.
Key Takeaway Messages
Nosebleeds are common
Gather your supplies (afrin nasal spray), so you are ready to treat your nosebleed when it occurs
When having a nosebleed, apply pressure to the fleshy part of your nose
Keep your nose moist (Vaseline and salt water nasal spray)
If you cannot control your nosebleed, go to your local emergency department and let the emergency room doctor or the ear, nose and throat doctor take care of you