If you’ve been tilting your head back to stop a nosebleed, you’ve been doing it wrong. Read on to learn the basics about nosebleeds and when you need to see a doctor.
Nosebleeds are a fairly common — and generally not too serious — occurrence. Though the first drops of blood may take you by surprise, a bloody nose doesn’t usually cause much harm. Occasionally, though, it can indicate a more serious condition. Here are the differences and what to do in each case.
Common — and not so common — causes
The tissue that lines the inside of the nose, which is full of small blood vessels, is prone to bleeding. These blood vessels help warm and humidify the air we breathe, so they sit close to the surface of the membrane. Nosebleeds often happen in the winter, when indoor air is heated and dry and mucus in the nose becomes crusty. A hearty sneeze or substantial nose blow may irritate the crusts and cause them to bleed. And while a nosebleed can occur in both nostrils, it usually just happens in one.
“A nosebleed occurs when a blood vessel in the nose is damaged and opens into the nasal cavity,” explains Elisabeth Ference, MD, MPH, an otolaryngologist at Keck Medicine of USC and assistant professor of clinical otolaryngology in the USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery at the Keck School of Medicine of USC. “Most often, nosebleeds are due to damage to vessels in the front of the nose along the middle wall, called the septum. Septum blood vessels bleed due to nasal dryness, trauma from picking the nose and irritation from allergies or colds. But a nosebleed can also occur, more dangerously, in the deeper tissue in the nose.”
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Nosebleeds that occur in the front of the nose are called anterior nosebleeds, while those in the deeper tissue in the back of the nose are called posterior. The latter are more common in older people and may stem from daily aspirin use, high blood pressure, bleeding disorders or atherosclerosis. They may also occur after a blow to the face and may signal internal bleeding. In a posterior nosebleed, the blood flow may start high in your nose and run down into your throat. If any of these circumstances apply to you, seek medical attention for your nosebleed right away. Your doctor will be able to tell whether or not it’s serious.
Frequent nosebleeds may indicate an underlying medical condition, such as a deviated septum. The septum, comprising bone and cartilage, divides the nasal cavity in two. The two sides are frequently unequal (deviated). A crooked septum can impact your sinus drainage, leaving you vulnerable to sinus infections, nosebleeds and difficulty breathing.
In addition, “If you’re on a medication such as aspirin, which decreases the ability of the body to make a blood clot, these nosebleeds can recur,” Ference says. “Other causes of recurrent nosebleeds can be more serious, including tumors or aneurysms.”
As with a posterior nosebleed, it’s essential to seek medical attention if you have frequent nosebleeds.
How to treat a nosebleed
Most of the time, it’s easy to stop a nosebleed. If it’s a regular one, Ference advises applying firm pressure on your nose in the area where the bones meet the cartilage. “You can find this by feeling along the sides of your nose and noticing where the hard area becomes softer. Hold the pressure for 10 minutes without stopping. You should sit up and lean forward, so blood will come out of your mouth instead of being swallowed.”
She adds that if you do swallow some blood, it’s nothing to worry about. “It isn’t dangerous, but it may upset your stomach and cause vomiting.” That’s not ideal when you’re trying to stop your nosebleed.
If the bleeding doesn’t stop after two 10-minute periods of firm pressure, you should go to your nearest emergency room, Ference adds.
When it does stop, “you can gently clean your nose with a saltwater spray, but do not pick out the clots, which could cause further damage,” she says. “You can put cotton in your nose, but be careful. Often when you pull it out, it can lead to more bleeding, or pieces of the cotton can get stuck in your nose and cause an infection.”
In most cases, prevention goes a long way. In the winter, when your heat is on, use a humidifier in the bedroom to moisturize the air while you sleep. When you sneeze, open your mouth. And if you’re a smoker, seek help in cutting down and stopping your cigarette intake.
by Deanna Pai