Nosebleeds are not uncommon—60% of all people in the US have had at least one, and they are far more frequent during the winter. Cold outdoor air and heated homes dry out nasal membranes, causing the delicate blood vessels they contain to rupture. The use of nasal cortisone mists and decongestant sprays adds to the dryness and irritation, making bleeding even more likely.
Nose-picking is the second most common cause of epistaxis (nosebleeds), especially in children. Other causes include sinus infections and the use of anticoagulants or medications that have a blood-thinning side effect, such as aspirin and ibuprofen. Rarer causes of nosebleeds include platelet disorders that impair blood-clotting: leukemia, hemophilia and liver damage, which is often the result of long-term alcohol abuse.
If you have a nosebleed, sit down and lean forward so the blood will drain out of your nose and into a washcloth, not down the back of your throat. Firmly pinch the soft part of your nose above your nostrils, squeezing against the bony ridge of your nasal bridge. Hold for at least five minutes, timing yourself. If bleeding persists, gently blow your nose, then spray each nostril with a nasal decongestant to constrict the blood vessels. Pinch your nose for 10 more minutes, this time with an ice pack or bag of frozen vegetables over your nasal bridge to slow blood flow. (You’ll have to tip your head back slightly for this.)
After the bleeding stops, avoid lifting, straining or harsh nose rubbing/blowing for a few days. Stay upright: Bending over puts pressure on the blood vessels in your nose and can lead to a rebleed. Report any nosebleed, even with successful home treatment, non-urgently to your medical provider if you take blood thinners, have a platelet disorder or develop symptoms of anemia—shortness of breath, lightheadedness, severe fatigue—from blood loss.
The following conditions require urgent evaluation: if you have significant trouble breathing during the nosebleed; if the amount of blood fills a measuring cup or lasts longer than 30 minutes; if you vomit from swallowing blood; if an injury caused the nosebleed; and if the sufferer is a child under the age of two. Emergency treatment usually includes cauterizing the bleeding vessels with silver nitrate or packing the nostrils with gauze.
To help prevent nosebleeds during winter months, run a humidifier in your bedroom to keep nasal passages moist. Apply a small amount of petroleum jelly shallowly into your nostrils with a cotton swab twice a day. You can also use nasal saline (spray, gel or drops) three times daily. (The drops can be made by boiling one quart of water with a teaspoon of salt for 20 minutes.) Stop smoking—smoke dries and irritates nasal passages. Keep your fingernails short and don’t pick your nose! If you want more information on nosebleeds go to: my.clevelandclinic.org.
Mary Jenkins is recently retired after nearly 40 years as a Family Practice physician in New York State.