Introduction
A nose bleed is a fairly common problem, especially among children and the elderly. It can be very inconvenient and embarrassing, not to mention create a great mess. In most cases the bleed is a small one that can be controlled fairly easily with pressure and other measures. However, large, recurrent and difficult-to-stop nose bleeds can be quite serious, and in some cases could lead to the need to attend hospital to have the problem addressed.
Causes
There are many causes for nose bleeds. Among children (and some adults) the cause is often related to simple trauma to the front of the nose. In this region of the nose there are some delicate blood vessels that are easily ruptured. Medical conditions such as high blood pressure and inherited bleeding problems can also contribute while in rare cases a nose bleed can be an indication of a serious problem such as a cancer or other growth in the nose.
Many nose bleeds are made worse by the use of medications and natural supplements that increase the tendency to bleed. “Blood thinners” such as aspirin, warfarin and clopidogrel are used to manage the risk of stroke, heart problems and clots. These medicines act to prevent the formation of clots and as a consequence they can lead to prolonged bleeding. In people who take these types of medications that then suffer a nose bleed it can prolong the bleed and lead to the need for medical attention.
Similarly, natural products like fish oil, garlic and St John’s wort can also act to thin the blood and increase bleeding risk. They may contribute to the tendency to develop a nose bleed while they also impact the ability to stop the bleed once it is active.
Symptoms
The symptoms are usually that of a bleeding from the nose alone. In some instances, it can lead to coughing up or even vomiting blood.
Diagnosis
A thorough medical history and a complete examination of the nose can often help identify the problem. In some cases, blood tests to check clotting ability, scans and other tests may help to define the problem.
Treatment
There are a number of options available to people experiencing nose bleeds and, in most cases, they can be remedied quite easily. Some people require advice only while others may need to consider particular medications for the nose to reduce the risk of bleeding.
People who are experiencing nose bleeds due to medical conditions and medications such as blood thinners should seek advice from their medical professionals and ENT surgeon before altering or stopping any medications as there may be very serious consequences when changes are made without proper advice.
In some instances, the cause of the bleeding may need to be addressed surgically. “Nasal cautery” is a common technique for correcting the blood vessel responsible. Other more complicated surgical techniques may be required in some cases. Dr Morrissey can further inform you as to the interventions that may best address your particular situation.
Prevention
There are a few simple measures that can help prevent a nose bleed. These include:
- Avoid trauma to the nose (especially picking);
- Avoid blowing the nose hard after a bleed as it may recommence the bleeding. Usually 3-4 days is required as a minimum to heal the nose sufficiently to allow for blowing of the nose;
- Products such as Nozoil, Nasalate cream and Vaseline can be used on the nose to keep it moist. A dry nose tends to bleed more readily.
Nose Bleed First Aid
When a nose bleed commences, there are some things that can be done in order to stop the bleed. Firstly, try to stay calm. Becoming anxious will increase your heart rate and blood pressure and lead to more bleeding. Secondly, position yourself in a comfortable sitting position, leaning forward and allowing the blood to run out the front of the nose. Then try the following measures to stop the bleed:
- Pinch the soft part of the lower nose firmly to stop the bleeding.
- Hold the pinch without letting go for 10 minutes;
- After 10 minutes, let go and if the bleeding recommences repeat the same process for another 10 minutes.
- Place a cold pack on the forehead or neck while pinching the nose; and
- Try not to swallow blood as it will make you feel really sick, and in some cases lead to vomiting.
Once the bleeding has stopped. The following measures can aid recovery and reduce the chances of a further bleed:
- Avoid heavy lifting, bending and straining for 1-2 weeks;
- If you need to sneeze, do so through an open mouth;
- Avoid blowing the nose for 3-4 days;
- Clean the nose gently with a saline nasal spray, available from most pharmacists; and
- Avoid hot foods, drinks and hot showers in the 3 days after the bleed as these things may recommence the bleeding.
If the bleeding fails to settle after around 20 minutes, can’t be controlled with simple nasal pressure, is especially profuse or you are worried for any other reason seek medical attention promptly via your nearest emergency department. You should not drive with an active nose bleed, so if there is nobody to drive you then do call an ambulance.
