Overview:
Most nosebleeds are not usually serious and can be stopped with home treatment. Most nosebleeds occur in the front of the nose (anterior epistaxis) and involve only one nostril. Some blood may drain down the back of the nose into the throat. Many things may make a nosebleed more likely.
The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose. Crusts can form that bleed when irritated. Nosebleeds occur more often in the winter, when cold viruses are common and indoor air tends to be drier.
Most nosebleeds occur on the front of the nasal septum. This is the piece of the tissue that separates the two sides of the nose. This type of nosebleed can be easy for a trained professional to stop. Less commonly, nosebleeds may occur higher on the septum / deeper in the nose. Such nosebleeds may be harder to control. However, nosebleeds are rarely life-threatening.
- Changes in the environment. For example:
- Cold, dry climates; low humidity
- High altitude
- Chemical fumes
- Smoke
- Injury to the nose. For example:
- Hitting or bumping the nose
- Blowing or picking the nose
- Piercing the nose
- An object in the nose. This is more common in children, who may put things up their noses, but may be found in adults, especially after an automobile accident, when a piece of glass may have entered the nose.
Definition:
A nose fracture is a break in the bone or cartilage over the bridge, or in the sidewall or septum (structure that divides the nostrils) of the nose.
Alternative Names:
Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture
Causes:
Nosebleed can be caused by:
- Irritation due to allergies, colds, sneezing or sinus problems.
- Very cold or dry air.
- Blowing the nose very hard, or picking the nose.
- Injury to nose, including a broken nose, or an object stuck in the nose.
- Deviated septum.
- Chemical irritants.
- Overuse of decongestant nasal sprays.
Repeated nosebleeds may be a symptom of another disease such as high blood pressure, a bleeding disorder, or a tumor of the nose or sinuses. Blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, may cause or worsen nosebleeds.
Symptoms:
- Blood coming from the nose.
- Bruising around the eyes.
- Difficulty breathing through the nose.
- Misshapen appearance (may not be obvious until the swelling goes down).
- Pain.
- Swelling.
The bruised appearance usually disappears after 2 weeks.
Considerations:
A fractured nose is the most common fracture of the face. It usually occurs after an injury and often occurs with other fractures of the face. Sometimes a blunt injury can cause the wall dividing the nostrils to separate.
Nose injuries and neck injuries are often seen together. A blow that is forceful enough to injure the nose may be hard enough to injure the neck.
Serious nose injuries cause problems that need a health care provider’s attention right away. For example, damage to the cartilage can cause a collection of blood to form inside the nose. If this blood is not drained right away, it can cause an abscess or a permanent deformity that blocks the nose. It may lead to tissue death and cause the nose to collapse.
For minor nose injuries, the health care provider may want to see the person within the first week after the injury to see if the nose has moved out of its normal shape.
Sometimes, surgery may be needed to correct a nose or septum that has been bent out of shape by an injury.
Who’s At Risk:
Those people living in cold, dry climates; those who suffer from colds and/or use nasal sprays; those with certain medical conditions, such as bleeding abnormalities; and those who disturb the blood vessels in the nose by picking are prone to nosebleeds.
Additionally, people who participate in strenuous activity or exercise, such as athletes, are prone to nosebleeds.
First Aid Guide:
The following self-care measures are recommended:
- Have the person suffering the nosebleed sit upright and lean forward. He/she should breathe out of his/her mouth.
- If there are any clots in the nostril, have the person gently blow them out.
- Firmly pinch the soft part of the nose, and place a cold compress on the bridge of the nose. This should be done continuously for 15 minutes. Do not release the pressure on the nose.
- If the person’s nose is still bleeding, repeat the above steps one more time.
Note: If the person’s nose is still bleeding after repeating the above steps one time, seek medical care.
In the case of an object lodged in the nose, removing the object promptly is important in avoiding infection as well as the possibility of the object moving further back into the nose. The below self-care measures should be attempted to remove the object.
- Determine which nostril is affected.
- Put gentle pressure on the opposite nostril using 1 finger.
- Have the person blow their nose.
- Encourage the person to sneeze by having him/her sniff pepper.
Note: Do not stick anything in the nose (eg, tweezers, pliers) to attempt to pull out the object.
In the case of a suspected broken nose, seek medical care. While awaiting medical care, the following self-care measures can be followed:
- Have the person breathe out of his/her mouth.
- Have the person sit upright and lean forward to help keep blood from going down the back of the throat.
- Apply a cold compress to the nose.
Note: Do not attempt to straighten a broken nose.
How to stop a nosebleed:
Follow these steps to stop a nosebleed:
- Sit up straight, and tip your head slightly forward.Note: Do not tilt your head back. This may cause blood to run down the back of your throat, and you may swallow it. Swallowed blood can irritate your stomach and cause vomiting. And vomiting may make the bleeding worse or cause it to start again. Spit out any blood that gathers in your mouth and throat rather than swallowing it.
- Use your thumb and forefinger to firmly pinch the soft part of your nose shut. The nose consists of a hard, bony part and a softer part made of cartilage. Nosebleeds usually occur in the soft part of the nose. Spraying the nose with a medicated nasal spray (such as Afrin) before applying pressure may help stop a nosebleed. You will have to breathe through your mouth.
- Apply an ice pack to your nose and cheeks. Cold will constrict the blood vessels and help stop the bleeding.
- Keep pinching for a full 10 minutes. Use a clock to time the 10 minutes. It can seem like a long time. Resist the urge to peek after a few minutes to see if your nose has stopped bleeding.
- Check to see if your nose is still bleeding after 10 minutes. If it is, hold it for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of direct pressure.
- Put a light coating of a moisturizing ointment (such as Vaseline) or an antiseptic nasal cream inside your nose. Do not blow your nose or put anything else inside your nose for at least 12 hours after the bleeding has stopped.
- Rest quietly for a few hours.
When to Contact a Medical Professional:
Get emergency care if:
- Bleeding does not stop after 20 minutes.
- Nose bleeding occurs after a head injury. This may suggest a skull fracture, and x-rays should be taken.
- Your nose may be broken (for example, it is in odd shape after a hit to the nose or other injury).
Call your doctor if:
- You or your child has repeated nosebleeds.
- Nosebleeds are occurring often.
- Nosebleeds are not associated with a cold or other minor irritation.
Home Care:
To stop a nosebleed:
- Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for a full 10 minutes.
- Lean forward to avoid swallowing the blood and breathe through your mouth.
- Wait at least 10 minutes before checking if the bleeding has stopped. Be sure to allow enough time for the bleeding to stop.
It may help to apply cold compresses or ice across the bridge of the nose. Do NOT pack the inside of the nose with gauze.
Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed. If bleeding persists, a nasal spray decongestant (Afrin, Neo Synephrine) can sometimes be used to close off small vessels and control bleeding.
Things you can do to prevent frequent nosebleeds include:
- Keep the home cool and use a vaporizer to add moisture to the inside air.
- Use nasal saline spray and water-soluble jelly (such as Ayr gel) to prevent nasal linings from drying out in the winter.
Prevention:
The following tips may reduce your risk for developing nosebleeds.
- Use saltwater (saline) nose drops or a spray.
- Avoid forceful nose-blowing.
- your finger in your nose to remove crusts.
- Avoid lifting or straining after a nosebleed.
- Elevate your head on one or two pillows while sleeping.
- Apply a light coating of a moisturizing ointment, such as Vaseline, to the inside of your nose.
- Limit your use of aspirin and non steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen, such as Tylenol, may be used to relieve pain. Be safe with medicines. Read and follow all instructions on the label.
- Use prescription blood thinners, such as warfarin (such as Councilman), enoxaparin (Lovenox), and clopidogrel (Plavix) as instructed by your doctor.
- Do not use nonprescription antihistamines, decongestants, or medicated nasal sprays. These medicines can help control cold and allergy symptoms, but overuse may dry the inside of the nose (mucous membranes) and cause nosebleeds.
- Keep your blood pressure under control if you have a history of high blood pressure. This will help decrease the risk of nosebleeds.
- Do not smoke. Smoking slows healing. For more information, see the topic Quitting Smoking.
- Do not use illegal drugs, such as cocaine or amphetamines.
Make changes in your home
- Humidify your home, especially the bedrooms. Low humidity is a common cause of nosebleeds.
- Keep the heat low [60°F (16°C) to 64°F (18°C)] in sleeping areas. Cooler air does not dry out the nasal passages.
- Breathe moist air, such as from a shower, for a while if your nose becomes very dry. Then put a little moisturizing ointment, such as Vaseline, inside your nostrils to help prevent bleeding. But do not put anything inside your nose if your nose is bleeding. Occasional use of saline nasal sprays may also help keep nasal tissue moist.
Prevent nosebleeds in children
- Keep your child’s fingernails trimmed, and discourage nose-picking.
- Caution children not to put any object in their noses.
First Aid – Do’s:
- Sit upright and tilt your head slightly forward. Pinch the soft part of your nose by applying pressure using thumb and a finger. Pinching sends pressure to the bleeding point on the nasal septum and often stops the flow of blood.
- Breathe through your mouth while the nostrils are pinched.
- After 10 minutes, check if the bleeding has stopped by releasing the pressure. If the bleeding hasn’t stopped, reapply the pressure for another 10 minutes.
- Apply an ice pack to your nose and cheeks. Cold will constrict the blood vessels and help stop the bleeding.
- Once the bleeding has stopped, rest quietly for a few hours.
- Crying may worsen the bleeding by increasing the blood flow to the face. If your child has a nose bleed and crying, reassure the child to keep calm and relaxed.
First Aid – Don’ts:
- Don’t pick or blow your nose.
- Don’t speak, swallow, cough, or sniff because this may disturb blood clots (if any) formed in the nose.
- Don’t allow the head to tilt back. This may allow the blood to run down the throat causing vomiting.
- Don’t bend down for several hours after the bleeding episode.