Nosebleeds: Your questions answered

Noses are delicate and bleed easily. Did you know the inside of the nose, both front and back, contains many blood vessels located close to the surface? Nosebleeds are common in young children as well as older adults.

 

Dr. Klein
Dr. Stephanie Klein, Chief Resident Physician, Family and Community Medicine

The Pulse sat down with Dr. Stephanie Klein, Chief Resident Physician, Family and Community Medicine at North York General Hospital, to answer commonly asked questions about nosebleeds.

Dr. Klein says there are two main types of nosebleeds depending on the location of bleeding. Those that come from the front of the nose are called anterior nosebleeds and comprise 90% of nosebleeds. These are the most common because the network of blood vessels known as “Kiesselbach's” plexus is easily exposed with nasal irritation. Many anterior nosebleeds can be managed at home by applying nasal pressure. 

The second type is called posterior nosebleeds and they involve bleeding from the back of the nose. While less common, they often are more severe and require medical intervention for bleeding to stop. 

1. Are nosebleeds serious?

The majority of nosebleeds will stop on their own with application of pressure to the front of the nose while leaning forward. However, there are some situations where bleeding is difficult to stop. If this is the case, proper evaluation by a physician is needed to help stop the bleeding. Factors that increase the risk of prolonged nose bleeding include the use of blood-thinning medications, having a bleeding disorder or having a nose bleed that comes from the back of the nose. 

2. When should you see a doctor?

You should see a doctor if the nosebleed does not stop despite adequate pressure on the nose for 20-30 minutes. You may require alternative treatments to stop the bleeding that can be best addressed in an urgent care centre or emergency department. You should also see a doctor if you have suffered a facial injury causing the nosebleed or if you have lost a lot of blood and begin to feel dizzy, faint, short of breath or have chest pain. If you experience many nosebleeds, you should also see your doctor for a checkup to identify and address any causes for their recurrence. 

3What will my doctor do for a nosebleed?

First, your doctor will ask you questions to try to determine a cause or contributing factors for the bleeding. If you have tried to put pressure to the front of the nose to stop the bleeding and have been unsuccessful, the next step includes blowing the nose to remove clots and allow for examination. Your doctor will attempt to find the area of bleeding and may apply a medicine called silver nitrate to the bleeding vessel. Other treatment options include medicines that constrict blood vessels such as lidocaine, epinephrine and tranexamic acid-soaked cotton balls within the nose. Your doctor may also stop bleeding with nasal packing, which is petroleum jelly-coated gauze or a nasal tampon that stays within the nose for 48 hours. 

boy with nosebleed
The first thing you should try to do when you have a nosebleed is gently blow your nose to remove any clots inside.


4What causes nosebleeds?

The most common causes of nosebleeds include

  • irritation from cold/dry air

  • allergies

  • infections causing repeated nose-blowing/rubbing

  • nose picking

  • facial injury

  • objects inserted into the nose

  • bleeding disorders

  • medications that thin the blood

  • substances that are inhaled through the nose


5. Tips on preventing nosebleeds?

Avoid precipitating factors such as nose picking and repeated nose-blowing/rubbing. It can be helpful to avoid nasal dryness by using a humidifier in the home during the winter months and keeping the nose moist by applying petroleum jelly inside. You should speak with your doctor if you are on a blood-thinning medication and get recurrent nosebleeds. Never stop your blood thinner without speaking to a doctor first. 

6. What should I do when I get a nosebleed?

  • The first thing you should try to do is gently blow your nose to remove any clots inside.

  • Then pinch the soft area at the front of your nose while leaning forward at the waist.

  • It is very important not to tilt your head back during a nosebleed. While it seems that tilting your head back may help to counteract gravity, it is more dangerous as it increases your risk of choking and swallowing lots of blood which can cause nausea and vomiting.

  • Hold pressure at the front of your nose for at least 15 minutes and do not let go until the time is up.

  • If you are still bleeding after 20–30 minutes, see a doctor.


7. Is there anything to do once the bleeding stops?

Once the bleeding stops, be sure not to retraumatize the nose. Avoid sticking anything inside the nose or blowing your nose vigorously. You can apply petroleum jelly if your nose feels very dry.

8. Are nosebleeds more common in winter?

Yes, they are. This is due to the dryer air that is irritating to the lining of the nose.

9. Can nosebleeds be a sign of a separate disease?

In some circumstances nosebleeds can be a sign of an underlying medical condition. These conditions may include severe liver disease, bleeding disorders and, rarely, a tumour within the nose.

This article first appeared in the April 2018 issue of The Pulse. 

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