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Doctor, explain
nosebleeds
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What causes a
nosebleed?
Most nosebleeds
(epistaxis) are
mere nuisances.
But some are
quite
frightening, and
a few are even
life
threatening.
Physicians
classify
nosebleeds into
two different
types.
Anterior
nosebleed:
Most nosebleeds
begin in the
lower part of
the septum, the
semi-rigid wall
that separates
the two nostrils
of the nose. The
septum contains
blood vessels
that can be
broken by a blow
to the nose or
the edge of a
sharp
fingernail. This
type of
nosebleed comes
from the front
of the nose and
begins with a
flow of blood
out one nostril
when the patient
is sitting or
standing.
Posterior
nosebleed:
More rarely, a
nosebleed can
begin high and
deep within the
nose and flow
down the back of
the mouth and
throat even if
the patient is
sitting or
standing |
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Which
type of
nosebleed
did I
have?
Obviously,
when the
patient
is lying
down,
even
anterior
(front
of nasal
cavity)
nosebleeds
may seem
to flow
posteriorly,
especially
if the
patient
is
coughing
or
blowing
his
nose.
It is
important
to try
to make
the
distinction
since
posterior
(back of
nasal
cavity)
nosebleeds
are
often
more
severe
and
almost
always
require
a
physician's
care.
Posterior
nosebleeds
are more
likely
to occur
in older
people,
persons
with
high
blood
pressure,
and in
cases of
injury
to the
nose or
face.
Anterior
nosebleeds
are
common
in dry
climates
or
during
the
winter
months
when
heated,
dry
indoor
air
dehydrates
the
nasal
membranes.
Dryness
may
result
in
crusting,
cracking,
and
bleeding.
This can
be
prevented
if you
place a
bit of
lubricating
cream or
ointment
about
the size
of a pea
on the
end of
your
fingertip
and then
rub it
inside
the
nose,
especially
on the
middle
portion
of the
nose
(the
septum).
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What are my treatment
options? Many
physicians suggest any
of the following
lubricating creams or
ointments. They can all
be purchased without a
prescription: Bacitracin,
A and D Ointment,
Eucerin, Polysporin, and
Vaseline. Up to three
applications a day may
be needed, but usually
every night at bedtime
is enough. A saline
nasal spray will also
moisten dry nasal
membranes.
If the nosebleeds
persist, you should see
your doctor. Using an
endoscope, a tube with a
light for seeing inside
the nose, your physician
may find a problem
within the nose that can
be fixed. He or she may
recommend cauterization
(sealing) of the blood
vessel that is causing
the trouble.
What about rebleeding?
 To
prevent rebleeding after
initial bleeding has
stopped:
- Do not pick or
blow nose.
- Do not strain or
bend down to lift
anything heavy.
- Keep head higher
than the heart.
- Use a humidifier
during dry winter
months.
If rebleeding
occurs:
- Attempt to clear
nose of all blood
clots.
- Spray nose four
times in the bleeding
nostril(s) with a
decongestant spray
such as Afrin or Neo-Synephrine.
- Perform steps 1
and 2 shown in the "To
stop an anterior
nosebleed" box in this
leaflet. Repeat these
steps as necessary.
- Call your doctor
if bleeding persists.
What causes my nose
to bleed?
- Allergies,
infections, or dryness
that cause itching and
lead to picking of the
nose.
- Vigorous nose
blowing that ruptures
superficial blood
vessels in the elderly
and in the young.
- Clotting disorders
that run in families
or are due to
medications.
- Fractures of the
nose or of the base of
the skull that can
cause bleeding and
should be regarded
seriously when the
bleeding follows a
head injury.
- Rarely, tumors
(both malignant and
nonmalignant) have to
be considered,
particularly in the
older patient or in
smokers.
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©
Arnaldo Garro, M.D. 2005
Any information provided on this
Web site should not be considered medical advice or a substitute for a
consultation with a physician. If you have a medical problem, contact your
local physician for diagnosis and
treatment.
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juan
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