What Causes Nosebleeds?
The vast majority of nosebleeds are caused by the inside of the nose becoming
too dry. This dryness can cause the mucosa (the moist lining of the nose)
to become thin and somewhat fragile. Small blood vessels (called capillaries)
lie just underneath the mucosa, and these can rupture and bleed when the
overlying mucosa is thin. Nosebleeds are more common in older persons
both because the mucosa becomes thinner and more fragile as we age, and
also because the mucous glands in the nose work less well, resulting in
a drier nose overall. The dryness factor is also why nosebleeds are more
common in the winter, both because the air itself is somewhat drier, and
also because heating the air in our homes and offices lowers its humidity
Although many people with nosebleeds worry about possibly having a tumor
in their nose, this is extremely rare. One exception would be a teenage
boy with recurrent nosebleeds. In this case, there would be a slight possibility
of a rare tumor called a nasal angiofibroma, which is curiously only seen
in teenaged boys.
is the bleeding coming from?
Although for some reason many people seem to think their bleeding is coming
from high up in the nose, in fact, most nosebleeds come from low down
in the nose along the septum, which is the thin piece of cartilage that
divides the nose into two sides. The reason for this is that the mucosa
on the septum is particularly thin, leaving the capillaries particularly
vulnerable in this area.
What’s the best way to
stop a nosebleed?
Stopping a nosebleed requires a little common sense, a little knowledge
of the nose, and sometimes, a little pharmacology. First, keep your head
as high as possible. Elevation of the head above the level of the heart
reduces blood flow to the nose. Second, lean forward so that the blood
drips out of the front of your nose and not the back. Blood dripping down
the back may cause you to cough, which raises your blood pressure. Third,
now that you know that most nosebleeds come from the front of the septum,
you can apply direct pressure to this area by squeezing the nostrils together
(breath through your mouth!). Holding pressure like this for a few minutes
will stop most nosebleeds. If it does not, soak the side of the nose that’s
bleeding with any over-the-counter decongestant spray and hold pressure
again. An even better way is to soak a cotton ball or a rolled up piece
of tissue paper with the decongestant and then put that in the bleeding
nostril and hold pressure. If all of these fail, you’ll need to
call your doctor or go the Emergency Department.
What can be done to
Everything you can do to keep your nose moist will help to prevent nosebleeds.
This would include using nasal saline spray (3 sprays each nostril 3 times
a day) and using a humidifier at night. For maximum benefit, the humidifier
should be placed in the bedroom and run 24 hrs a day if possible, with
the bedroom door shut. If you can’t run the humidifier during the
day, turn it on as soon as you get home from work, as it takes about 6
hrs to achieve maximum humidification. A small, battery-operated hygrometer
(a device that measures humidity) is helpful to monitor humidity levels
in the winter. Radio Shack sells a nice one for $29.99. Finally, if you
are prone to nosebleeds, applying petroleum jelly to your septum twice
a day helps a lot. A Q-tip is necessary to do this right, as it needs
to be applied directly to the septum about 2/3 of an inch back.
When should you see
a doctor about nosebleeds?
If you are having a significant nosebleed once a week or more, it would
probably be helpful to visit an otolaryngologist. Sometimes, if the bleeding
is coming from a small blood vessel, it can be cauterized in the office
and the problem fixed. However, beware of anyone telling you that your
nosebleeds are because of a “deviated septum”. The truth is,
almost everyone’s septum is deviated to one side or the other, but
only in rare cases does this cause nosebleeds.