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 even more.

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.


Where 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 prevent nosebleeds?

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.