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 front 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.
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).
What are my treatment options?
Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Ayr saline gel and Vaseline. We can give you specific treatment for your problem after you’ve been seen in the office. If the nosebleeds persist, we may use an endoscope, a tube with a light for seeing inside the nose, to find a problem within the nose that can be fixed with cauterization (sealing) of the blood vessel that is causing the trouble.
What about rebleeding?
To prevent rebleeding after initial bleeding has stopped:
Continue to apply Ayr saline gel or Vaseline to the septum at least 3 times per day for 2-3 weeks after the office visit
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.
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.