Chronic nosebleeds can be the result of minor, temporary conditions but they can also indicate serious underlying health problems. Nosebleeds are classified as either anterior (just inside your nostrils) or posterior (from the back of the nose). The majority of nosebleeds are anterior, resulting from a damaged blood vessel in the septum.
Causes of Anterior Nosebleeds:
- Picking and blowing nose too hard
- Blocked or stuffy nose due to cold or flu
- Dry air
- High altitude
- Excessive use of nasal decongestants
- Nasal obstruction: either present from birth (congenital) or the result of an injury (deviated septum)
Posterior nosebleeds are more serious, as the bleeding originates from branches of arteries that supply blood to the nasal cavity. They are more common in adults than in children. If the blood flow is heavy, it can be a dangerous condition that requires medical attention.
Causes of Posterior Nosebleeds:
- Blow to the head or a fall
- Broken or injured nose
- Recent nasal surgery
- Hardened arteries (Atherosclerosis)
- Frequent use of aspirin and anticoagulants (Warfarin and Heparin)
- Tumor in the nasal cavity
- Blood clotting abnormality (Hemophilia or von Willebrand disease)
- Hereditary Hemorrhagic Telangiectasia (HHT), a genetic condition that affects the blood vessels
- High blood pressure
There are several at-home treatments you can do to stop a nosebleed if you don’t require medical attention. Sit upright and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 minutes. Lean forward and breathe through your mouth, as this will drain blood down your nose instead of down the back of your throat. You can also apply a soft ice pack (covered with a towel) to the bridge of your nose in order to slow down the bleeding. It is important to stay upright, instead of laying down, as this will reduce the blood pressure in the vessels of your nose and stop further bleeding.
Seek Medical Advice If:
- You take blood thinners or have a clotting disorder
- You have symptoms of anemia, like heart palpitations, shortness of breath, and a pale complexion
- Children under 2 years of age have nosebleeds (this is rare and can be serious)
- You have regularly recurring nosebleeds
Seek Emergency Medical Help Immediately If:
- Bleeding continues for more than 20 minutes
- The bleeding is heavy and you have lost a lot of blood
- You have difficulty breathing
- You are swallowing large amounts of blood and/or vomiting
- The bleed occurs after a serious injury to the head or nose
Medical Treatments for Chronic Nosebleeds:
- Cautery/Electrocautery – if the doctor can identify where the bleeding is coming from, they can do a minor procedure to seal the bleeding vessel.
- Nasal packing – if the doctor cannot identify the specific cause of bleeding, they may pack the nose with gauze or special nasal sponges to stop the flow of blood by applying pressure to the source of the bleeding. This procedure can be done with or without anesthesia.
- Ligation – a procedure using small instruments to tie off bleeding blood vessels in the back of the nose (posterior)
- Blood transfusion – your doctor may recommend this if you have lost a lot of blood
- Tranexamic acid – a medication that can reduce bleeding by helping your blood to clot
Recovery & Prevention
There are several precautions you can take to avoid recurrent nosebleeds and the need for medical attention. Avoid blowing or picking the nose, as well as heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot beverages for 24 hours after the bleed. Try to sneeze with your mouth open to reduce the pressure in the nose. Do not remove any crusts that form inside of the nose; although they may be unpleasant, it is a helpful part of the healing process. Additionally, avoid people with coughs and colds to avoid getting sick, which can worsen the condition.
If you or a loved one experiences chronic nosebleeds for which immediate medical attention is not necessary, schedule a consultation with Dr. Marc Dean.
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