What’s Causing Your Nosebleed?

What is a nosebleed?

A nosebleed is when the tissue inside your nose starts to bleed. The medical name is epistaxis. Nosebleeds can happen at any age, but they’re most common in young children and older adults.

Most nosebleeds are caused by picking at the inside of your nose or simple impact, such as getting hit in the face with a ball. They can also be caused by breathing in too much dry air.

Though annoying and scary, they usually aren’t serious. Nosebleeds mostly stop on their own and don’t cause long-term harm. But there are ways to help stop the bleeding. If the bleeding doesn’t stop, you’ll need to see a doctor.

Most common symptoms

The main symptom is blood draining out of one nostril. If there’s a lot of blood, you might also taste some in your mouth. You may feel it in your throat as it drips down from the back side of the nose.

A bad nosebleed can make you feel lightheaded, weak, anxious, or confused.

Causes

There are many blood vessels in the nose, where multiple arteries come together to create a plexus, or a collection of small vessels. Because the blood vessels are small, and there are many of them, there is a greater chance of nosebleeds. Bleeding from the front of the nose is usually caused by this plexus.

Bleeding in the back of the nose most often starts with an artery called the sphenopalatine artery, or one of its branches.

The most common cause of a nosebleed is some kind of minor trauma to the nose, such as picking or itching the inside of your nose. You can also get a nosebleed from being hit in the nose, with a ball, for example.

It can also be caused by dry air. It is common in the winter because the air is less humid and people have their heat on, which dries out the air.

Though much less common, a nosebleed can be from a health or genetic condition that makes you bleed more easily.

If a child often has nosebleeds, it could be a sign of a genetic disorder. The most well-known disorder is hereditary hemorrhagic telangiectasia (also known as Osler-Weber-Rendu syndrome). This causes dilated and malformed blood vessels, making someone more likely to bleed. Other disorders that cause nosebleeds include hemophilia, von Willebrand disease, or platelet disorders.

What makes you more likely to get a nosebleed?

Other possible reasons you may be more likely to get nosebleeds include:

• Repeat sinus infections, which weaken blood vessels and increase inflammation in the nose.
• Taking blood thinners (including Aspirin and Coumadin).
• Liver disease.
• Emphysema with oxygen treatment at home. The oxygen can dry out your nose.
• High blood pressure. The condition puts more pressure on the blood inside your arteries.
• Genetic bleeding disorders.
• Taking certain dietary supplements that might reduce your ability to form blood clots. These include saw palmetto, ginseng, St. John’s wort, ginkgo biloba, kava, fish oil, evening primrose, garlic supplements, cranberry juice supplements, vitamin E, and echinacea.
• Tumors in the nose.

Next steps

The first thing you need to do is stop the nosebleed. There are two common mistakes people make when trying to stop a nosebleed. The first is pinching the bones at the top of the nose. The second is tipping your head backwards. Tilting the head back can cause you to swallow or inhale the blood into your lungs.

To stop a nosebleed, pinch the soft part of the nose, including the nostrils. Also, lean your head forward, which prevents blood from going down your throat. Swallowing blood can irritate the stomach. Pinch steadily for 5 to 15 minutes until the bleeding stops. It is very important to apply constant pressure for the pinching to work. You may need to do this twice to stop the bleeding.

If the bleeding is not stopping or you feel dizzy, weak, or confused, go to the ER. Also go to the ER if you have a bleeding disorder and experience a severe nosebleed. Depending on the situation, various procedures will likely be considered.

Treatment

A doctor will first try to identify where the bleeding is coming from. They might ask you to gently blow your nose to remove any clots and make it easier to view the nasal cavity. They may use a spray to constrict the blood vessels to slow the bleeding.

If a localized area of bleeding is identified, the doctor may cauterize (burn tissue) with a cotton-swab-like device with silver nitrate. This is one way to cauterize small blood vessels. Cauterizing the skin creates scarring that helps stop the bleeding. This only works if the bleeding is coming from one side of the nose. You can’t cauterize both sides.

The doctor might then try intra-nasal packing. They first spray an anesthetic, then insert a nasal tampon with a lubricating or antibiotic ointment up the nostril. The pressure should stop the bleeding.

If blood is coming from the back of the nose, the doctor may spray an anesthetic, then try a technique that uses a catheter (a very thin, flexible tube) and a wad of gauze. This helps pack the back of the nose.

If you are losing a lot of blood and have dizziness, weakness, changes in mental status, or changes in vital signs, you may need a procedure called surgical ligation. Under general anesthesia, the doctor will insert a tiny camera (an endoscope) to find the source of the bleeding.

Preventative tips

• Don’t pick or touch the inside of your nose.
• In colder months when the air is drier, use nasal saline spray or a humidifier to add moisture to the air.
• If you have more than one nosebleed, talk to your doctor about the supplements and medication you’re taking in case they could be the reason.