When a nosebleed is more than a nuisance
One of the most widespread physical complaints might be one of the most awkward: nosebleeds.
“They’re incredibly common,” said Courtney Miller, MD, an otolaryngologist with Cape Cod Ear, Nose and Throat Specialists in Hyannis. “Generally in little kids, it’s trauma from the fingers. In adults, it’s usually related to the dryness of the air or if they’re on blood thinners.”
And, yes, you would be right to interpret “trauma from the fingers” as nose picking. When you go after that booger or dried mucus in your nose, you can disrupt the lining underneath. “That lining is very thin and it’s adherent to the cartilage underneath. It doesn’t have much give,” Dr. Miller said. “[Nose picking] will just tear a tiny bit off or just create an abrasion, and then it can bleed.”
Most nosebleeds, or epistaxis, start in the front of the nose, or septum - the cartilaginous structure in the middle of the nose that divides the left and right nasal cavities, Dr. Miller said. “Less than 10 percent come from the back of the nose, and those tend to be more severe. They usually happen in people with smoking history or hypertension.”
Nosebleeds tend to be one-sided and flow from the front of the nose, she said. But if the bleed is coming from higher up in the nose, it may pour out both nostrils or go down the back of the throat. “That tends to be a bit more profuse – a little bit heavier – much harder to stop,” she said.
When to Seek Help
There are times when a nosebleed can be a sign of an underlying condition. For example, nosebleeds are rare in very young children, Dr. Miller said, and parents should consult their pediatrician. People on supplemental oxygen may get nosebleeds because the oxygen can irritate the nose.
Recurrent nosebleeds from one side could be a sign of a lesion or mass, mucosal melanomas or vascular tumors. And one issue tends to affect boys as they go through puberty: juvenile angiofibroma, a type of rare but usually benign vascular tumor.
“It’s basically a vascular tumor in the back of the nose and for some reason it only affects teenage boys,” Dr. Miller said.
If nosebleeds aren’t resolving with the normal measures, or are associated with pain or obstruction or persistent one-sided bleeding, seek help, she said.
How to Stop a Nosebleed
To stop a nosebleed, first try pinching the soft part of the nostrils – not the bony part – for at least 10 minutes, Dr. Miller said. That should do it for children. If the bleeding continues in an adult, try over-the-counter decongestants or nose spray such as Afrin or neosynephrine. You can repeat pinching for 10 minutes and spray up to three times, but if bleeding persists after that, you should go to urgent care or the emergency room, Dr. Miller said.
People on blood thinners are at higher risk for nosebleeds and may find them harder to control, she said. If a nosebleed seems unstoppable, doctors can help by packing the nose for three to five days to apply pressure on the bleed, or by cauterizing the spot with silver nitrate.
How to Prevent
What can you do to prevent nosebleeds? First, two things are critical: stopping smoking and treating high blood pressure, Dr. Miller said. Smoking leaves the blood vessels more fragile, making the bleeding harder to control. High blood pressure also makes the bleeding harder to control, according to a Korean study of more than 70,000 patients cited by the National Institutes of Health.
“Really for nosebleeds, humidification and hydration are the key,” Dr. Miller said. She suggests humidifiers for your home, as well as applying a saline solution spray or petroleum jelly to your nose at least twice daily in the winter to prevent crusting and bleeding.
“Sometimes nosebleeds are inevitable and they’re hard to predict – why did it crop up all of a sudden?” she said. “But trying to prevent it by increasing the humidity in the nose goes a long way.”
