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Nosebleeds: Treatment, Causes and Therapy

Health Hub
Author name: Lee Health

Florida’s tourist season offers visitors from the Midwest, Eastern seaboard, and other wintry regions of the United States a break from cold, dry air—an all-too common factor of nosebleeds.

Cold air moving through the nose can dry and irritate the membranes that line the inside of the nose. Nosebleeds are more common in the winter—when cold viruses are prevalent and indoor air typically is drier—but they can happen in any season and for other reasons, too.

Seven in 10 people will have at least one nosebleed in their life. They’re more common in kids between 2 and 10 years old, and in adults older than 50.

Most nosebleeds look worse than they are. They can also be messy and uncomfortable but they’re rarely life threatening.

So don’t worry, in most instances. If you’re having nosebleeds but you’re unsure why, this information can help you find a solution.

Types of nosebleeds

Michael Horowitz, M.D., a board-certified neurosurgeon with Lee Physician Group, says while most nosebleeds are harmless and easily treated, the more serious cases of nasal bleeding involve repeat bouts that resist treatment and prevention.

“Ten percent of nosebleeds can be considered serious events because they can lead to airway obstruction from blood in the throat, breathing blood into the lungs, and significant blood loss,” he says.

Dr. Horowitz says there are two types of nosebleed, or epistaxis as it’s known medically:

  • Most nosebleeds occur in the front part of the nose where the septum—the wall separating your nostrils—is rich with blood vessels. This type of nosebleed responds to remedies like applying pressure over the affected area.
  • Posterior nosebleeds typically occur much deeper in the nose. These nosebleeds usually produce gushing blood from both nostrils and may also bleed into the throat. They’re less common, last longer, and more difficult to control than anterior nosebleeds.

How to treat a nosebleed

  • To slow bleeding, sit upright to reduce the pressure in your nose.
  • Tip your head forward to avoid swallowing blood.
  • Pinch the soft part of your nose (just below the bony part) and breathe through your mouth for about 10 minutes.
  • If your nose still bleeds after 10 minutes of pressure, pinch it for an additional 10 minutes. If the bleeding continues, contact your doctor.
  • Once the bleeding has stopped, don’t pick or blow your nose. Also, avoid bending forward.

What causes a nosebleed?

  • Picking your nose or rubbing it too hard
  • Very cold or heated air that dries out the inside of your nose.
  • Allergy medicines, decongestant nasal sprays, or other medications
  • Colds, sneezing, sinus or respiratory infections
  • Chronic sinusitis or rhinitis
  • Environmental irritants

Posterior nosebleeds typically require advanced treatment approaches, according to Dr. Horowitz. Blood thinners such as Warfarin and Plavix, and even aspirin, can cause or worsen posterior nosebleeds. Other causes include high blood pressure, blood clotting disorder, and arteriovenous malformation (AVM).

“AVM is an abnormal tangle of blood vessels connecting arteries and veins,” Dr. Horowitz explains, who is also a neuroendovascular surgeon. “Nosebleeds are common manifestations of genetic disorder called Osler-Weber-Rendu Syndrome, which affects about 1 in 5,000 people. But whatever the cause of any recurrent and excessive nosebleeds you’re having, see your doctor for evaluation and treatment. Treatment options are available.”

Endovascular treatment: One and done

For the appropriate patient, Dr. Horowitz says endovascular therapy offers a sound treatment option for controlling excessive nosebleeds.

The procedure is painless, minimally invasive, and quick.

For patients undergoing endovascular surgery on a non-emergent basis, the procedure doesn’t require a hospital stay or follow-up, either.

When to see your doctor

 You should call the doctor or visit the emergency department if:

  • You feel dizzy, weak, or faint (like you might pass out).
  • Your nose is bleeding fast or you seem to be losing a lot of blood.
  • You just started taking a new medicine.
  • You have other symptoms like unusual bruising on your body.
  • You are bleeding for a long time after you get hurt.
  • You are bleeding from other areas of your body, such as your gums.

Michael Horowitz, M.D., a neurosurgeon and neuroendovascular surgeon with Lee Physician Group, is board-certified in neurosurgery. Dr. Horowitz completed both a general surgery internship and a neurological surgery residency at the University of Pittsburgh Medical Center, in Pittsburgh. He completed a fellowship in neuroendovascular surgery/interventional neuroradiology at the University of Texas Southwestern Medical Center, in Dallas. Dr. Horowitz has specialized interests in vascular neurology, stroke, cranial nerve disorders, brain tumors, and hydrocephalus.

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