Family doctor

Overview

• Although common, nose bleeds can be frightening and in some cases endanger life. Anterior nose bleeds - those at the front of the nose are common and not as dangerous as posterior nose bleeds which occur at the back of the nose.
• Nose bleeds are usually caused by local irritation, injury or the drying out of the inside of the nose.
• First aid consists of applying pressure and measures to avoid restarting bleeding. Treatment may include application of ointments, stopping the use of Aspirin, or surgery in some cases.
• If a posterior nosebleed is suspected, medical help should be sought, especially if the sufferer is elderly.

What is a nose bleed?

While most nose bleeds cause only nuisance, they can be distressing and in some cases are life threatening. There are two main types of nose bleeds:

•   Anterior - the nosebleed comes from the front part of the nose and comes from one or the other nostril.
• Posterior - the nosebleed comes from deep in the nose and flows down the throat and mouth even when the person is sitting.

Nosebleeds in children and young people are usually the anterior type. The dividing wall at the front of the nose - the nasal septum - consists of thin, flat cartilage and bone separating the nostrils and nose into its two sides. The septum easily bleeds when damaged when knocked, scratched or even from frequent nose blowing.

As people get older they are more prone to nosebleeds from further back in the nose. These are more severe and can be difficult to control and stop. In older people, a posterior nose bleed can be life-threatening.

Whatever the age of the sufferer, it is important to try to make the distinction between the type of nosebleed, as posterior nosebleeds are often more severe and almost always require medical care.

What are nosebleeds caused by?

When the septum become dry and crusty, it is prone to bleeding. This is the most common cause of nose bleeds in children, usually from nose picking.

Anterior nosebleeds are common in dry climates or in winter, when nasal membranes crack and bleed as they become dried out.

A nose bleed may be from local causes - nose picking, injury or a broken nose or nasal surgery .

Disorders of blood clotting may occasionally cause nose bleeds.

Nosebleeds relating to nasal cancer are rare but should be considered in unusual or recurrent unexplained bleeding.

A common causative factor of spontaneous nose bleeds is the use of Aspirin.

In rare cases, some people with bleeding noses have a family history of bleeding disorders.

Posterior nosebleeds are more likely to occur in older people, people with high blood pressure, or following injury to the nose or face.

What are the symptoms of each type of nosebleed?

It is important to try to identify what type of nosebleed is occurring, since posterior nosebleeds are often more severe and almost always require medical attention

Anterior nosebleeds tend to bleed from the nostril, not down the throat and into the mouth. If the sufferer is lying down, an anterior nosebleed may seem to flow in both directions, especially if the person is coughing or blowing his nose.

Posterior nosebleeds will tend to flow down the throat and into the mouth, whether the sufferer is upright or lying down.

What is the initial first aid treatment for a nosebleed?

Initial first aid for a bleeding nose is simple:

•   apply pressure to stop bleeding(to the front soft part of the nose,not the bony top)
• apply cold pack
• avoid restarting bleeding

Apply pressure by pinching the nose with the first two fingers and thumb, pressing gently back towards the face. Continue this pressure for 5 minutes(continuously), timed by a clock if necessary.

If possible, have the sufferer stand, or sit and lean forward, to stop blood flowing back down the throat. Aim to have the head above the level of the heart.

If blood continues to flow down the throat it may indicate a posterior nosebleed and medical help should be sought.

To prevent the nose from bleeding again soon after stopping: do not pick or blow the nose (gentle sniffing is possible); do not strain or bend down or lift anything heavy; and keep the head higher than the heart.

If bleeding recurs soon after, clear the nose of all blood clots by sniffing inwards strongly; spray the nose with a decongestant spray (such as Afrin, Duration or Neo-Synephrin); and try applying pressure again as described above.

Seek medical advice if bleeding is not stemmed, or nose bleeds are recurrent.

What are the treatment methods?

For recurrent nosebleeds, antibiotic ointment may be applied to the inside of the nose to reduce crusting.

If the sufferer is taking Aspirin, it may be ceased for a couple of weeks until nosebleeds settle down. This needs to be discussed with the patient's doctor.

In some cases the blood vessels causing problems may be cauterised (sealed by burning) using silver nitrate, under a local anaesthetic. This procedure can be done by a general practitioner or ear, nose and throat specialist and does not usually cause significant discomfort.

If there is no obvious blood vessel in the front of the nose, the bleeding is probably from the back of the nose and is best dealt with by an ear, nose and throat specialist.

When should medical help be sought?

Seek medical help if:

•   bleeding can not be stemmed or continues to recur
• bleeding is rapid or blood loss is considerable
• the sufferer feels weak or faint (usually from blood loss)
• bleeding begins down the back of the throat rather than starting at the nose.

Posterior nose bleeds can be dangerous, especially in the elderly. Seek medical help immediately if a posterior nose bleed is suspected.

How can nose bleeds be prevented?

Anterior nosebleeds can be prevented by using a lubricating cream on insides of nostrils and the septum, dividing the nostrils. Apply a pea-sized dab per nostril up to three times a day if necessary, or just at bedtime. This may be especially effective in cold or dry climates, or when the sufferer has a cold or frequent sinus problems.

Suitable, easily available creams and ointments include Vicks Vaporub, Vaseline, Borofax ointment, A and D ointment and Mentholatum.

Surgery to cauterise a blood vessel which continuously begins bleeding may be recommended in some cases.