Nosebleeds

The blood vessels within the nose lie very near the surface, and bleeding may occur with the slightest injury. In children, picking the nose is a common cause. Keeping their fingernails cut and discouraging the habit are good preventive measures.

Nosebleeds are frequently due to irritation by a cold virus or to vigorous nose blowing. The main problem in this case is the cold, and treatment of cold symptoms will reduce the probability of a nosebleed. If the mucous membrane of the nose is dry, cracking and bleeding are more likely.

Remember these key points:
a. You can almost always stop the bleeding yourself
b. The majority of nosebleeds are associated with colds or minor injury to the nose.
c. Treatment such as packing the nose with gauze has significant drawbacks and should be avoided if possible.
d. Investigation into the cause of recurrent nosebleeds is not urgent and is best accomplished when the nose isn't bleeding.

Follow these steps in case of nosebleeds:
1. Is the bleeding major, and does it continue after home treatment?

if YES: see doctor now!
if NO: proceed to #2.

2. Are nosebleeds recurrent and becoming more frequent?

if YES: make appointment with doctor.
if NO: proceed to #3.

3. Is the nosebleed associated with symptoms of a cold?

if YES: apply home treatment and see Colds and Flu
if NO: use home treatment

HOME TREATMENT

The nose consists of a bony part and a cartilaginous part:
a "hard" portion and a "soft" portion. The area of the nose that usually bleeds lies within the soft portion, and compression will control the nosebleed. Simply squeeze the nose between thumb and forefinger just below the hard portion of thenose. Pressure should be applied for at least five minutes. The patient should be seated. Holding the head back isn't necessary. It merely directs the blood flow backward rather thaan forward. Cold compresses or ice applied across the bridge of the nose may help.
Almost all nosebleeds can be controlled in this manner if sufficient time is allowed for the bleeding to stop. If it won't stop and bleeding is major, of course you should go to the emergency room.

Nosebleeds are more common in the winter when viruses and dry, heated interiors are common. A cooler house and a vaporizer to return humidity to the air help many people.

If nosebleeds are a recurrent problem, are becoming more frequent, and aren't associated with a cold or other minor irritation, a doctor should be consulted. A doctor need not be seen immediately after the nosebleed because examination at that time may simply restart the nosebleed.

*To stop a nosebleed, sit down and squeeze just below the hard portion of the nose. Hold for five minutes. It isn't necessary to tilt the head back.


WHAT TO EXPECT AT THE DOCTOR'S OFFICE

To stop bleeding, the doctor will seat the patient and compress the nostrils. This will be done even if the patient has tried this at home, and it will usually work.
If the nosebleed can't be stopped, the doctor will try to find the bleeding point in the nose. If a bleeding point is visible, the doctor may try to make the blood clot by searing the bleeding point with either electrical or chemical cauterization. If this isn't succesful, packing of the nose may be unavoidable. Such packing is uncomfortable and may lead to infection; thus the patient must be carefully observed.

If a doctor is visited because of recurrent nosebleeds, questions about events preceding the nosebleeds and a careful examination of the nose itself should be expected. Depending on the history and the physical examination, blood-clotting tests may be ordered on rare occasions.



Source: Take Care of Yourself by Vickery and Fries. 6th Ed.