Winter Nose Bleeds
December 11, 2003

Dear HouseCall Docs,
Every winter I get nose bleeds - why is that?
Tanner – Sonora, CA

A nosebleed can be scary to get--or see—but when one occurs you should try to stay calm. Most nosebleeds look much worse than they really are. Most nosebleeds are not serious and occur in the front part of the nose and stop in a few minutes. Almost all nosebleeds can be safely treated at home.

The most common causes of nosebleeds are dryness (often caused by indoor heat in the winter) and nose picking. These two things work together--nose picking occurs more often when the mucus in the nose is dry and crusty and becomes irritating.

The most common location of nosebleeds is the small, superficial blood vessels located on the nasal septum. That is the thin area of tissue that separates the nostrils just inside your nose. These are relatively easy nosebleeds to control. The difficult ones to control are the ones located farther back or in the “posterior” portion of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, atherosclerosis, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed. They will more often require a trip to the emergency room because there is no way for direct pressure to control these.

Less common causes include injuries, colds, allergies or cocaine use. Children may stick small objects up the nose. Older people may have atherosclerosis ("hardening of the arteries"), infections, high blood pressure and blood clotting disorders, or they may be taking drugs like aspirin or coumadin that interfere with blood clotting. The cause of nosebleeds often can't be determined.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will make your nose bleed less. Lean forward so the blood will drain out of your nose instead of down the back of your throat or all over your shirt. If you lean back, you may swallow the blood. This can cause nausea, vomiting and diarrhea.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don't let go for at least 5 minutes. If it's still bleeding, hold it again for 10 straight minutes. If it continues to bleed after that, hold it continuously for 20 minutes. Avoid the temptation to keep checking during the squeezing period.

You can also place a cold compress or an ice pack across the bridge of your nose.
Once the bleeding stops, don't do anything that may make it start again, such as bending over or blowing your nose. If you need to sneeze try to let the air out through your mouth.
You'll need to get medical attention if a nosebleed goes on for more than 20-30 minutes, if it is severe and there is significant blood loss, or if it occurs after an injury, such as a punch in the face, especially if you think you may have a broken nose. A nosebleed after a fall or car wreck could be a sign of internal bleeding.

If your nosebleed persists your doctor may look into a couple of options…..

Cauterization involves using special solutions or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.

Packing the nose involves putting special gauze, or an inflatable latex balloon or sponge into the nose so that enough pressure is placed on the vessel to make it stop bleeding.

Tips on preventing nosebleeds
1. Keep the lining of your nose moist: Gently apply a light coating of petroleum jelly (brand name: Vaseline) inside your nose with a cotton swab twice a day.
2. Keep children's fingernails short to discourage nose picking.
3. Counteract the drying effects of indoor heated air by using a humidifier at night in your bedroom.
4.Quit smoking. Smoking dries out your nose and also irritates it.
If you have any questions please send them to us at docs@twainhartetimes.com. Until then stay healthy and happy.

Dr. Matt and Dr. Bob

Bob Uslander, MD and Matthew Personius, MD founded Sierra HouseCalls Medical Group, a local company providing at-home physician visits to the Tuolumne County area. Ph: 532-4287.

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