Nose Bleeds

 I remember as a child having a nose bleed and my grandmother dropping a cold key down my back as part of the treatment to stop it.

Times have moved on a bit – for a start few doors have big enough keys to make any difference to body temperature! But for all the advances, nose bleeds are still very much a feature of life. One in seven people will develop a nose bleed at some time in their lives. Interestingly they occur more during the winter in dry, cold weather and statistics show they occur more often in the morning, although reasons for this haven’t yet been identified.

There is an official medical term for a nose bleed – epistaxis . The diagnoses of course is totally clear, blood flows down just one or sometimes both nostrils of the nose, and while nose bleeds might be common, nevertheless a severe nose bleed can be quite dramatic and even frightening.

Anterior nosebleeds are the most common type of nose bleed, originating from a blood vessel on the nasal septum in the front of the nose. Far less common are posterior nose bleeds, when the bleeding comes from an artery in the back part of the nose. Nose bleeds can occur at any age but are more common in children under 10 and adults between 50 and 80 years old. Posterior nose bleeds are far more common in older people than the young.

Causes of nose bleeds can vary considerable. Obviously a big bang to the nose can cause a nose bleed; but other causes can be exposure to dry air for prolonged periods; nasal and sinus infections; over vigorous nose blowing and even picking the nose. Certain medications can also predispose someone to nose bleeds, such as blood thinning medications.

Treatment is dependent on the severity of the nose bleed. Generally, it is important to remain calm and sit down, keeping still but sitting up straight, and lean slightly forward. If you tilt your head back this will cause you to swallow the blood. Pinch the nostrils together tightly and apply direct pressure with the thumb and index finger for around 10 minutes. This can seem a long time but it is important not to release the nostrils too soon.

For most simple nose bleeds this should be enough to stop the bleed. Once it has stopped, be careful not to aggravate the nose any further by nose blowing, or even sneezing if you can help it, for at least 24 hours.

Interestingly, ice packs do not help stop nose bleeds. If you live in a very dry home, it might be worth investing in a humidifier to keep the air moist. You can also buy nasal saline sprays and other medications to help tissue healing and to keep the nasal passages moist.

If the nose bleed seems severe, or simply won’t stop, then medical attention is needed. Sometimes the problem blood vessel may need to be cauterized (or sealed). This can be done with a local topical anaesthetic inside the nose and is often done through a chemical called silver nitrate. In more complicated cases, nasal packing can be used to stop the bleeding and promote clotting. Sometimes an antibiotic is also used.

Posterior nose bleeds are more serious and sometimes require admission to hospital. Treatments can include posterior nasal packing; a balloon nasal pack is common in these cases. Other treatments including surgical procedures.

How to treat a nose bleed is really a matter of common sense, but if in doubt then seek immediate medical advice; loss of blood should never be considered lightly.

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