Some of you out there may have a medical conditions which make you bleed more than the average person. If this is true then hopefully you are already aware of the condition from your doctor.
Below are listed the usual suspects when it comes to developing regular or heavy nosebleeds. Plenty of these risk factors are avoidable now and in the future, so make sure you are prepared. You don’t want to be stuck without medical help, losing large volumes of blood from something that could have been prevented. Review the causes below as it is always better to be prepared and prevent disaster. Trying to fix something when it has already gone wrong is always much harder.
Sometimes, a nosebleed is bad enough to make you concerned but you don’t need to rush to the emergency room. The steps below are best to know about now rather than later so you can get the right help if you need to. If you have any of the following and are experiencing regular nosebleeds contact your family doctor and book an appointment.
1. If you have already been told that your blood can’t clot properly, because you have a condition such as haemophilia go see your doctor now. They may want to do further tests to see if your blood level has dropped too low.
2. Regular nosebleeds at any age. More than 10 a year is quite frequent.
3. A child under 2 years old has just one nosebleed. It is much rarer for an infant to have nosebleeds so it’s always safer and get them checked.
4. Symptoms or signs of low blood cell count, known as anaemia. If you start to feel light headed, look pale and feel your heart rate rising you likely don’t have enough blood in your circulation.
5. If you also start to have difficulty breathing then skip your family doctor and go to an emergency department. They will likely give you a transfusion so you have enough blood to carry the oxygen you need.
6. Coumadin, or Warfarin is a blood thinning drug that is taken by many people. If you currently take this medication and have lots of nosebleeds let your doctor know.
There are times, however, when you need to seek urgent attention to prevent further illness or even death. Don’t let this scare you! Although mortality is a possibility, it takes a long time to lose a worrying amount of blood from a nosebleed. Just make sure if the next points apply to you, the emergency room is your next stop.
1. Your nosebleed lasts longer than 20 minutes. If a clot hasn’t formed after this time or your technique to stop the bleeding is failing, then you need to think amount moving before any symptoms begin to develop.
2. Common sense. Regardless of what any guide might say don’t forget to follow your own common sense. Do you feel fine or not? Are you staring at an ever growing pool of blood that isn’t slowing down? Get to a hospital.
3. Any vomiting. If you think the bleeding has slowed or stopped and then you vomit up blood, it hasn’t. What has happened is that a clot in your nose is pushing all the fresh blood down the back of your throat and into your stomach. This counts as bleeding you can’t stop so don’t hesitate to seek medical attention.
4. Any strikes or blows to the head? If this has led to a nosebleed then you need to call an ambulance and get to hospital right away. They will do a CT scan to make sure that it is just a nosebleed and not anything more serious.
5. Feeling faint or dizzy? If your ability to stand up is affected in any way your blood level has dropped too far and you need a transfusion.
6. Any difficulty breathing. It’s so important we put it in both lists. If at any point during a nosebleed it doesn’t feel like you can breathe properly then get to hospital as quick as you can.
How to stop a minor nosebleed
Once you have read the emergency section above, and decided that it does not apply to you, you can move on to the steps listed below. The good news is that the following method will stop the majority of nosebleeds at home with no medical attention required so remember it well!
1. Sit down. You are going to need to hold position for at least 10 minutes, so make sure you are comfortable.
2. Now sit forward and pinch the top of your nose, just below the hard part of bone at the top.
3. Hold this pinch without checking for at least 5 minutes, catching any blood in a tissue.
4. By staying with your head leaning forward you can breathe easily through your mouth.
5. This also allows the blood to trickle through your nose instead of through your mouth and down your throat.
6. If it is trickling through your nose then you also know when the bleeding has stopped.
7. This is much better than checking to see if the bleeding has stopped by releasing your pinch. Letting the pressure off your nose leaves you at risk of breaking the clot and needing to start the process all over again.
8. To speed things up you can hold a bag of ice or frozen peas at the bridge of the nose, just above where you are holding.
9. Whatever you do don’t lie down! Not only will you start to swallow blood which could make you vomit you will also increase your blood pressure. A higher blood pressure could mean the clot never manages to stick leaving you waiting a very long time.
How hospitals deal with a major nosebleed
At hospital, they have instruments which allow clinicians to see the source of the bleed. This makes their job much easier than yours, as they will know if the actual bleeding point is being treated.
That being said, if you go to the emergency department they will likely make you carry out the above standard steps first whilst they get a treatment kit ready. If this manages to stop the bleed before they carry out a procedure then all the better!
If there seems to be a single, easily visible bleeding point when you have been examined staff will likely want to cauterize it. This means burning the wound but is a lot more tolerable than it sounds!
There are two ways that clinicians will try to cauterize in the hospital setting. The simplest way that you can also do this at home is with silver nitrate sticks. These sticks have the chemical compound in a small round blob at the end.
When you rub this inside your nose the silver nitrate reacts with the natural moisture in your nostril and causes a chemical burn. The issue with doing this at home is that you can’t see what you are doing. Without a guided aim you will have to burn a good portion of your nostril before the bleeding stops. Get some help if you can.
If they try and fail with silver nitrate in the emergency room then there are two routes they may go down. If the bleeding point has been located then they may use an electric cauteriser. This is definitely hospital-only equipment, so don’t try to make your own at home.
A thin metal device like a pen has two nibs at the end. The doctor will place these nibs on the bleeding point and press a button on the pen. This causes an electric current to pass through the bleeding area and the temperature skyrockets. It may sound extreme but barely stings but there is a bad smell of burning in your nose. The quick zap closes the wound and stops the bleeding much more effectively than silver nitrate.
Do Tampons Work?
The alternative goes by the trade name of Rapid Rhino and yes, they do look like tampons. These sticks of cotton have a small balloon inside them. This is blown up by hospital staff with water and a syringe. The internal pressure can feel quite uncomfortable but it does a very good job of blocking of the blood vessels to the nose. Once the blood flow has been reduced like this it is much easier for the blood to finally clot.
Using a tampon is similar, but has some differences you should be aware of. Obviously, they are designed to be inserted into a vagina, not your nose. They are designed to stop the flow of blood, but do this by swelling with absorbed blood. Tampons are very absorbent for these reasons, so initially they will not help with clotting, they will in fact speed up the bleeding. Once the tampon has become soaked with blood however, this will begin to clot and slow the bleed.
Make sure if you resort to using a tampon you lean your head forward otherwise nothing will be clotting! Bear in mind our other advice: a time limit of 20 minutes. If you have been failing to stop your bleed then don’t rely on a tampon to get to work. Try it by all means but once you hit the 20 minute mark start thinking about getting some medical attention.
What causes nosebleeds?
The inside of your nose is covered in a mucous membrane more fragile than the skin. If you live in a dry environment, hot or cold then you could be more susceptible to this drying out. The dry skin breaks easily, and this can happen if you smoke and have the habit of blowing out through your nose. Air conditioning is the main perpetrator of this outside of the natural environment.
This is a polite way of saying picking your nose. As already mentioned, the inside of your nose is covered in a thin mucous membrane. Repeated irritation of this skin by constantly picking your nose can cause it to tear.
There are lots of tiny blood vessels near the surface which break when this happens and they are the source of the bleeding. Luckily this is an easy problem to solve, just make sure you are not doing it absentmindedly!
Deviated Septum, i.e. a bent nose
You may have a nose that is not completely straight, either naturally from birth or because of an old injury. Either way, this means that your blood vessels will have to shape around the form of your nose. Any hard angles put strain on the blood vessels and make them more likely to break.
The allergies themselves do not affect your nose directly. They do, however, make the mucous glands in your nose more active, otherwise known as feeling nasally congested. When your eyes and nose are running from allergies such as hayfever you will naturally want to blow your nose. Just like picking your nose the repeated trauma can lead to a bleed.
Known thin blood disorders i.e. haemophilia
There are a variety of different thin blood conditions your doctor may have informed you of. If you have one of these conditions they are usually inherited so ask your parents if you don’t know already!
High Blood Pressure
Any increase in blood pressure will inevitably put pressure on your nasal blood vessels. If they get knocked or irritated, you are at greater risk of having a bad bleed on your hands.
Medication side effects
This drug is commonly used to treat pain, inflammation, and to reduce fever. It is widely used by many, but does increase your risk profile for bleeding in a number of ways. As well as simply thinning your blood which could lead to more frequent nosebleeds, aspirin can also irritate your stomach.
Blood thinners (anticoagulants), such as warfarin and heparin
These drugs are meant to thin your blood, usually so it is 250% thinner than average human blood. This lowers their risk of stroke and heart disease, but it does mean that you are more likely to bleed from small scuffs and scrapes. If you hit your head whilst taking a blood thinner get to a hospital even if there is no bleeding.
Cocaine is a chemical, and as such causes a chemical burn inside your nostrils. You might have seen the famous pictures from the 90s of celebrities with no septum (the middle of their noses) left! Aside from being an illegal substance, cocaine can leave permanent burn damage to your nose. Don’t use it.
Although you may not be able to develop thin blood without cause, you can induce it in yourself very easily! Alcohol is the number one way people thin their blood and increase their bleeding risk. Couple that with the fact that, as you drink more, your blood gets even thinner. This is a bad combination.
Alcohol makes you overconfident and increases the risk of accidents, especially head injury. Injuring your face can cause you to bleeding into your sinuses which is harder to stop than a standard nosebleed.
All of the above covers just short term drinking, but what happens if you drink a lot over a long period of time? We don’t have space to go into all the health risks of alcohol here but just know this: Your liver produces enzymes which enable your blood to clot. Drinking heavily over years can damage your liver’s ability to produce these enzymes. If your blood cannot clot, then a small nose bleed can quickly become a big problem.
Chemical irritants, such as ammonia
Ammonia is found in many household goods and has quite a distinctive smell. If you are doing lots of cleaning or working with chemicals, make sure to wear a breather mask to filter out the worst of the airborne chemicals.
Foreign body in the nose
This one is usually more for children, but it should be listed here so you know it’s a possibility! If a young child keeps having nosebleeds and maybe even complains of nasal pain there is a chance there is something stuck in their nose. Whether a bit of food or a piece of Lego, it’s best to have something like this removed by a doctor or nurse, depending on how far up it has become lodged!
Although this could be listed along with allergies, I have decided to include it in this list because it can be self-inflicted. Nasal sprays, when used correctly, should not increase your risk of having a bleed.
Some people with troubling allergies get into the habit of using the spray very frequently, sometimes more than five times a day. This is a learned behavior that makes the user feel better mentally rather than give any real medical benefit. In fact the repeated spraying of chemicals into the nose can damage the mucous membrane and cause further bleeding.
Directly to the nose
Although this can be serious, it’s more likely to be a simple frontal nosebleed. This is treated with the basic steps we have laid out for you.
To the head
If you have an impact or trauma to your head that causes a nosebleed, this is much more worrying. Head injury implies that the bleeding is coming from somewhere inside your head rather than your nose! It could be something minor like a bleed from your sinus or a more major arterial rupture. An impact that causes any bleed from your face needs to be investigated further in a hospital.
Do this even if you feel completely normal. There have been multiple cases of sudden death after a head injury that has not been investigated. Any head injury has the potential of causing a bleed in the brain, causing either a build of blood called a haematoma or a bleed in the lining covering the brain.
You can feel well even with either of these bleeds present in your brain. They can then suddenly get much worse, leading to losing consciousness, and even death. Go to your local hospital after any head injury to get the appropriate scan.
Having a viral infection in your sinuses. For the same reason as allergies and other irritations to the internal skin, having any infection, especially one that continues for a long time. Chronic sinusitis comes about after prolonged or repeated infection and leads to weakening of the mucous membrane and bleeding.
A Final Reminder
There are plenty of things you can be doing right now to lower your risk of a bleed. Fix risks first if you know about them already and make sure you know the correct way of stopping a simple bleed, rather than swallowing your blood like everyone else does! Do this and minor injuries and bleeds will remain no problem.