Nosebleeds are often annoying for the people who have them regularly. They may occur due to trauma, infection, drying and due to the usage of nasal sprays and anticoagulants. Whatever may be the reason for their occurrence, some are easier to treat and some are quite difficult to locate and control. Let us understand how you can control and stop them when they occur.
Understanding the location of Nosebleeds
Modern Medicine divides the lining of the nose into a front portion, or anterior aspect, and a rear portion, or posterior aspect. Most nosebleeds (or “Epistaxis” in medical jargon) occur in the rich vascular plexus that underlies the thin, delicate mucus membrane along the front of the nasal septum (the “wall” between the two nostrils). These are typically easier to treat and prevent.
In older patients and those with significant hypertension (high blood pressure), the source of bleeding is frequently in the posterior aspect of the nose and along the much more complex, lateral nasal wall. These bleeds tend to be much more difficult to locate and control. Surgical intervention in these cases is not uncommon.
What are the Causes of Nosebleeds?
a. Trauma: There is a thin mucus membrane (mucosa) – the lining of the nose, which is perfectly designed to allow the flow of air through it; but activities like frequent nose-blowing, picking, rubbing and swabbing the nose to clean it can damage the delicate membrane and may lead to damage to the rich plexus of blood vessels beneath it. It is actually possible to “prick” a hole in the septum or even sidewall of the nose from frequent, repetitive trauma.
b. Drying: Nosebleeds are more common during summer due to the drying effects of air on the nasal mucus membrane that lead to cracking and disruption, thus in turn tearing or rupturing the underlying blood vessels.
c. Infection: Chronic staphylococcal (“Staph”) infections of the front portion of the nose (nasal vestibule—where the nose hairs arise) seem to cause nosebleeds in some cases. Much less commonly, chronic sinusitis can cause nosebleeds as well.
d. Prescription Nasal Sprays: Many prescription nasal sprays, like nasal steroids (Flixonase™, Nasonex™, etc) can create nosebleeds—usually mild, but occasionally severe. This is especially true in the presence of one of the other noted risk factors for nose bleeds.
e. Anticoagulants: Patients on anticoagulants (medication that “thins” the blood) including Aspirin, Warfarin, Coumadin, Plavix, etc., are at a significantly increased risk of nosebleeds and should be cautious enough to avoid any unnecessary trauma to the nose.
f. Hypertension: Patients with high blood pressure—especially the elderly—are at significantly higher risk of posterior nosebleed. The usage of anticoagulants in these patients may augment the risk even further.
How to Avoid Nosebleeds?
a. Nasal Douche: In lieu of nose blowing or other traumatic nasal cleaning rituals, saline irrigations of the nasal passages is safe. This will not increase the risk of nose bleeds. It is highly recommended to any patient with any chronic nasal condition, including repetitive nosebleeds.
b. Avoidance of trauma/manipulation: Avoiding trauma to the nose is an absolutely critical component of therapy for recurring or persistent nosebleeds. This includes avoiding any nose blowing, picking, or rubbing. For many people, nasal “cleaning” becomes subconscious and almost ritualistic. Such habits are very hard to break. Particularly in children, these behaviors frequently occur at night, while the child is asleep. Trimming the child’s finger nails short and placing socks over their hands seem to help.
c. Humidification: Keeping the lining of the nose moist significantly reduces the risk of bleeding as noted above. A humidifier or vaporizer next to the bed at night time can help achieve this.
d. Antibiotics: In some cases, a prescription antibiotic ointment that specifically treats staphylococcal infections can be prescribed.
A better understanding of the causes and preventive measures thus helps to prevent nosebleeds. However, if you find it difficult to control your problem, it is always better to approach a specialist as early as possible.