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Nosebleeds

Epistaxis (nosebleeds) usually occur in the front (anterior) portion of the nose. A cluster of blood vessels is present on the anterior nasal septum, the wall of flesh seperating the two sides of the nose. 

Boy with bloody nose

These blood vessels are close to the surface of the thin membrane which covers the septum. They may crack and bleed with dryness of the nose, from self-induced nasal trauma, finger-picking at the nose and from engorgement of the vessels associated with a cold or allergy of the nose.

They occur more often in patients on anticoagulants (blood thinners), such as aspirin, and in dry climates as in cold, dry winter air. A rare cause may be an unusual tumor of the nose or bleeding disorder.

Controlling Nosebleeds

Most nosebleeds can be controlled by applying pressure to the anterior nose. This is performed by closing the nose by pinching the thumb and index fingers, so one has to breathe through the mouth. 

Pressure to this area for 10 minutes will frequently control the bleeding.  If bleeding still occurs the process may be  repeated several more times.  If available, a decongestant nasal spray may be used to constrict the blood vessels, followed by pressure as described. 

The spray is only to be used to treat the active bleeding, not for prevention. If the patient is using an anticoagulant (blood thinner), controlling the bleeding will take a longer time.

It is not recommended to place material such as cotton or  paper in the nose as bleeding may reoccur when it is removed and the forming clot is pulled away.When the bleeding is controlled, do not blow the nose as this may induce more bleeding by blowing out the clots.If bleeding becomes recurrent, cauterization of the bleeding area and/or packing of the nose may be required.These methods are performed by a physician.

Prevention includes avoidance of picking the nose with fingers and also the use of a nasal gel to control dryness and crusts. If a steroid nasal spray is being used it should be discontinued and discussed with the physician. Visit Preventing Tips for Nosebleeds for more information and a printable copy.   

Severe or Chronic Nosebleeds

If your bleeding does not stop after 20-30 minutes, call your physician or go to the emergency room for evaluation. Severe nosebleeds may require cauterization, packing the nose, and occasionally invasive procedures to stop the bleeding. 

A note about Afrin (oxymetazoline) or Neo-Synephrine nasal sprays:
Afrin and Neo-Synephrine are very good medications for short-term use to help stop bleeding and to relieve congestion in the nose. However, when used for longer than 3-4 days at a time, they can be addicting and alter the normal behavior of the nose causing the congestion to be much worse. Thus, do not use for more than 3-4 days at a time.