There you are- you have been following your daily routine with nothing out of line. You woke up, brushed your teeth, ate breakfast, ran out the door with the coffee slopping down your arm, got frustrated in traffic, and made it to work just on time. But now, out of nowhere, and without warning, your nose starts to bleed. What should you do? And why did this happen? Will it keep happening? Could it be something serious?  These are all thoughts that flicker across your mind. Don’t worry, we will address all these thoughts below.

What to do during a nosebleed?

The first thing NOT to do is to panic.  Nosebleeds are actually pretty common and most people will experience this at least a couple times in their lives.  Lean forward.  It you tilt your head back, you just make the blood go down your throat.  Swallowing blood can make you nauseous later and can even make you choke if there is too much of it.  Next, pinch the soft part of your nose together like you are jumping into a pool.  Now you can ask someone to get you an ice pack (or better yet, frozen peas) which you can place on your face (but don’t stop pinching your nose).  If you have any Afrin (oxymetazoline) handy, spray two squirts on both sides and then continue pinching your nose.  Give yourself at least 15 minutes.  After this, you will likely have stopped bleeding.  If you haven’t, this would be a good time to start making moves to go see your ENT or go to an urgent care.  In summary, when you get a nosebleed: lean forward, pinch the soft part of the nose, cold compress and Afrin nasal spray.  This will stop more than 90% of normal nosebleeds.

What is not a normal nosebleed?

Lots and lots of blood (more than 1 cup of bright red blood) is too much to be a run-of-the-mill nose-bleed.  Also, bleeding that doesn’t stop with the tricks from above.  For either of these cases, you should be seen by a doctor.  Your nose may need to be “packed.”  “Packing” a nose is something that is almost guaranteed to stop even the worst nose bleeds.  This involves putting a nasal tampon into the nose to put pressure on the bleeding site.  Pressure is always the first way to stop any type of bleeding.  Sometimes the packing that we use will absorb on its own in the next few weeks.  Sometimes, we have to put in packing that we will take out later in clinic.  For this “non-absorbable” packing, you will need to be on antibiotics while it is in your nose.  This prevents any type of infection.  In very rare cases, you may have to be taken to the operating room to stop the bleed.

Why did you get the nosebleed?

There are many reasons that a nose could bleed.  Before they can be fully explained, we should go over how a nose is laid out.  A nose has a structure that divides the left and right side, running down the middle; this is called the septum.  The side of the nose has bones covered in a lining like the inside of your mouth.   These bones are called turbinates and help our bodies moisten and warm the air that we breathe.  Every part of the body needs blood.  Blood provides oxygen and nutrients as well as taking away the trash that our cells make.  The nose has many blood vessels on the septum and the turbinates that help the nose stay healthy, but these same vessels are what lead to our nose-bleeds.  If the covering over one of these vessels were to get dry, the covering could crack and some of the blood could leak out.  This causes lots of problems for people who don’t have completely straight noses on the inside.  Air runs faster through tight areas, and faster running air dries out the lining more than slower running air.  In the same way, less humid air or colder air dries out the lining of your nose.  This explains why we get more nosebleeds when it is winter or when we are around air-conditioning or heating.  Certain people are more prone to nose bleeds than others- mainly people with thin blood.  Blood is normally thin because of specific blood thinning medications (such as Aspirin) that doctors prescribe for heart or vessel problems.  You can imagine a small cracked vessel with a tiny hole bleeding much more if the blood is thin and able to escape easier.  Thin blood doesn’t form clots (which are patches to plug up holes) as well as normal blood does.  Another cause of nosebleeds can be from something we put into our nose that dries it out or irritates it- such as nasal spray or, gasp, a finger.

Could it be something serious?

 Almost all nosebleeds actually come from the very front part of your septum (the structure that divides the two sides of your nose).  That is why pinching the soft part of your nose works so well- it puts pressure exactly from where you are most likely bleeding.  Some nosebleeds have more dangerous causes, though.  Bleeding from vessels deeper in the nose could be a sign of sinus disease or even a mass.  These typically are not easily stopped and bleed a large amount.  The bleeds often keep coming back as well.  If you are worried about this, we can easily check in the office with a small camera and make sure that nothing is wrong deep in your nose.

Will the bleeds come back?

Most nosebleeds don’t come back, but if they do, it could be a sign that you have thin blood, are using a nose spray wrong, have a deviated septum, have sinus disease, or have something more worrisome.  If you are having frequent bleeding from the nose, we would love to take a look and see if there is anything to be done.

What can I do to prevent nosebleeds?

 Keep your nose moist.  Since dryness causes the cracks in the vessels, you need to constantly spray saline in your nose throughout the day.  No amount of saline will be too much.  Also, using Vaseline or other types of ointment at the front of your nose before you go to bed will moisten your nose throughout the night.

So there you have it!  Everything you could ever want to know about nosebleeds!  If you have more questions or if you think that you may need to be evaluated, please come and see us here at Texas Sinus and Snoring.  I’m sure you can tell, we love noses and want to make sure yours is as healthy as possible!