What causes nosebleeds?
The nose is a part of the body rich in blood vessels (vascular) and is situated in a vulnerable position as it protrudes on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to a bloody nose if they are taking medications which prevent normal blood clotting warfarin (Coumadin), aspirin, or any anti-inflammatory medication]. In this situation, even a minor trauma could result in significant bleeding.
The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home results in drying and changes in the nose which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons. The following factors predispose people to nosebleeds:
- Trauma, including self-induced by nose picking, especially in children
- Allergic and non-allergic rhinitis
- Hypertension (high blood pressure)
- Use of blood thinning medications
- Alcohol abuse
- Less common causes include tumors and inherited bleeding problems
How do you stop the common nosebleed?
- Pinch all the soft parts of the nose together between your thumb and index finger.
- Press firmly toward the face - compressing the pinched parts of the nose against the bones of the face.
- Lean forward slightly with the head tilted forward. Leaning back or tilting the head back allows the blood to run back into your sinuses and throat and can cause gagging or inhaling the blood.
- Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding.
- Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.
- Apply ice (wrapped in a towel) to nose and cheeks.
How do you prevent the nose from bleeding again?
- Go home and rest with head elevated at 30 to 45 degrees.
- Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
- Do not strain during bowel movements. Use a stool softener (for example, Colace,Cremaffin).
- Do not strain or bend down to lift anything heavy.
- Try to keep your head higher than the level of your heart.
- Do not smoke.
- Stay on a soft, cool diet. No hot liquids for at least 24 hours.
- Do not take any medications that will thin the blood (aspirin, ibuprofen, clopidogrel bisulfate [Plavix] or warfarin [Coumadin]). If these have been prescribed by your physician, you need to contact them regarding stopping these medications.
- Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).
- If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can temporarily use a remedy such as a nasal decongestant spray, such as Afrin or Neo-Synephrine. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction so they are recommended for short-term usage. Also, do not use if you have high blood pressure.)
- Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the doctor and/or visit to the emergency/casualty room.
What precautions can you take to prevent nose bleeding?
When should you call your doctor or report to the emergency room?
- If bleeding cannot be stopped or keeps occurring.
- If bleeding is rapid, or if blood loss is large.
- If you feel weak or faint, presumably from blood loss.
- If your nosebleed is associated with a fever or headache.
- If your infant or baby has a nosebleed, contact the pediatrician.
- If bleeding cannot be stopped or keeps occurring.
- If the nosebleed persists or is recurrent, see your doctor, who may then recommend stopping the nosebleed with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble) or application of a topical medicine called thrombin that promotes local clotting of blood. Blood tests may be ordered to check for bleeding disorders. If bleeding is still persistent, the doctor may place nasal packs, which compress the vessels and stop the bleeding. In rare situations, you may be admitted to the hospital or require surgical treatment or a procedure where material is used to plug up the bleeding vessels in the nose (angiographic embolization).
What should I do if the doctor has placed nasal packs?
Nasal packs are used when less conservative measures fail (see above). These packs are frequently placed in both sides of the nose. The packs are usually made of a material called "Merocel" which is a compressed sponge-like material used to help compress the area of the nose that is bleeding. The doctor usually does not remove them for several days (two to three days). This requires a follow-up appointment.
You will need someone to drive you and bring you home after the nasal packs are removed. During this time, you may be prescribed antibiotics and pain medications as needed.
It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. Your doctor may permit you to clean your nostrils with hydrogen peroxide soaked Q-tips. Finally, you should consider the prevention methods described above to help to avoid bleeding again.
Remember, patients with nosebleeds should not to take aspirin or any other blood thinning products. If patients are already taking these medications when the nosebleed is noticed, they should consult their doctor.
Nosebleed At A Glance
- Nosebleeds are common due to the location of the nose on the face, and the large amount of blood vessels in the nose.
- The most common cause of nosebleeds are drying of the nasal membranes and nose picking (digital trauma) and this can be prevented with proper lubrication of the nasal passages and not picking the nose.
- Most nosebleeds can be stopped at home.
- Consult a doctor for a nosebleed if bleeding cannot be stopped, there is a large amount of blood lost, or you feel weak or faint.
- A doctor may use nasal packs to stop nosebleeds when conservative measures fail.
- Do not take aspirin or other blood thinning products when you get a nosebleed (if they are doctor-prescribed, consult your doctor before stopping any medication
Vomiting blood is a backward flowing (regurgitation) of blood through the upper gastrointestinal (GI) tract. The upper GI tract includes the stomach, mouth, throat, esophagus (the swallowing tube), and the first part of the small intestine.
ConsiderationsVomiting blood results from upper gastrointestinal bleeding. It can sometimes be difficult to tell the difference between vomiting blood and coughing up blood (from the lung) or a nosebleed.
Conditions that cause vomiting blood can also cause blood in the stool.
CausesThere are several reasons why someone may vomit blood. For example, vomiting that is very forceful or continues for a very long time may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit.
Other causes may include:
- Bleeding ulcer in the stomach, first part of the small intestine, or esophagus
- Bleeding esophageal varices or stomach varices
- Defects in the blood vessels of the GI tract
- Infection of the stomach and intestines (gastroenteritis)
- Inflammation of the esophagus lining (esophagitis)
- Inflammation of the stomach lining (gastritis)
- Irritation or erosion of the lining of the esophagus or stomach
- Swallowing blood (for example, swallowed after a nosebleed)
- Tumors of the stomach or esophagus
Home CareAlthough not all situations are the result of a major medical problem, this is difficult to know without a medical evaluation. Seek immediate medical attention.
When to Contact a doctorCall your doctor or go to the emergency room if vomiting of blood occurs -- this requires immediate medical evaluation.
What to Expect at Your doctors VisitThe doctor will examine you and ask questions such as:
- When did the vomiting begin?
- Have you ever vomited blood before?
- How much blood was in the vomit?
- What color was the blood? (Bright red or like coffee grounds?)
- Have you had any recent nosebleeds, surgeries, dental work, vomiting, stomach problems, or severe coughing?
- What other symptoms do you have?
- What medical conditions do you have?
- What medicines do you take?
- Do you drink alcohol or smoke?
- Blood work, such as a complete blood count (CBC), blood chemistries, blood clotting tests, and liver function tests
- Esophagogastroduodenoscopy (EGD)
- Rectal exam
- Tube through the nose into the stomach to check for blood
- Blood transfusions
- Fluids through a vein
- Medications to decrease stomach acid,
- Possible surgery if bleeding does not stop