Causes and treatment of nosebleeds

I have written recently about sneezes, yawns and hiccups, three physiological phenomena the are not fully understood. Another common occurrence that often has no clear cause is the nosebleed — or epistaxis, to use the medics’ fancy term.

Nine out of 10 nosebleeds arise in the part of the nasal septum known as Little’s area or Kiesselbach’s area, where several arteries supplying the internal nose converge in an easily damaged vascular network, Kiesselbach’s plexus. Bleeding can be caused by blows to the schnozz or the insertion of a finger or foreign body into the nose. It may also occur if the mucous membranes are inflamed as a result of allergy or upper respiratory infections or if they become dry because of decongestant medications or low atmospheric humidity. 

The risk of nosebleed is increased by changes in ambient air pressure, as when travelling by plane. (My own worst nosebleed occurred shortly after I flew back to London from an overseas pharmacy conference. As I stepped off the bus 200 yards from home, my nose began bleeding profusely. With a heavy bag to carry in each hand, I had to walk home with my head lowered, dripping blood onto the ground as I went. It was weeks before the trail of bloodstains from the bus stop to my doorstep finally faded.)

Nosebleeds may involve a scary amount of blood but they rarely present a serious threat. Indeed, a few years ago a study for the US Centers for Disease Control found that of 2.4 millions US deaths in 1999 only four could be attributed to nosebleeds.

So if your nose bleeds, do not panic. Instead, sit with your head tilted forward, pinch the soft part of the nose just above the nostrils and hold firmly for at least 10 minutes. If possible, place an ice pack or a bag of frozen veg, wrapped in a towel, on the bridge of the nose.

You could supplement this process with harmless folk remedies such as putting a cold metal object down the back of the neck or holding coins between the lips and teeth — actions that just might have a physiological effect that we do not yet understand. But I wouldn’t bother with other traditional fixes such as wearing a necklace of red beads, tying string round a pinky or letting your nose bleed onto a white rock in a hidden place and creeping away after turning the rock over.

Once the blood flow has stopped, you can reduce the risk of further bleeding (and infection) through a 24-hour curb on nose-blowing, nose-picking, heavy lifting, strenuous exercise, lying flat and glugging alcohol. Should you need to sneeze, keep your mouth open to reduce the pressure in your nose.

If these measures don’t work or if bleeding recurs, then you may need to seek medical attention.

Last updated
The Pharmaceutical Journal, Causes and treatment of nosebleeds;Online:DOI:10.1211/PJ.2015.20068982

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