What is a nosebleed?

A nosebleed occurs when the membranes lining the inner nose are disturbed or irritated enough to cause abnormal bleeding. The medical term for nosebleed is epistaxis.

There are two types of nosebleeds: anterior and posterior. If the bleeding is near the front of the nose, it is an anterior nosebleed. A posterior nosebleed occurs in the back of the nose and is not always characterized by rapid bleeding but may be a slow, steady ooze. It may be more difficult to locate the site of the damage in a posterior nosebleed than in an anterior nosebleed. An anterior nosebleed is usually not as severe or serious as a posterior nosebleed.

How does it occur?

If you have a nosebleed after a heavy blow to your skull, it could mean you have a fractured skull. You should be taken to the hospital immediately.

The most common causes of nosebleed are:

• A breakdown in the membranes lining the nose. This can be triggered by poorly humidified air or probing, bumping, picking, or rubbing your nose. Blowing your nose forcefully can also cause a nosebleed, especially if the nasal membrane is already inflamed because of a virus, bacteria, or allergy.

• Injury to the face or nose.

• Scars and damage from previous nosebleeds that reopen and bleed.

• Damage to the nasal membrane with repeated use of cocaine.

• High blood pressure.

• Drugs that slow the time normally required for the blood to clot.

What are the symptoms?

Symptoms of anterior nosebleed include intermittent or constant bleeding out of the front of your nose. Blood can flow from one or both nostrils and can flow into the throat.

Symptoms of posterior nosebleed include bleeding that stops and starts, rapid bleeding from the back of the nose, or a slow, steady ooze. Sometimes the blood flows back into your throat. Especially with posterior nose bleeding, you can lose blood quickly.

How is it diagnosed?

If you go to your doctor with a nosebleed, he or she will have you sit up and lean forward to determine the rate and site of the bleeding.

The doctor may check your pulse and blood pressure and take a blood sample to check for anemia and your blood type in case you need a transfusion.

How is it treated?

First aid for a nosebleed includes these steps:

• When your nose starts bleeding, sit up and lean forward to prevent blood from passing into your throat, which may cause choking.

• Pinch the nose firmly together between the thumb and index finger, just below the nasal bones, and hold it for 10 minutes.

• Moisten a cotton ball or pad with a saline nasal spray and press it against the bleeding part of the nose if possible.

• Continue to sit quietly and press on your nose.

• After the bleeding stops, apply zinc oxide to the septum to prevent drying and abrasions. Also, use a saline nasal spray to keep the nose moist.

If a nosebleed lasts more than 20 minutes or doesn't respond to first aid, call your doctor.

If you go to your doctor with a nosebleed, he or she will likely apply a cotton ball soaked in epinephrine, or a nose drop such as Neo-Synephrine or Afrin, to the site of the bleeding for 5 to 10 minutes.

If the bleeding starts again, your doctor may apply a cotton ball soaked in stronger medication for 5 minutes in order to numb and temporarily reduce the blood supply to the mucous membrane.

Most anterior nosebleeds respond to direct pressure. If this doesn't work, the doctor may numb the site of the bleeding again, then pack your nose. Packing for anterior nosebleeds is less complicated and more comfortable than the packing required for posterior nosebleeds.

The doctor may use a procedure called cauterization to force the blood to clot (coagulate) at the bleeding site.

Your doctor must remove any packing. Severe bleeding and improperly handled packing can be fatal. Treatment, especially for posterior nosebleeds, may sometimes include hospitalization.

How long do the effects last?

Most nosebleeds stop by themselves within 10 minutes.

How can I take care of myself?

Follow the treatment prescribed by your doctor. In addition you can:

• Use a cool-mist humidifier.

• Keep a nasal spray such as Neo-Synephrine or Afrin on hand.

• Put bacitracin ointment, Vaseline, or a saline nasal spray inside your nostrils to control dryness.

• Check with your doctor about any other medications you may be using. Nosebleeds may be more severe or frequent if you are taking aspirin.

• Don't use cocaine.

• Don't smoke.

• Limit your intake of spicy and hot foods and hot liquids.

• Don't take hot showers.

• Avoid bending over, straining, and lifting heavy objects. Don't exercise vigorously for a few days.

• Use a laxative to avoid straining during bowel movements.

• If a posterior nosebleed happens again, contact your doctor.

How can I help prevent a nosebleed?

Some causes of nosebleeds can be prevented or managed as follows:

• When you have nasal inflammation, keep your nasal septum well coated with a petrolatum-based ointment (such as zinc oxide or A&D ointment), or an antibiotic ointment, until your nose heals (usually 3 to 5 days). Then apply the ointment regularly to the nasal septum to prevent drying and breakdown of the membranes.

• Avoid injuring the nasal mucosa with nose-picking, rubbing, or forceful blowing.

• Keep your home humidified.

• Control minor recurrent nosebleeds by applying cotton balls or pads soaked in Afrin or Neo-Synephrine.