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Symptoms, Their Causes & Cures: Nosebleed

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Nosebleed

WHEN TO SEE YOUR DOCTOR

* Your nose is bleeding in gushes and won't stop even after you have pinched it tightly closed for five minutes.

* You also have high blood pressure, diabetes or any blood-

clotting problem.

* You are taking aspirin regularly.

* Your nosebleed began with blood going down the back of your throat rather than out of your nose.

* Your nosebleeds are recurrent.

What Your Symptom Is Telling You

Most nosebleeds seem worse than they actually are. The amount of blood lost is normally less than a tablespoon, and only 5 to 10 percent of nosebleeds ever need a doctor's care.

Noses are susceptible to bleeding because of their fragile anatomy. The inside of your nose is lined with hundreds of tiny blood vessels just inside your nostrils, and they are very vulnerable to trauma.

What's traumatic to your nose? Well, for one thing, there's digital trauma. Say again? Okay—nose-picking. Even though you've no doubt matured beyond the vigorous nose hunts of childhood and now probe adultly with a tissue-wrapped finger, the result can still be the same. Even a cotton swab can irritate the lining of the nose.

Another nasal trauma is the cold, dry air of winter. In that kind of weather, a simple sneeze or vigorous nose-blowing can trigger a bleed in almost anyone.

Older people have more nosebleeds. Older women are particularly vulnerable, since menopause causes shrinking and drying of the body's tissues, including those lining the nose.

Another type of shrinking—rapid weight loss, whether it's from dieting or illness—can also cause nosebleeds.

And speaking of illness, there are a couple of conditions, such as allergies, that can cause or contribute to nosebleeds. That includes two inside the nose: nasal infections and a fluid-filled, benign growth called a nasal polyp. And although high blood pressure doesn't cause nosebleeds, it does make them worse.

Finally, a number of medications can cause the problem. Using steroid nasal sprays for a runny nose may make you more susceptible to nosebleeds. Other medications include birth control pills, aspirin, ibuprofen and anti-arthritis medications like Naprosyn, Tolectin and Motrin.

Symptom Relief

There are several very effective methods for dealing with nosebleeds, even chronic ones. Here are four good ways to stop the bleeding now.

Squeeze and hold. Your first response: Squeeze your nostrils and hold them tightly together, says Sanford Archer, M.D., an assistant professor of otolaryngology at the University of Kentucky in Lexington. A nosebleed will usually clot on its own, says Dr. Archer, but adding pressure makes it stop more quickly and helps form a scab. And forget the oft-heard advice to hold your head back. That doesn't do any good and will just make you feel like choking.

Use a clothespin. Tired of pinching? An ordinary wooden spring-type clothespin will work as well as your fingers, says Jordan S. Josephson, M.D., an otolaryngologist in Brooklyn. Hold your nose, lean forward and apply the clothespin.

Try Neo-Synephrine. Moisten a piece of cotton with Neo-Synephrine, an over-the-counter decongestant spray available at pharmacies. Put the cotton in your nose and then pinch your nostrils together firmly for five minutes, suggests Alan Sogg, M.D., an ear, nose and throat specialist in Cleveland.

Stiffen your upper lip. Dr. Archer says there's a scientific basis for this folk cure: Put a little wad of cotton inside your upper lip against the gum. One of the major blood vessels supplying the interior of the nose goes right through the upper lip, he says, and the pressure from the cotton will help to suppress the bleeding.

Ice it. Along with any of these methods, an ice pack applied to the forehead and bridge of the nose will also help to stanch the bleeding. "It will cool things down and make clotting a little quicker," says Dr. Archer.

Preventing a Recurrence

One of the most annoying things about nosebleeds is that they can tend to repeat themselves. Here's how to prevent their return.

Let it be. While your nose is healing, no more digital trauma or even nose-blowing, says William H. Friedman, M.D., an otolaryngologist and director of the Park Central Institute in St. Louis. You may dislodge the scab and cause a fresh nosebleed.

Moisturize your nose. After a nosebleed, use a nonprescription nasal saline spray to keep your nasal membranes moist, says Dr. Archer. Use the spray as often as you'd like.

Petroleum jelly is another good moisturizer, says Dr. Archer. "Put a ball of it on the tip of your finger. Then scrape your finger against your nostrils so that the Vaseline goes into your nose. The trick is to do this without inserting your finger. Do this three or four times a day, and within five days the scab should be completely healed."

When applying moisturizers, be careful not to inhale a gob. Vaseline or any other petroleum-based moisturizer can cause a form of pneumonia if it gets inside your lungs, warns Susan R. Wynn, M.D., an allergist in private practice with Fort Worth Allergy and Asthma Associates in Texas.

Humidify the air. A humidifier or vaporizer is an excellent idea, both for your bedroom and your office, says Dr. Josephson. However, says Dr. Friedman, daily and thorough cleaning of those devices is critical so that there is no buildup of molds.

Drink plenty of water. Keep a healthy level of moisture in your nose (and throughout your body) by drinking at least six glasses of water a day, says Dr. Friedman.

Switch to acetaminophen. If you've been taking aspirin or other nonsteroidal anti-inflammatory medicines, ask your doctor whether you can use acetaminophen instead, suggests Dr. Sogg.

More Help from Your Doctor

If your nosebleeds are persistent, your doctor has several ways to help.

Pack it away. Your doctor can stop a serious nosebleed by packing your nose with surgical gauze and sponges. This must be performed by a specialist, Dr. Josephson says, as all packing carries a risk of toxic shock syndrome, a rare illness caused by poisonous bacteria entering the bloodstream.

Seal the blood vessels. An otolaryngologist can seal broken blood vessels in your nose by cauterizing (precise surgical burning), by applying silver nitrate or by tying off the blood vessels with tiny stitches.

Eliminate polyps. If your doctor finds that a nasal polyp is causing the bleeding, he'll have to determine what is causing the polyp, says Dr. Sogg. He may ask for a CT scan or x-ray of your sinuses. If infection is found, Dr. Sogg recommends a minimum of three weeks on antibiotics, with a steroid nasal spray or a course of oral steroids to reduce swelling. "If the infection is treated, the polyp may resolve completely, along with your nosebleeds," he says.

Ask for a blood checkup. "If you have repeated nosebleeds, get a blood count to rule out clotting problems," says Dr. Sogg.

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