Nosebleeds can be categorized based on their location in the nasal airway, with anterior nosebleeds seen in the front of the nose and posterior nosebleeds seen in back of the nasal airway. The most common location for nosebleeds to occur is in the anterior nasal airway on the anterior nasal septum. This area known as Kiesselbach's plexus is where the blood vessels of the external carotid artery meet the blood vessels of the internal carotid artery.
The causes of nosebleeds are many. Nasal trauma, nasal inflammation, coagulation or blood clot forming problems, high blood pressure and nasal tumors are the most common problems. Bleeding from nasal trauma can be related to sports injuries, surgical procedures and foreign bodies inserted by children. Nasal inflammation can occur due to colds or viruses, bacterial infections of the nose or sinuses, nasal allergies, and irritation of the nasal lining such as from cigarette smoke or nasal steroid sprays . Coagulation problems can occur due to kidney or liver disease but are most often due to anticoagulation drugs such as aspirin, coumadin and newer generation drugs such as Xarelto. Poorly controledl high blood pressure can increase the risk of nosebleeds, and require input from a patient’s primary care physician. Nasal tumors are a rare cause of nosebleeds and are found on nasal examination and/or nasal endoscopy. Episodes of bleeding increase during the winter months when the indoor and outdoor humidity is low, and the nose can become excessively dry.
Home remedies for nosebleeds include using a bedside humidifier to bring moisture to the nasal lining, applying a water based nasal gel such as AYR gel or a petroleum jelly based product such Vaseline, and spraying saline nasal spray regularly in the nasal airway. A short course of topical nasal decongestant spray such as Afrin can also help by shrinking swollen blood vessels in the nose. Applying pressure to the nose by pinching the lower one third of the nose with your thumb and first finger can help resolve a sudden nosebleed. Laying on your back will often make the situation worse as blood will drain into the throat and stomach leading to nausea and vomiting.
Seeing an Ear, Nose and Throat doctor can help identify factors that contribute to nosebleeds, locate the source of nasal bleeding and provide treatment to stop both recurrent episodes and a severe active nosebleed. Management of nosebleeds by an Ear, Nose and Throat doctor includes the insertion of nasal packing, cautery of the bleeding blood vessel with silver nitrate sticks or electrocautery and surgical procedures.
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