Episode 68: April 26, 2012
by Rob Lamberts, MD
If there is one thing that keeps people out of a medical profession, it’s blood. It’s all fine and good when it’s on the inside of a person, but when blood comes out to where people can see it, they duck and cover. Today’s article will cover a common means by which blood--lots of it--makes its way from the inside to the outside: nosebleeds.
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Doctors call nosebleeds epistaxis. I’ve mentioned before that doctors like fancy names for things; it just sounds smarter to use a Latin or Greek word. It’s especially good at parties.
What Are Nosebleeds?
Nosebleeds are scary because they often involve a lot of blood. The good news is that they are almost never a real threat to a person’s life. Still, it’s hard not to panic when you or your child puts out enough blood that it makes a scene reminiscent of a horror movie. Despite all that blood, only about 10% of nosebleeds are brought to the doctor or emergency room. The rest of them just scare people and necessitate the use of lots of Oxy-Clean.
Are There Different Types of Nosebleeds?
The nose can bleed from two main sources, the front (or anterior) portion, and the back (or posterior) portion.
Anterior nosebleeds are by far the most common, and almost always get better without much medical intervention. Posterior bleeds, on the other hand, can be quite serious; but thankfully, they are relatively rare.
Anterior nosebleeds: Anterior nosebleeds usually originate from a bundle of blood vessels known as Kesselbach’s plexus. You can find Kesselbach’s plexus by inserting your finger into your nostril in a way that points vertically. I don’t recommend doing this in public, although I have seen many people checking Kesselbach’s plexus while stopped at a stoplight in their car.
Posterior nosebleeds:To point out where a posterior nosebleed occurs would take very long and thin fingers. I don’t recommend trying this, as extraction of the finger requires medical procedures requiring plungers, the jaws of life, and other embarrassing interventions.
What Causes Nosebleeds?
So what causes nosebleeds? One of the most common causes is the inspection of Kesselbach’s plexus using the finger. The good news is that a simple inspection of the offending nostril by the doctor can show the fingerprints of the culprit. Other causes of nosebleeds include:
Inflammation of the mucous membranes - this is usually caused by allergies or possibly by upper respiratory infections.
Dryness to the mucous membranes - decongestant medications and a dry environment can make the inside of the nose dry and make them prone to bleed.
Foreign substances – objects such as peas, cheerios, cocaine, or even steroid nasal sprays can make the nose bleed.
Trauma - yes, being punched in the nose can make it bleed. You probably didn’t need a doctor to tell you that one.
Do Clotting Disorders or High Blood Pressure Cause Nosebleeds?
What about clotting disorders or high blood pressure? A person with a clotting disorder may have an increased risk of nosebleeds, but people with nosebleeds don’t have to be evaluated for clotting disorders unless they get them a whole lot. As far as blood pressure, there isn’t much evidence that a high blood pressure makes the nose bleed more than normal, but experts seem to think that it may prolong the bleeding.
5 Tips for Dealing with a Nosebleed
What should you do about nosebleeds?
Tip# 1: Don’t Panic - despite the horror-movie appearance of the scene, nosebleeds are rarely a dangerous thing.
Tip# 2: Blow your nose - this doesn’t seem to make sense, but often the presence of clots in the nose prolong the bleeding. Blowing out the clots won’t make the nose bleed more, but less. Trust me on this one.
Tip# 3: Use a decongestant nasal spray - if you have neo-synephrine or Afrin nasal spray, a spray of that will cause the blood vessels to shrink and stop bleeding.
Tip# 4: Hold the nose - pinch the nose closed just below the tip for 10 minutes continuously (without peeking).
Tip# 5: Insert cotton and apply ice to the bridge of the nose - if the other measures fail, this can slow things down.
When Should You Worry About a Nosebleed?
You should seek medical attention under the following four circumstances:
If the above measures don’t work.
If the nosebleeds recur.
If you have a blood clotting disorder or are on medications that thin the blood.
If the nosebleed is caused by trauma and the bleeding doesn’t stop or you suspect the nose is broken.
Some people are prone to anterior nosebleeds, requiring a minor procedure to cauterize Kesselbach’s plexus. Posterior nosebleeds are very serious problems that require hospitalization and surgical intervention, but it’s hard to tell anterior from posterior nosebleeds other than the fact that the above procedures to stop the nose from bleeding don’t work real well on posterior bleeds.
As always: when in doubt, get it checked out by your doctor.
And try to keep your fingers off of Kesselbach’s plexus!
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!