Nosebleeds: Minor Irritation or Cause for Concern?

If a nosebleed occurs out of the blue, it can be a pretty scary event. But nosebleeds are pretty common and usually don’t indicate anything too serious.

Our noses contain a great number of small blood vessels that are close to the surface and can bleed easily if aggravated. As such, nosebleeds tend to occur more often during the winter months because the cold winter air and dry indoor heat irritate the nose.

Other causes of nosebleeds include:

• Allergies
• Common cold
• Nasal sprays used to treat colds or allergies, if used frequently
• Sinusitis
• Non-allergic rhinitis (chronic sneezing or congestion without an identified allergen as the cause)
• Trauma to the nose (ranging from a hard punch or fall to something as seemingly innocuous as picking your nose)
• Foreign body in the nose
• Aspirin use
• Hemophilia or other bleeding disorders
• Chemical or other environmental irritants (e.g., ammonia fumes or solvents)
• Cocaine use
• Deviated septum

Less common causes of nosebleeds include:

• Excessive use of alcohol
• Genetic and other disorders in which the blood doesn’t clot properly or the blood vessels grow abnormally
• Leukemia
• Nasal polyps or tumors
• Nasal surgery
• Second or third trimester of pregnancy, when pregnancy hormones cause blood vessels to dilate, and the increased blood supply in your body puts pressure on the fragile blood vessels of the nose

How can you treat a nosebleed?

• You need to sit upright and lean forward. Leaning forward will decrease the blood pressure in the veins of your nose, which will reduce the bleeding. Sitting upright helps prevent swallowing blood which can irritate your stomach.
• Pinch your nostrils and breathe through your mouth for 5-10 minutes. Pinching your nose puts pressure on the bleeding point of your nasal septum and helps stop the flow of blood.
• After the bleeding has subsided, do not pick or blow your nose or bend down for several hours.
• If your nose begins to bleed again, blow your nose forcefully to clear away any blood clots and spray both sides of your nostrils with a decongestant nasal spray containing oxymetazoline (e.g., Afrin), then pinch your nose once again as described above.

When should you contact your physician?

• If the bleeding lasts for more than 20 minutes
• If you have recently had an accident to your head such as a fall or injury
• If you are experiencing persistent nosebleeds with significant loss of blood
• If you are experiencing nose bleeds while taking blood thinners (aspirin, warfarin) – you may need to adjust your medication dosage
• If you are feeling weak, dizzy, or faint from the bleeding

About Dr. Thomas Kaegi

Dr. Thomas Kaegi is an internist at Harvard Vanguard’s Concord practice and is board certified in internal medicine. He received his medical degree from the University of Rochester School of Medicine and Dentistry in Rochester, NY. He completed his residency and internship at Johns Hopkins Bayview Medical Center in Baltimore, MD. Dr. Kaegi is currently welcoming new patients. For more information about becoming a patient, please call 1-800-249-1767.

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