FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TRAUMA AND "NOSE PICKING" AMONG COMMON CAUSES OF NOSEBLEEDS

Question: I have a question concerning nasal bleeding which has been bothering me over the past week. I assume the problem is in the nasal mucosa. It has either been damaged, or I have some kind of infection or an allergic reaction. My nose is blocked in the morning, and when I try to clean it, I get the bleeding from the sores in the mucosa. The bleeding stops within a minute after the sores dry. It happens three to four times a day. I would like to know what could be the reason that caused it and how can the sores be healed?

Answer:
Nosebleeds are relatively common and generally not of serious medical consequence in young people. Nosebleeds, or epistaxis, can occur from one or both sides of the nose. A common cause of nosebleed is direct trauma -- such as a blow to the nose in a fight or an elbow to the nose in a basketball game. Also, nose picking is a frequent cause of nosebleeds. This may be why nosebleeds are common in children. Other relatively common causes include dry air, foreign bodies, irritation from chemical vapors and too forceful nose blowing. Smoking can also dry out nasal passages and lead to bleeding. In addition, nasal bleeding can also signal overuse of aspirin and certain serious illnesses that I’ll detail later.

The majority of nosebleeds come from the front part, or anterior, of the nose. Specifically, this bleeding-prone area lies along a portion of the septum -- the middle cartilage that separates the nasal passages -- called Kiesselbach's plexus. These nosebleeds are usually easily controlled by squeezing the fleshy part of the nose tightly for at least five minutes.

If this simple procedure does not stop the bleeding, give the nose one good, hard blow to remove any excessive formation of clotted blood. Even though clotted, or semi-clotted, this blood may actually be impeding your efforts to stop the bleeding. Then after this, blow to clear the nostril and pinch the fleshy part of the nose between the thumb and index finger for an additional five to seven minutes. Don’t lie down or put your head back as this can cause the blood to run down your throat. An ice pack across the bridge of your nose may be helpful.

Once the bleeding in you nose has stopped, the sores will scab over. They should heal in about a week if you take a few common sense steps:

·Avoid picking at the scabs even though they may be uncomfortable and picking may provide some short-term relief;
·Use an over-the-counter saline spray several times a day to keep your nasal passages moist; and
·Place a cool mist humidifier at your bedside at night.

Although most nosebleeds are no cause for alarm, you should seek medical attention if your nosebleeds are frequent, difficult to stop, or cause you to lose excessive amounts of blood. If you have any of these warning signs, it could mean that your nosebleeds are due to an underlying medical condition. These can include chronic nose or sinus infections, small growths in the nose called polyps, problems with clotting and other blood disorders, immune disorders, high blood pressure or certain cancers. In these cases, in order to stop the nosebleed, you’ll first need to treat the illness that’s the root cause.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.