Getting Too Many Nosebleeds? When You Should Worry

Nosebleeds happen. They don’t discriminate based on whether you have tissue at hand — and they don’t delay because you’re in a job interview or penned in a crowded theater.

There’s just that rush of blood and a race to contain it. If you frequently get nosebleeds, you probably know all too well the sense of urgency and embarrassment.

But why do nosebleeds happen? And who is most at risk? Otolaryngologist Brandon Hopkins, MD, answers these questions and shares tips for prevention. He also offers steps to take when you get a nosebleed to promptly stop the problem.

Also, while nosebleeds are generally nothing more than a nuisance, in rare cases, a chronic problem can be a sign of a rare, serious disorder called hereditary hemorrhagic telangiectasia. It often goes undiagnosed and involves abnormal blood vessels that enlarge in the lungs and brain. Find out who is at risk.

Is your child prone to nosebleeds?

In all of us, children and adults alike, the nasal cavity has a large blood supply. In particular, a lot of blood flows into the front bottom part of the nasal septum, known as Kiesselbach’s plexus. Nearly 90% of nosebleeds happen in this region, which houses five arteries.

Children have more blood vessels in the nasal plexus, which makes nosebleeds more likely for them than for adults. If your child picks his nose, the risk for nosebleeds is further elevated. Picking sometimes scratches the plexus and triggers a nosebleed, Dr. Hopkins says.

“Nosebleeds tend to happen more often in the summer because warm temperatures cause your plexus to be engorged, and also during the winter, because dry air can irritate the blood vessels in your plexus,” he says.

The good news? If your child suffers from nosebleeds, they’ll probably grow out of it by the teenage years, he says.

What causes nosebleeds in older adults?

In older adults, medications and atrophy of the skin are the most likely culprits when it comes to nosebleeds, says Dr. Hopkins.

If you regularly take blood thinners like aspirin, ibuprofen or Coumadin®, or other drugs that dry out your nasal cavity, you are at greater risk for nosebleeds.

Atrophy of the skin, a common condition in older adults that causes a loss of elasticity, also makes nosebleeds more likely. The tissue in your septum and surrounding blood vessels becomes more fragile as you age.

How can you prevent nosebleeds?

If you suffer from chronic nosebleeds, these tips may help keep them at bay.

1. Use a humidifier. In winter months when air is dry, use a humidifier (especially if you have radiant heat in your home). This helps keep your nasal plexus from drying out.

2. Use saline spray. An over-the-counter saline spray may help keep nasal passageways moist.

3. Try a water-based lubricant or nasal cream. If saline spray isn’t providing relief, try a more sticky/thick spray, which may do a better job of coating the nasal passages, Dr. Hopkins says.

4. Don’t pick your nose. Nose-picking often irritates or scratches the nasal plexus, and that damage makes more nosebleeds likely.

If you have nosebleed, how can you stop it quickly?

When a nosebleed happens, Dr. Hopkins suggests doing the following:

• Use an over-the-counter, nasal-decongestant spray that contains oxymetazoline, such as Afrin®. This often helps stop bleeding. However, only use nasal decongestants for brief periods of time (one to three days). After that, you’ll need to take a break for a week or so. If not, you can get rhinitis medicamentosa, or extreme congestion.
• Sit down and lean slightly forward (don’t tilt your head back).
• Using your thumb and index finger, firmly pinch the bottom, fleshy part of your nose. Pinch for between 8 and 10 minutes. Hold a tissue or damp cloth under your nose to absorb any blood.

While nosebleeds are sometimes bothersome, they are usually not cause for concern, Dr. Hopkins says.

However, if you have applied firm pressure for 20 minutes and used a decongestant and your nose is still bleeding heavily, seek medical treatment quickly, he advises.