Transcription:
What Causes Nosebleeds and How to Treat Them

Scott Webb: When it comes to nosebleeds, it seems that my grandma was wrong about how to treat them. But fortunately, we have a doctor in the house to help us understand how to prevent and treat nosebleeds and when to seek medical attention. And that doctor is ENT Dr. Alissa Kanaan with the University of Arkansas for Medical Sciences.

This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb.

So Dr. Kanaan, thanks so much for joining me. You are an ear, nose and throat doctor at UAMS Health. We were just talking off the air. People don't really talk too much about nosebleeds. So let's do that. What are the most common causes of nosebleeds?

Dr. Alissa Kanaan: I mean, nosebleeds are pretty common. They can happen at any age and, you know, 60% of people get one during their lifetime. So it happens because their nose has rich blood supply. There's a lot of blood vessels that feed into the nose and, you know, the layer that covers the nose is called the mucosa. And sometimes that mucosa can thin out and start bleeding if one of the blood vessels is exposed and that can happen for multiple reasons.

It could be from like local trauma, which, you know, you get hit on your nose, that can cause it to bleed. It could be from medications, such as sprays that you could be using in your nose that could cause nosebleeds. Dryness in the nose, so cold weather, uh, dry weather can cause nosebleeds. And, you know, this is why we called the winter time, which is coming up now, uh, nosebleed season. Nose picking is one of the common things that can cause nosebleeds, especially in little kids, which we really don't think about much, but you know, this is one of the common complaints.

Actually, the most common thing that could cause nosebleeds, uh, patients who are on blood thinners. So if you're taking aspirin or Coumadin or any of those blood thinners, that could cause that too, or any bleeding disorder, really. So patients who have tendency to bleed, it can show up as a nosebleed because it's kind of like the most exposed to the environment, the one with the thinnest mucosa that could potentially happen... any surgery that could cause nosebleed. More serious things would be like a tumor in the nose, it can also cause nosebleeds. So those would be the most common reasons.

Scott Webb: Yeah. And you're so right. We are heading into the unofficial nosebleed season here, the cold season. I've always wondered, and I wanted to ask a doctor, once we get nosebleeds, why are they so hard to stop? Why are they so hard to control?

Dr. Alissa Kanaan: So, like I said, because of the rich blood supply to the nose, the vessels can actually be like arterial, which are the ones that have like the biggest flow of blood. And, you know, if a patient gets a nosebleed, they get anxious about it. And that drives the blood pressure up and the blood pressure going up makes the nosebleed actually worse. So you get stuck in this vicious cycle where, you know, you're anxious about your nosebleed and then your blood pressure rises and that causes it to get worse. And then, you know, because the nose is kind of like an open surface, like when it bleeds, it causes a lot of anxiety because it looks like there's a lot of blood that you're losing in a short amount of time.

And most of my patients tell me, "Oh my God, like my bathroom looked like a crime scene." And you know, this is why-- because it's stressful to have one. And you know, if you don't kind of take care of it and treat it and keep it moisturized in there, then it will have a tendency to come back.

Scott Webb: What are some of the best ways we can stop nosebleeds? What are some of the most effective things we can do?

Dr. Alissa Kanaan: Right. Let's say you're having a nosebleed and, you know, it's coming out real fast, the first thing you want to do is you want to put your head down and you want to pinch the soft part of your nose and like keep pinching it for like 10 minutes at least so that this helps stop it.

Most commonly, the nosebleeds will happen in the front of the nose and we luckily have access to those by just like pinching the nose. So basically, it's as if you're and your finger on that blood vessel and telling it, "Okay, you can't bleed anymore. You have to stop now." So you put your head down to avoid the blood running to the back of your throat. And because you're having to breathe through your mouth now, you don't want the blood to go in the wrong way and go into your lungs. So that's why you want to put your head down so that if it goes to the back of your nose and your throat, you actually spit it out instead of it going into your lungs or aspirating it.

Scott Webb: It's so good to hear you say some of this stuff, because we've all had nosebleeds and we've all experienced, you know, some of the things you're describing and it does seem like common sense, but it's so great to hear it from a doctor. So you talked about the crime scene, sort of, you know, a situation that some people have described, but when should someone worry when they've got a nosebleed?

Dr. Alissa Kanaan: So, I mean, if you have a nosebleed that doesn't stop in the next 10 minutes and it keeps happening, uh, very frequently, then you probably will need to seek medical care for that. And the reason is, you know, it could be just a simple blood vessel that we're going to need to cauterize for you. Um, but if you don't treat it, I mean, it will probably keep bleeding on you. And sometimes if the front of the nose gets infected, then you know, what ends up happening is that they're kind of like a small bacteria that starts growing in that area and that exposes the blood vessels. And then, you know, there's a clot that forms. And then, uh, you know, you can't breathe out of that side of your nose, so patients will tend to pick on that clot and then once they take it off, it starts bleeding again. And it doesn't heal until, you know, either it's cauterized or treated with proper antibiotic ointment that will be applied in the front of the nose and that can take care of it.

So if it's really a recurrent nosebleed, uh, or, you know, if it's a nosebleed with nasal blockage, so if you feel that that side of your nose is blocked and then it's bleeding, then we want to investigate something more serious like a mass on that side of the nose. Um, but usually if it's recurrent, then this is when you need to seek medical attention for it.

Scott Webb: Yeah, definitely. And you mentioned, uh, some of the treatment options, so let's go through those treatment options, the type of, you know, medical intervention that, you know, would be appropriate for, let's say, the persistent or really, really bad nosebleeds.

Dr. Alissa Kanaan: Right. So let's say a patient is having a nosebleed and he comes to see us. So first thing we check is the blood pressure, right? Because if the blood pressure is elevated, sometimes even if we do lots of interventions, it's not really going to help. So first of all, we'll try to control the blood pressure. I'll have the patient like blow their nose, because sometimes if there's a blood clot in there, it kind of works like against, uh, the bleeding to stop. So instead of it helping the bleeding stop, it actually makes it worse. So we need to get rid of that blood clot. So if the patient can blow their nose, uh, that would help. If not, we can suction out the blood clot. And then pressure, leaning forward, those help.

Then, you know, if you can put in a local anesthetic to help kind of reduce the pain so that in case, we need to pack the nose, then it's kind of numbed little bit. And with that local anesthetic, we can put something called phenylephrine or like a type of Afrin, Afrin is that medication that you find over the counter that is oxymetazoline and that one can, you know, help kind of shrink the blood vessels or kind of help them, uh, constrict, we call it, so that they're not bleeding as much.

Once we have failed these, then we have to move on to something more medicated. So there is a medication called the TXA that we could also put on like a cotton or a pledget, we call it. And then we put that in the nose and see if that helps. If we are able to see a vessel in the front of the nose, then we do something called silver nitrate cauterization. So if we fail all the previous conservative measures and we see the blood vessel, it's just kind of like a matchstick. And then it has that medication on the top of it. And then we just kind of lay it on that mucosa where the bleeding is happening or that blood vessel, and it helps cauterize it. And if we fail that, then we might need to move on to packing the nose.

But like I mentioned before, there's a type of bleeding that happens in the front of the nose, but there's also a lesser common type of bleeding that can happen in the back of the nose. We call it a posterior bleed and the posterior bleed will be harder to manage. Um, it typically requires more extensive packing, sometimes surgery. But luckily the most common ones happen in the front of the nose and we can usually control these with minimal intervention bedside.

Scott Webb: Anything else, doctor, you'd like to tell people about nosebleeds, how to prevent them, how to treat them and so on?

Dr. Alissa Kanaan: So first make sure that your nose stays moisturized, especially in the dry weather season. You know, we all turn on our heaters, it gets dry in the house. It's dry outside. It's really cold. You know, sometimes the nose gets runny and we tend to maybe like rub on the nose or, you know, in some cases use a lot of tissue, which could also dry up the nose. So there are some, uh, over-the-counter, just saline-based gels that you could just put on a Q-tip, put it in the front of your nose twice a day to help, you know, keep it moisturized so that it doesn't bleed on you. And if a bleeding happens, like I said, make sure you put pressure on the soft part of your nose, lean forward and try to stop it that way.

But if it gets to be a recurrent, then you know, you will need to seek medical attention. But like I said, the most important thing is just to keep it moisturized and try to avoid like manipulation of that area.

Scott Webb: This has been so helpful and informative today. Thank you so much for your time today, doctor, and you stay well.

Dr. Alissa Kanaan: Okay. Well, thanks. You too.

Scott Webb: That's ENT Dr. Alissa Kanaan. For more information on UAMS' Ear Nose and Throat Program, which is among the top 50 in the nation according to US news and World Report, visit UAMSHealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest.

This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb. Stay well.