You are going about your daily routine or maybe you are peacefully asleep, dreaming about a delicious chicken drumstick you had, (what’s with chicken wings?) or maybe you are dreaming up a future with someone you just met, smiling and cuddling your pillow a bit tighter. Maybe its a nightmare, like those ones where you are falling through a bottomless pit or one of a hospital corridor because you’ve been having a really bad cold of late. Maybe its a dreamless sleep, anyway you are asleep and you feel a warm liquid run down your nose. You rub at it and turn in your sleep, your dream interrupted; definitely not a running nose . You jerk up from your sleep and put the lights on and there at the back of your hand or on your finger is a red blood stain.
Disbelievingly, you rub at your nose again. Blood. So what do you do? Do you call your doctor friend? Call a friend who has a friend who knows a doctor? Lie back down? Put ice on your nose?
Nose bleeding is a scary experience especially if its happening for the first time. The good news is that most nose bleeds are no serious and resolve in a short time with home first aid. Very few cases need medical attention. They are also painless, unless the cause is a blow to the face or nose.
Most common cause of nosebleeds is a dry inner nose lining. The inner lining of your nose has many small blood vessels and mucous keeps the inner lining of your nose moist. This protects the inner lining of the nose from drying out. Most nose bleeds will occur when the inner lining of the nose dries out and cracks, exposing the many blood vessels just below the surface and causing then to bleed. This type of bleed is mainly minimal and from the anterior(front) aspect of your nose. Some nose bleeds can start from the back of your nose(posterior bleeds).this area of the nose has more blood vessels causing a heaver nose bleed that usually requires medical attention.
Some causes of a dry inner lining of the nose that lead to nose bleeds include
- Common cold and sinusitis
- High altitudes
- Dry air and excess heat
- Some drugs and medications
- Allergies and frequent use of nasal sprays and medications to treat itchy, runny or stuffy nose.
- Change in climates (from a cool place to a hot dry environment)
- Chemical irritants (chemicals in cleaning supplies, chemical fumes at the workplace, other strong odors).
Poking your nose or putting objects in the nose is a common cause of nose bleeding. this is a common cause in children especially. Its not uncommon for an adult with the habit of picking their nose to develop a nose bleed. This usually brings about an anterior nose bleed that is easily controlled
Blowing your nose too often or too hard could lead to a nose bleed. Sneezing through your nose sometimes causes trauma to the blood vessels and lead to a bleed. When sneezing, do so with an open mouth, with a cloth or your hand covering your sneeze.
A blow to the head, nose or face can cause a nose bleed. This is usually serious and immediate medical attention should be sort.
Some medical conditions and drugs used can predispose one to having frequent nosebleeds. Nose bleeds from this can last long and have heavy bleeding and require medical attention.
Other causes of nosebleeds include;
- Conditions that prevent blood from clotting properly such as hemophilia, leukemia or immune thrombocytopenia
- Abnormalities in blood vessels such as atherosclerosis
- Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin, and others).
- Facial and nose surgery.
- Growths in the nose eg polyps or tumor.
- Pregnancy (blood vessels are dilated and at more risk of bleeding)
- Cocaine and other drugs used through the nose.
Home first aid, as described below, works in most nose bleeding cases. In very few cases do you one need to seek medical attention for a nose bleed. If a nose bleed does not stop within 20 minutes of first aid, seek medical attention.
Here is how to deal with a nose bleed.
- DO NOT PANIC. Remind yourself that most nosebleeds will resolve in no time. If someone else is having a nose bleed let them know nose bleeds are common it will most likely end in no time.
- CONTROL THE BLEEDING. Pinch the soft part of your nose together and breath from your mouth. Pinch for 5 minutes before checking and if still bleeding pinch for another 10minutes.
- BREATH THROUGH YOUR MOUTH. Taking deep controlled breaths through your mouth will go a long way to keep you calm through the first aid process.
- SITTING POSITION. Be seated upright, slightly slanted forward with a bowl or cloth or tissue to catch the blood. This position prevents the blood from flowing backwards into your throat and causing irritation. Also swallowed blood can irritate the stomach and cause you to vomit.
- DO NOT SWALLOW BLOOD. Spit out any blood that goes back down to your throat. This helps you know how much you’ve bleed also protect you from nausea and vomiting.
- COOL YOUR NOSE. Use a ringed out wet towel, or ice cubes rapped in towel or cloth and place them at the ridge of your nose. The cooling helps the blood vessels to contract which reduces bleeding. This is an additional step and not always required.
- CHECK FOR PROGRESS; Release your pinch after 10 minutes and observe if the bleeding has stopped. If no more bleeding, then rest in an upright position for a few minutes and then practice post nose bleed care as discussed later. If still bleeding, pinch your nose again for 10 minutes and recheck. If still having a bleed after 20 minutes, reapply pressure and pinch seek medical help.
- NASAL SPRAY USE; If available, some nasal sprays can be used.
- SEEK MEDICAL HELP; Seek medical attention after 20 minutes of first aid and you still have an active nose bleed.
WHEN TO SEEK MEDICAL HELP
- If the nose bleed is caused by an accident or trauma eg blow to your face or nose or if there is anything stuck in the nose
- You develop or have difficulty breathing.
- You vomit because you’ve swallowed a lot of of blood.
- FOR children below 2 years who get a nose bleed.
- Heavy bleeding with clots that soaks up a handkerchief/cloth in a few minutes or bleeding that fills a cup.
- Frequent and heavy nose bleeds; 2-3 days or more every week or every month
- Experiencing symptoms of low blood level like headaches, dizziness, awareness of heartbeat, blurring of vision, getting tired easily.
- As mentioned before, a nosebleed lasting more than 20 minutes.
- If you experience a nose bleed after starting a new medication or treatment.
- A nose bleed for those with medical conditions that put them at risk.
POST NOSEBLEED CARE.
- Take a 30 to one hour rest from any tasking activities
- Don’t blow or poke your nose for a day or two despite the feeing of having crusted dried blood in your nose. You could gently apply a moisturizer (Vaseline) to reduce the discomfort. If you have to blow your nose, do it very gently to avoid another nose bleed.
- If you have a dry inner nasal lining due to any of the reasons mentioned earlier, use a moisturizing nasal spray or Vaseline to keep your nasal mucosa from drying out.
- For recurrent and heavy bleeding due to an underlying medical condition, keen follow-up with your doctor is recommended.
- Avoid blowing your nose too hard.
- Sneeze through an open mouth and into your elbow.
- Avoid picking your nose or putting anything solid into your nose.
- Limit your use of medications that put you at risk of a nose bleed
- Wear protective head gear in activities that could result in an injury to your face and nose.
- Train your child about dangers of picking their nose and keep their child’s fingernails short.
- Use a saline nasal spray or saline nose drops or Vaseline for dry nasal mucosa.