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Nosebleed (Epistaxis

Why do people get nosebleeds?

The nose is a part of the body that is very rich in blood vessels (vascular) and is situated in a vulnerable position on the face. As a result, any trauma to the face can cause bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out, crust, and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to bleeding if they are taking medications which prevent normal blood clotting (COUMADIN, warfarin, aspirin, or any anti-inflammatory medication). In this situation, only a very minor trauma could result in significant bleeding.

The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home results in drying and changes in the nose which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons. The following list of factors predispose people to nosebleeds:

Allergic and non-allergic rhinitis
Use of "blood thinning medications"
Alcohol abuse
Less common causes include, tumors and inherited bleeding problems
How do you stop the common nosebleed?

Most people who develop nose bleeding can handle the problem without the need of a physician if they follow the recommendations below:

Pinch all the soft parts of the nose together between your thumb and index finger.
Press firmly toward the face - compressing the pinched parts of the nose against the bones of the face.
Hold the nose for at least 5 minutes (timed by the clock). Repeat as necessary until the nose has stopped bleeding.
Sit quietly, keeping the head higher than the level of the heart; that is, sit up or lie with the head elevated. Do not lay flat or put your head between your legs.
Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks.
How do you prevent the nose from bleeding again?

Go home and rest with head elevated at 30 to 45 degrees.
Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
Do not strain during bowel movements. Use a stool softener (for example, COLACE).
Do not strain or bend down to lift anything heavy.
Try to keep your head higher than the level of your heart.
Do not smoke.
Stay on a soft cool diet. No hot liquids for at least 24 hours.
Do not take any medications which will "thin the blood" (aspirin or aspirin products). If these have been prescribed by your primary care physician, you need to contact him or her regarding stopping these medications.
Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).
If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can try using a nasal decongestant spray, such as AFRIN, DURATION, or NEO-SYNEPHRINE. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction.)
Repeat the steps above on how to stop the common nose bleed. If bleeding persists, then call your doctor and/or come to the emergency room.

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