FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

ASPIRIN LIKELY CULPRIT IN READER’S NOSEBLEED

Question: My husband has had at least one nosebleed each month for nearly two years now. It is always the right side of his nose that bleeds. His blood pressure is good and he doesn’t take any medication except aspirin or Advil. What could be causing his nosebleeds?

Answer: Nosebleeds, or epistaxis in doctor language, are quite common. Most of us have had one. The nose, like any body part, will bleed when injured. Trauma is the most common cause for nosebleeds in children. In fact, I can distinctly remember having one after accidentally running into my sister’s fist -- but that is another story. Nosebleeds are often the result of nose picking. While children don’t think of this as an injury, it’s evidence that it doesn’t take much force to scratch the sensitive nose tissues and cause bleeding.

Nosebleeds are generally a minor problem in the sense that they stop quickly and usually don’t involve a life-threatening amount of blood loss. The best way to treat a nosebleed is to sit up, bend the head down, and to press the sides of the nose firmly together for five minutes. Five minutes seems like an eternity when you are doing this, so don’t use your judgment for determining the elapsed time, use a watch. Sitting up and holding the head tilted downward helps the blood pool and clot in the nose instead of running down the back of the throat.

After the required five minutes have passed, let go of the nose and see if bleeding resumes. It probably won’t, unless you blow your nose. Blowing the nose will clear the clotted blood and mucus that is making it hard to breath through the nose, along with the clot that is stopping the bleeding!

Nosebleeds aren’t always a “minor” problem. Individuals who suffer from bleeding disorders such as those with hemophilia and elderly individuals without hemophilia can have potentially life-threatening amounts of blood loss from the nose. This type of nosebleed is quite frightening for the patient and for his or her physician. Fortunately, they are uncommon.

Your husband has the most common type of bleeding disorder. His platelets don’t work very well because he takes aspirin and other non-steroidal, anti-inflammatory medications (like Advil). Aspirin reduces the risk of heart attack in those who have had a previous one by creating this type of minor bleeding disorder. This helps prevent the formation of a blood clot that would then block a coronary artery, which, in turn, could cause a heart attack. So, a small amount of aspirin every day is a good idea for someone who has had a previous heart attack, but it isn’t necessarily a good idea for those who haven’t.

The mucosa, the skin-like tissue that lines the nose, can become thin and easily damaged as a consequence of many problems. A common cause of this is excess drying caused by breathing very dry air. This is prevalent throughout the winter months when central heating is on, and the colder it is outside, the dryer the inside air becomes. Another common cause of injury to the nasal mucosa is frequent use of decongestant nose sprays. None of these cause nosebleeds, they just make them more likely.

You mentioned that your husband’s blood pressure was normal. That’s good. There is a common myth that high blood pressure causes nosebleeds. This simply isn’t true. If it were, nosebleeds would be one of the most common health complaints and they aren’t.

Anyone who has a nosebleed that doesn’t stop after five minutes of firmly squeezing the nose shut should go to the emergency department of a local hospital. Most of these individuals will turn out to have a nosebleed that can be stopped by relatively simple measures. Nonetheless, the hospital is the correct place to be just in case more complicated treatment is called for.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.