Nosebleeds

Who among us has never had a nosebleed? Whether a dab of blood on a tissue or a terrifying flood, a nosebleed can arise from many causes: dry winter air, colds, injuries, or the common if unsavory habit of picking ones nose. In many cases, no cause can be identified with certainty.

Sometimes nosebleeds arise more frequently because of faulty or weak collagen, a strengthening protein present in blood vessel walls and the surrounding connective tissue. Collagen problems may lead to nosebleeds in people who take corticosteroids and those with a condition called "fragile capillaries."

Corticosteroids, including nasal steroids used for allergies, can thin the collagen in the mucous membranes lining the nose. In fragile capillaries, weak or defective collagen in blood vessel walls may contribute to bleeding. People with collagen problems may have problems with bleeding gums, heavy menstrual periods, and bruising (blood collecting under the skin) in addition to nosebleeds.

Rarely, the cause of nosebleeds and other bleeding lies in the blood itself. Anything that reduces blood clotting may lead to nosebleeds. Drugs such as warfarin (Coumadin) or heparin, or regular use of aspirin, can decrease the bloods tendency to clot. Caution: if you are taking such medications and begin to experience nosebleeds, talk to your doctor. Even natural substances such as ginkgo, high-dose vitamin E, and garlic may increase the tendency to bleed.

Conventional treatments for nosebleeds include various maneuvers for stopping acute bleeding, followed by the diagnosis and treatment of any underlying problems. Sometimes a physician can prevent future nosebleeds by cauterizing the blood vessel responsible.

Principal Proposed Treatments for Nosebleeds:

One supplement that may help prevent nosebleeds is citrus bioflavonoids. Bioflavonoids (or flavonoids) are plant substances that bring color to many fruits and vegetables. Citrus fruits are a rich source of bioflavonoids, including disomin, hesperidin, rutin, and naringen. One study has found that citrus bioflavonoids can help decrease symptoms of easy bleeding, such as nosebleeds, among people with fragile capillaries.

What Is the Scientific Evidence for Citrus Bioflavonoids?

A double-blind study of 96 people with fragile capillaries found that a combination of the bioflavonoids diosmin and hesperidin decreased symptoms of capillary fragility, such as nosebleeds and bruising. In this 6-week trial, participants—41% of whom had problems with nosebleeds—took 2 tablets daily of the bioflavonoid combination or placebo. Those who received bioflavonoids had significantly greater improvements in both their symptoms and their capillary strength compared to those taking placebo. Unfortunately, the researchers didnt state how much the nosebleeds improved.

For more information, including dosage and safety issues, see the full citrus bioflavonoids article.

Other Proposed Treatments for Nosebleeds:

Although there are no other well-documented treatments for nosebleeds, numerous substances are used to treat other conditions that involve capillary fragility. It is possible, but certainly not proven, that some of these same treatments may be helpful for nosebleeds.

OPCs (Oligomeric Proanthocyanidins)

OPCs are bioflavonoid-like compounds found in large amounts in grape seed and grape extract products. Test tube studies have found that OPCs protect collagen, partly by inhibiting an enzyme that breaks it down. One rather poorly designed double-blind study of 37 people—most of whom had fragile capillaries—found that OPCs were more effective than placebo in decreasing capillary fragility; however, the study authors left many questions unanswered in their report, making it hard to determine how seriously to take their results, and they did not address nosebleeds specifically.

For more information, including dosage and safety issues, see the full OPCs article.

Anthocyanoside

Anthocyanosides are present in high concentrations in bilberry, a food related to the blueberry. Like OPCs, anthocyanosides may strengthen capillaries through their effects on collagen. For more information, including dosage and safety issues, see the full bilberry article.

Vitamin C

Vitamin C is vital for the development of normal collagen. People with scurvy (severe vitamin C deficiency) may bleed easily from the nose, as well as developing spontaneous bruises and other bleeding symptoms. True vitamin C deficiency is extremely rare in Western countries; marginal deficiencies are more likely to occur in people without access to much fresh food, such as some elderly people in institutions. However, there is no evidence as yet that vitamin C supplementation helps to decrease nosebleeds in the absence of true scurvy.

Other Treatments

The herb shepherds purse (Capsella bursae pastoris) has been traditionally used as a topical application to control nosebleeds, although scientific evidence of its effectiveness is lacking. The herb should not be used during pregnancy because it can stimulate uterine contractions.Other proposed natural treatments for fragile capillaries include proteolytic enzymes, such as bromelain and the digestive enzymes trypsin and chymotrypsin. Again, there is as yet no evidence showing that these substances can help prevent nosebleeds.