Understanding Nosebleeds | MS and Nosebleeds | NSAIDs | Management | MS Comorbidities | Support

Nosebleeds might happen when dry air causes the lining in the nose to crack and bleed, or when the use of certain medications affects the blood’s ability to clot. People with MS may take these drugs to address symptoms of MS or other coexisting conditions. Therefore, people with MS could experience nosebleeds from medications, but not directly from MS.

Another way that people with MS could experience nosebleeds is through trauma or injury to the nose. Sometimes, MS produces issues with balance and trouble walking. Falling and hitting your nose could result in a nosebleed.

Although nosebleeds can be scary, they are usually not serious. Nosebleeds can be treated at home, but there are several situations when a nosebleed may require medical attention.

Understanding Nosebleeds

Nosebleeds (also called epistaxis) occur when there is damage to the blood vessels in the nose that results in bleeding. This type of bleeding is rarely serious, but if you experience nosebleeds frequently or for longer than 30 minutes, you may need to seek professional medical advice.

There are several different reasons someone may experience a nosebleed. More common reasons include:

• Dry air or heat
• Nose picking (mainly in children)
• Use of anticoagulants such as aspirin or warfarin
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Health conditions such as liver disease, kidney disease, or chronic alcohol consumption

Less common causes of nosebleeds include:

• Trauma from an injury
• Interior deformities or abnormalities of the nose or sinuses
• Intranasal tumors (rarely)

MS is not considered a cause of nosebleeds.

Multiple Sclerosis and Nosebleeds

MS can produce a range of symptoms. It is a disorder in which the immune system mistakenly attacks the protective sheath (myelin) that covers nerve cells in the central nervous system (the brain and spinal cord). Symptoms of MS affect different parts of the body, and they may change or worsen as the disease progresses. Some common symptoms of MS include:

• Numbness or weakness in the limbs
• Shock-like sensations in the neck
• Blurred or double vision
• Spasticity (feelings of stiffness in the muscles and limbs)
• Fatigue or unexplained excessive tiredness
• Speech problems
• Dizziness
• Tremors or lack of coordination when moving

Although nosebleeds are not a symptom of MS, medications used to treat the symptoms of MS and the chance of injury due to MS symptoms could influence the risk of nosebleeds in people with the condition.

NSAIDs and Nosebleeds

NSAIDs, which include ibuprofen (Motrin or Advil), are a type of medication that is sometimes used to address symptoms of neuromuscular pain in people with MS. NSAIDs affect the ability of blood to clot and are indicated as a cause of nosebleeds. People who take NSAIDs regularly may be at an increased risk of nosebleeds.

Aspirin and Nosebleeds

Aspirin is another medication used to address specific MS symptoms. Fatigue is a common symptom in people with MS, and some doctors may recommend medical treatment for fatigue. A research study found that taking regular aspirin twice daily helped reduce MS-related fatigue.

Aspirin also affects blood clotting and is listed as a cause of nosebleeds. Taking aspirin regularly, whether for fatigue or other reasons, could affect your risk of nosebleeds.

MS-Related Injury and Nosebleeds

Some symptoms of MS, like spasticity, dizziness, reduced coordination and balance, and difficulty walking increase the risk of falling and injury in people with MS. According to the Cleveland Clinic, 40 percent to 50 percent of people with MS experience falls that result in injury. One member of MyMSTeam wrote, “Fell on my face — severe nosebleed.”

MS Comorbidities and Nosebleeds

Treatment options for MS comorbidities may also affect the risk of nosebleeds. Comorbidities are other diseases or conditions that exist in people with a given disease. Comorbidities are not caused by the other disease.

Common comorbidities in people with MS include:

• Depression
• Anxiety
• Cerebrovascular diseases
• Diabetes
• Thyroid disease
• Cardiovascular diseases

Cardiovascular disease, or heart disease, includes issues such as high blood pressure (hypertension), high cholesterol (hyperlipidemia), heart attack, stroke, and heart failure. Often, medications like aspirin or anticoagulants are used for the treatment of heart disease and the prevention of blood clots that may cause heart attacks or strokes. Aspirin and anticoagulants can cause nosebleeds, however.

“Had an issue this week with nosebleeds due to all of the heart medications I am on,” wrote a MyMSTeam member.

Tips for Managing a Nosebleed at Home

Most nosebleeds can be managed at home and do not require medical attention. If you have a nosebleed, follow these steps:

• Sit up straight and tilt your head slightly forward. Do not tilt your head back, as doing so may cause blood to reach your stomach and result in nausea and vomiting.
• Use a tissue or washcloth to catch the bleeding.
• Try to breathe through your mouth.
• Use your thumb and forefinger to pinch the lower, soft part of your nose shut.
• Pinch your nose shut for 10 minutes, without stopping. If your nose is still bleeding, then pinch your nose shut for another 10 minutes.
• If you have an ice pack handy, apply the ice pack to your nose and cheeks to slow the bleeding.
• When the bleeding has stopped, you may use a saline nasal spray or antiseptic nasal cream to soothe the area. Do not blow your nose or bend over, strain, or lift anything heavy for several hours to let the area heal.

You may require immediate medical attention if you:

• Have a severe nosebleed, or one that actively bleeds for longer than 30 minutes or causes more than one cup of bleeding
• Vomit due to swallowing large amounts of blood
• Have difficulty breathing
• Have a nosebleed that was a result of a serious injury like a major fall or car accident

In these situations, you should call your doctor, call 911, or have someone drive you to an emergency room or urgent care center. Do not drive — attempting to drive with a nosebleed can cause distractions and be dangerous.

Sometimes, nosebleeds do not require immediate medical attention, but you should talk to a health care professional about them soon if:

• You experience frequent nosebleeds
• You have a blood clotting or bleeding disorder or take anticoagulants and the bleeding won’t stop
• You show symptoms of anemia, including feeling weak, cold, short of breath, and having pale skin
• The nosebleeds seem to be a result of starting a new medication

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis. On MyMSTeam, more than 182,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you have MS and experience nosebleeds? Share your experience in the comments below, or start a conversation by posting on your Activities page.