Epistaxis (Nosebleeds)

WHY DO PEOPLE GET NOSE BLEEDS?

The nose is a very vascular structure which is situated at a vulnerable site on the face. Because there are so many small blood vessels in the nose any trauma to the face may cause the nose to bleed. The bleeding may be profuse, or simply a minor nuisance. 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 will make the blood not clot (Coumadin, Warfarin, Plavix, Aspirin, Ibuprofen or any anti-inflammatory medication). If you are using a blood thinning medication a very minor trauma to the nose may result in a large amount of 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. Some of the things which may predispose you to having nosebleeds are:

  1. Infection.
  2. Trauma.
  3. Allergic and non-allergic rhinitis.
  4. Hypertension.
  5. Use of “blood thinning medications”.
  6. Alcoholism.
  7. Less common causes of nosebleeds include tumors and congenital bleeding problems.

HOW DO YOU STOP THE COMMON NOSE BLEED?

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

  1. Pinch all the soft parts of the nose together between your thumb and index finger.
  2. Press firmly toward the face – compressing the pinched parts of the nose against the bones of the face.
  3. Hold it for at least 5 minutes (timed by the clock), repeat as necessary until the nose has stopped bleeding. 4. 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.
  4. Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks.
  5. Soak a piece of cotton ball with Oxymetazoline (Afrin) nose spray. Then put this inside the bleeding nostril. Now wait and you may repeat from step 1.

HOW DO YOU PREVENT THE NOSE FROM BLEEDING AGAIN?

  1. Go home and rest with head elevated at 30 to 45 degrees.
  2. 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.
  3. Do not strain during bowel movements. Use a stool softener (example Metamucil or Colace).
  4. Do not strain or bend down to lift anything heavy.
  5. Try to keep your head higher than the level of your heart.
  6. Do not smoke.
  7. Stay on a soft cool diet. No hot liquids for at least 24 hours.
  8. 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.
  9. Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).
  10. 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, Oxymetazoline, or Neosynephrine. These types of sprays will constrict blood vessels, but if used for many days at a time they 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.

WHAT PRECAUTIONS CAN YOU TAKE TO PREVENT BLEEDING?

The most common cause of a nose bleeds is drying of the nasal membranes. If you are prone to recurrent nosebleeds, it may be helpful to try lubricating the nose with an ointment of some type. This can be applied with your clean fingertip up inside the nose, especially on the middle portion of the nose (the septum). Many patients use A & D ointment, Mentholatum, Bacitracin ointment, polysporin/neosporin ointment, or Vaseline. Saline mist nasal spray is often helpful (Ocean spray).

WHEN SHOULD YOU CALL YOUR DOCTOR OR GO TO THE EMERGENCY ROOM?

  1. If bleeding cannot be stopped or keeps reappearing.
  2. If bleeding is rapid or if blood loss is large.
  3. If you feel weak or faint, presumably from blood loss.
  4. If the nosebleeds persist or are recurrent, you should make an appointment to see your doctor at Central Coast Otolaryngology

WHAT MAY BE DONE FOR MY NOSEBLEEDS?

Your doctor or the physician’s assistant may recommend cautery to the blood vessel that is causing the nosebleeds. Blood tests may be ordered to check for general bleeding disorders. If bleeding is still persistent, the doctor may place nasal packs, which will compress the vessel and stop the bleeding. In rare situations, you may have to be admitted to the hospital or require surgical treatment or angiographic embolization of the bleeding nasal vessels.

WHAT SHOULD I DO IF THE DOCTOR HAS PLACED NASAL PACKS?

Nasal packs are used when less conservative measures fail (see above). These packs are frequently placed in both sides of the nose. The packs will help compress the area of the nose which is bleeding. Some packs are made of special materials which will help to stop the bleeding. Your doctor will usually not remove them for several days (2 to 7 days). Make sure you have an appointment for follow-up. You will need someone to drive you and bring you home after the nasal packs are removed. While the packs are in place you may be prescribed an antibiotics and pain medications as needed. Remember; do not take aspirin or any other blood thinning products. It is not uncommon for the nose to drain a blood tinged material while the packing is in place. Folded gaze taped under the nose (a mustache dressing) is often useful. You may clean your nostrils with hydrogen peroxide and then rinse with cool water. In addition to these recommendations, you should follow the directions under how to prevent the nose from bleeding again.