Nosebleeds

Most nosebleeds (epistaxis) are mere nuisances but some can be quite frightening Fortunately, nosebleeds are rarely life threatening. They are generally caused by excessive nasal dryness. The mucus membrane lining in the nose has small blood vessels embedded within it. When this mucus membrane dries out, it tends to crack and the bleeding comes from these cracked blood vessels. Certain factors can increase the risk of nosebleeds: dry climates, high blood pressure, blood thinners or aspirin, liver disease, or nose-picking. Otolaryngologists classify nosebleeds into two different types.

Anterior nosebleed

The overwhelming majority of nosebleeds occur in the front part of the septum, which is the flexible wall that separates the two nostrils. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood from one nostril when the patient is sitting or standing.

Posterior nosebleed

Rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing.

Which type of nosebleed did I have?

It is important to determine which type of nosebleed is present. Most anterior nosebleeds respond well to simple measures while posterior nosebleeds are usually more severe and require a physician’s care.

What can I do to prevent or reduce the bleeding?

Most nosebleeds can be prevented by simply increasing nasal moisture. This can be accomplished via nasal saline spray, Ayr gel, Vaseline, Bacitracin, or lotion applied with a Q-tip to the middle part of the nose (septum). One application per day (at bedtime) is usually sufficient, but this can be repeated up to three times per day if needed. However, water soluable agents such as saline spray or Ayr gel can be applied several times per day. If the nosebleeds persist in spite of this, you should see your doctor. If the cause o the nosebleeds is not readily apparent, the otolaryngologist may place a small scope in your nose to find the bleeding source. He may recommend cauterization of the blood vessel that is causing the problems.

What can I do to stop an active nosebleed?

  1. First, be calm. Attempt to clear nose of blood clots if present. Sit or lie back a little with the head elevated.
  2. Spray 4 puffs of over-the-counter decongestant such as Afrin or Neo-Synephrine into bleeding nostril.
  3. Pinch the soft parts of the nose together between your thumb and index finger.
  4. Hold that position for a full 5 minutes by the clock.
  5. If the bleeding persists, soak a cotton ball with Afrin or Neo-Synephrine and pinch the nose for another 5 minutes.
  6. Call your doctor if bleeding persists.

To prevent re-bleeding after initial bleeding has stopped:

  • Do not pick or blow nose.
  • Do not strain or bend down to lift anything heavy.
  • Keep head higher than the heart.
  • Use a humidifier by the bedside.