Nosebleeds

Nosebleeds (epistaxis) are quite common in Texas. Our climate dries the delicate mucous membrane lining the septum (middle wall) of the nasal cavity, allowing it to crack and tear the small, superficial blood vessels underneath. In addition, chronic or improper use of nasal sprays can cause irritation or ulcer formation on the septum leading to bleeding. High blood pressure, bleeding disorders and blood-thinning medications (Plavix, Aspirin, Coumadin, etc.) increase the risk of nose bleeds. Most nosebleeds are a nuisance but some can be frightening and very rarely, they can be life-threatening.

How to stop your nosebleed

Most nosebleeds are anterior and can be stopped with straight-forward intervention. If you have frequent or troublesome nosebleeds, keep the “Supplies for home” mentioned above in your medicine cabinet. The decongestant nasal spray causes vasoconstriction which helps stop the bleeding (small blood vessels are constricted-temporarily stopping or slowing the blood flow through them).

At the onset of bleeding:

Immediately pinch the nostrils together (against the septum) with your thumb and index finger
Soak a cotton ball with the decongestant spray
Release pressure on the nose briefly and spray 3 squirts of the nasal decongestant into the affected nostril.
Stuff the decongestant soaked cotton ball into the affected nostril (leave enough of the cotton ball showing so that you can retrieve it with your fingers or tweezers).
Pinch the nostrils together against the septum with your thumb and index finger for 15 continuous minutes. This will also squeeze the cotton ball against the bleeding area.
Release pressure. If bleeding continues, place a newly soaked cotton ball and resume pressure for 15 more minutes; repeat up to 3 times if still bleeding. If bleeding continues despite 3 cycles of nasal pressure, then proceed to the nearest emergency room.
After bleeding is stopped, leave the decongestant soaked cotton ball in place for 30 minutes before gently removing.
Very gently apply a thin layer of antibiotic ointment to the septum and internal nostril. This is accomplished by first washing the hands thoroughly with soap and water. Apply a pea-sized amount of ointment to the pinky finger. Gently massage this onto the septum and internal nostril to moisturize the nasal cavity. Repeat the ointment application twice daily for one week.
Do NOT blow nose for 2-3 days after experiencing a nose bleed that required a cotton ball packing to be placed.
Gently apply nasal saline spray to both nostrils 3 times daily after any significant nose bleed for the next 1-2 weeks. This will keep the nasal lining moist and help to wash out old blood clots.

Preventing nosebleeds:

Moisturizing the nasal cavities is the key to preventing nosebleeds. Use nasal saline spray, 2-3 squirts each nostril several times daily and as needed to keep the mucous membranes from cracking and bleeding. Allergy and chronic sinusitis sufferers, and those living in particularly dusty environments (new construction areas) will find relief in a once or twice daily nasal saline rinse. Sinus Rinse® used as directed on the product insert is an excellent over-the-counter solution. Applying a pea-sized amount of antibiotic ointment once or twice daily to the septum and vestibule (area of the nose just inside the nostrils) with your pinky finger will keep the front of the nose moist and promote healing of cracked and ulcerated areas. Run a humidifier or vaporizer in your bedroom at night to help moisturize the nasal passages as well. Consult your doctor regarding any blood thinning medications you may be taking. Certain heart conditions and blood clotting disorders require continuing the blood thinning medications despite frequent nose bleeds.

Causes

Allergic rhinitis
An object stuck in the nose
Barotrauma
Blowing the nose very hard
Chemical irritants
Direct injury to nose, including a broken nose
Nose picking
Overuse of decongestant nasal sprays
Repeated sneezing
Surgery on the face or nose
Taking large doses of aspirin or blood-thinning medicine
Upper respiratory infection
Very cold or very dry air

Repeated nosebleeds may be a symptom of another disease such as high blood pressure, allergies, a bleeding disorder, or a tumor of the nose or sinuses.

Get emergency care if:

Bleeding does not stop after 20 minutes
Nose bleeding occurs after an injury to the head -- this may suggest a skull fracture and x-rays should be taken
Your nose may be broken (for example, it is misshapen after a blow or injury)

Call your doctor if you or your child has repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.

Prevention

A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray and water soluble jelly (such as Ayr gel) can help prevent nosebleeds, especially during the winter months.