Nose Bleeds

 

by P. Scott Bennett, MD

 

Nosebleeds occur when small blood vessels inside the nose rupture. This can occur as a result of trauma such as a blow to the nose or picking at the nose. Nosebleeds can occur at all ages, but are most common in children and the elderly. In children nosebleeds are common due to repeated irritation of the nose from frequent colds, which can result in crusting at the front of the nose and an urge to "pick" at the crusts. In the elderly the nasal lining can become thin and more fragile, allowing the nose to bleed more easily. This, combined with other factors such as hypertension and use of medications which reduce the blood's ability to clot (such as aspirin, ibuprofen, Coumadin, Plavix), are common factors which contribute to nose bleeds. In all ages nasal dryness can result in small cracks in the lining of the nose, which can tear the blood vessels. Patients who need to use nasal cannula oxygen or CPAP are at more risk for nosebleeds due to dryness as well. Rarely nosebleeds can be caused by abnormal growths in the nose or bleeding disorders such as hemophilia. A thorough office examination is recommended for all patients who experience recurrent nasal bleeding.

 

Prevention of Nosebleeds

 

1) Avoid picking at your nose with fingers or Q-tips.

2) Prevent nasal dryness by running a humidifier while you sleep, applying small amount of ointment (such as Polysporin or nasal saline gel) inside your nose when it feels dry, and using nasal saline spray or gel to moisturize the nose.

3) If you are having frequent bleeding and use Aspirin (Bufferin, Alka-Seltzer, Excedrin), Ibuprofen (Motrin, Advil), or Naprosyn (Aleve) products for pain, consider stopping them temporarily or switching to Tylenol. If are taking aspirin or other blood thinners (such as Coumadin or Plavix) for a heart condition or history of strokes, you should talk to the prescribing doctor about the problems you are having with nosebleeds, and only discontinue these medications if advised by that physician.

4) If you have high blood pressure that is not under control, see your primary care doctor to have this treated. Hypertension is a common cause of nosebleeds in adults.

5) Avoid strenuous activity such as heavy lifting or straining. Avoid bending over. Use stool softeners to avoid straining if you are constipated.

 

Stopping a Nosebleed

 

1) Pinch and hold pressure on the lower part of your nose for 10-15 minutes.

2) Ice may be applied over the nose to constrict the blood vessels. Rinsing the nose with saline spray may help clear old blood clots and control bleeding.

3) Put 2-3 sprays of Afrin Nasal Decongestant Spray in each nostril. This medicine can constrict the blood vessels and slow bleeding. Reapply pressure after doing this.

4) Sit with your head up. This lowers the venous pressure in your head.

5) If these methods fail to control bleeding, you may need to seek help at our office, in the Emergency Room, or at an Urgent Care Center.

 

Nasal Cauterization

 

If your nosebleeds persist, it may become necessary to cauterize the blood vessels to control the bleeding. We can usually perform this procedure at our office, using a topical anesthetic to "numb" the nose to reduce discomfort. Occasionally these procedures may need to be performed in the operating room under general anesthesia, particularly in young children who might not be able to cooperate in the office. Cauterization destroys the fragile superficial blood vessels in the nasal lining that are easily bleeding. Cautery also injures the nasal lining temporarily, and as it heals you will develop a scab. Brief re-bleeding may occur during this healing process. Apply Polysporin to the inside of the nose 3-4 times daily for 10-14 days after cauterization. Follow the same instructions outlined above for prevention of nosebleeds after cauterization. Sleep with your head elevated on 2-3 pillows. Avoid blowing your nose. Sneeze with your mouth open to allow the pressure to escape.

 

Nasal Packing

 

Severe nosebleeds may be controlled by putting a pack in the nose to apply continuous pressure to the vessels. These packs are often left for 3-5 days to allow good control of the bleeding, and give the nasal lining some time to heal. You will have to breathe through your mouth with a pack in place. Sleep with your head elevated on 2-3 pillows. Your doctor will prescribe an oral antibiotic to prevent the nose from getting infected while the pack is in. It is not unusual to have some oozing of blood around the pack, but if you have heavy amounts of fresh blood down your throat or around the pack, let your doctor know. Again, follow the instruction above for prevention of nosebleeds once the pack is removed.