Care and Prevention of Nosebleeds

Care and Prevention of NosebleedsNosebleeds (epitaxes) are extremely common. In fact, up to 70 percent of Americans have experienced at least one in their lifetime. Nosebleeds can occur at any age, but are most common in children age 2 to 10 and adults age 50 to 80.

Why are nosebleeds so common?
The nose contains many tiny blood vessels that are broken easily. Simple problems may cause a nosebleed, including:
• Low humidity in indoor air, especially in the winter months
• Allergies, infections, or dryness
• Vigorous nose-blowing that ruptures superficial blood vessels
• Nose picking
• Certain medications, including anticoagulants and anti-inflammatories, that thin the blood

Nosebleeds also may be a symptom of more serious conditions, including hereditary clotting disorders; fractures of the nose or the base of the skull; tumors; high blood pressure; leukemia; anemia; and vasculitis.

Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front (anterior) or back (posterior) of the nose.

Anterior nosebleeds
Most nosebleeds begin in the lower part of the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. Nosebleeds coming from the front of the nose, often begin with a flow of blood from one nostril when the person is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air irritates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rubbing it inside the nose especially on the middle portion of the nose (the septum).

How do I stop an anterior nosebleed?
• Stay calm, or help a young child stay calm. An agitated person may bleed more profusely than someone who’s been reassured and supported.
• Keep the head higher than the level of the heart. Sit up.
• Lean slightly forward so the blood won’t drain in the back of the throat.
• Gently blow any clotted blood out of the nose. Spray a nasal decongestant in the nose.
• Using the thumb and index finger, pinch all the soft parts of the nose. Do not pack the inside of the nose with gauze or cotton.
• Hold the position for 5 minutes. If it’s still bleeding, hold for an additional 10 minutes.

Posterior nosebleed
More 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. It is important to try to make the distinction between anterior and posterior nosebleeds because posterior bleeds are often more severe and  almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, people with high blood pressure, and in cases of injury to the nose or face.

Seeking treatment for nosebleeds
Individuals should seek medical advice for frequent nosebleeds as well as those that continue for more than 20 minutes.

King’s Daughters otolaryngologist Greg Baker, M.D., can assist with determining the underlying cause of nosebleeds. He will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose.

Based upon findings, Dr. Baker may cauterize the vessel or pack the nostril. In cautery, the physician heats the blood vessel with an electric current, silver nitrate, or a laser. If packing is appropriate, he will insert special gauze or an inflatable balloon, which will apply pressure on the blood vessel, causing it to seal.

Should other, more serious conditions be discovered, Dr. Baker will discuss further testing and treatment options.

Tips to prevent nosebleeds
• Keep the lining of the nose moist by gently applying a light coating of petroleum jelly or an antibiotic ointment with a cotton swab three times daily, including at bedtime. Commonly used products include Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline.
• Keep kids’ fingernails short to discourage nose picking.
• Counteract the effects of dry air by using a humidifier.
• Use a saline nasal spray to moisten dry nasal membranes.
• Quit smoking. Smoking dries out the nose and irritates it.

Tips 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.

If re-bleeding occurs:
• Attempt to clear nose of all blood clots.
• Spray nose four times in the bleeding nostril(s) with a decongestant spray.
• Repeat the steps to stop an anterior nosebleed.
• Call a doctor if bleeding persists after 30 minutes or if nosebleed occurs after an injury to the head.

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