Dealing with Frequent Nosebleeds
Supplies for home
- Nasal Saline Spray (Ocean®, Deep Sea®, etc.)
- Antibiotic ointment (Mupirocin, Bacitracin® or Neosporin®)
- Nasal decongestant spray (Neosynepherine or Afrin®)
- Neil Med Sinus Rinse®
- Small room air humidifier or vaporizer for the bedside
- Cotton balls
General
Nosebleeds are quite common in Arizona. Our arid 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.
Classification
Physicians classify nosebleeds into two types: Anterior and Posterior. Anterior nose bleeds are much more common than posterior nosebleeds.
An anterior nosebleed is one that comes from the front part of the nose. Bleeding occurs at the cracked or ulcerated septal lining and usually flows out of the front of the affected nasal passage. If you are lying down or the head is tilted backward blood can flow into the throat. If the bleeding nostril is blocked, blood can flow out of the opposite nasal passage.
A posterior nosebleed is brisk bleeding that comes from slightly larger blood vessels further back in the nose. The blood often flows down the back of the throat right away.
Anterior nose bleeds are often controlled with simple measures at home or with minor procedures in the doctor’s office or emergency room. Posterior nose bleeds usually require more care (balloon packing or electrocautery) and patients are often hospitalized for some period of time.
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, 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.
Preventing nosebleeds
Moisturizing the nasal cavities is the key to preventing nosebleeds. Use nasal saline spray, 2-3 squirts each nostril several times daily or 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. Neil Med 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.