Nosebleeds

Nosebleeds are a very frustrating problems for patients, their family and their doctor. Once a nosebleed occurs, it means that a blood vessel and the overlying mucous membrane in the nose are injured. Even if medication, packing, or cauterization is used to treat the nosebleed, the exposed and injured lining in the nose persists until it fully heals. Unfortunately, further bleeding may occur for up to 3-4 weeks later until the nose fully heals. Fortunately, most of these episodes can be prevented or controlled by following the instructions below.

Common causes

  • Extreme changes in weather, especially during the Spring and Fall.

  • Dry air, especially due to forced air heating.

  • Nose crusting and nose picking.

  • Nasal deformity (nasal septal deviation, nasal collapse, etc.).

  • High blood pressure.

  • Medications which prolong bleeding, such as anti-inflammatory drugs (i.e., aspirin, ibuprofen, naproxen, Aleve, Advil, Motrin, Lodine, etc) or blood thinners (i.e., Coumadin, Plavix, Lovenox, etc.).

  • Medications, which dry the nose (i.e., oral decongestants, antihistamines, antidepressants, medicated nasal sprays, etc).

  • Aging which results in more fragile blood vessels.

  • Nose trauma from an injury or surgery.

  • Pregnancy.

How to Prevent Nosebleeds

  • Liberally use a nasal saline spray (Ocean, Ayr, Natru Vent, etc) or saline gel to keep the nasal mucous membranes moist.

  • Use petroleum ointment (Vaseline) or an antibiotic ointment around the inside of the nostrils.

  • Use a cool mist vaporizer or humidifier at home, especially in your bedroom.

  • Set your heating system humidifier at least 40% relative humidity.

  • Do not blow your nose for one week and then only gently.

  • If you must sneeze, open your mouth so air comes out of your mouth.

  • Sleep with your head elevated on 2-3 pillows or in a reclining chair.

  • Avoid picking your nose or putting anything in it.

  • Avoid bending over, lifting heavy objects, and straining during bowel movements (take laxatives if needed).

  • Avoid nasal steroid sprays (i.e., Flonase, Nasonex, Nasocort, Nasarel, Rhinocort, etc.).

  • Avoid anti-inflammatory drugs (i.e., aspirin, ibuprofen, naproxen, Aleve, Advil, Motrin, Lodine, Mobic, etc) which prolong bleeding. Tylenol, Celebrex, Bextra, and Vioxx are not a problem.

  • Avoid blood thinners (i.e., Coumadin, Plavix, Lovenox, aspirin etc.) which prevent normal clotting, but only if approved by your primary physician or cardiologist.

  • Avoid medications that dry the nose (i.e., oral decongestants, antihistamines, antidepressants, medicated nasal sprays, etc) unless instructed below.

  • Avoid hot drinks, caffeinated beverages, alcohol and smoking.

  • Use homeopathic medicine available at health food stores: Ferrum phosphoricum 9C five pellets 1-4 times a day as needed

How to Treat an Active Nosebleed

  • Sit up and hold steady pressure by pinching the nostrils together with your fingers for 15 minutes by the clock.

  • Apply a covered ice bag to the bridge of the nose.

  • If persistent, use oxymetazoline decongestant nasal spray (Afrin) available over the counter to constrict the blood vessels.  More effective control is possible by saturating a cotton ball with this medication and placing it in the nose. May be repeated in 10 minutes if persistent.  Use only for active bleeding since regular use may actually worsen nosebleeds.  This is the same medication used to stop nasal bleeding during nasal surgery.

  • Go to the nearest emergency room if you are unable to stop the bleeding. .



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