Nosebleeds 101
The leaves are changing color, the weather is cooling down and all things pumpkin are out. Wonderful right?
This is the time of year I see more patients with nosebleeds (epistaxis), related to the decrease in humidity outdoors and increase in indoor heat use (which can further dry out the nasal mucosa). Add to that any inflammation from seasonal allergies or viruses and you are looking at a box of tissue shoved up your nose!
There are certain groups of patients particularly prone to epistaxis, including those who use medications that thin the blood (aspirin, warfarin/Coumadin, apixaban/Eliquis, clopidogrel/Plavix, NSAIDS/ibuprofen/naproxen, even high dose omega-3 supplements). Teenagers are another common group, likely due to rising estrogen levels with puberty impacting the nasal mucosal vessels. Young kids who are “exploring” their noses with fingers round out the most common groups. Other less common risk factors include those with nasal trauma, bleeding disorders, liver disease, hypertension, or history of cocaine (or other intranasal drug) use.
Most nosebleeds are from the front/anterior of the nose and can often be stopped at home with proper care. Although rare, a posterior nosebleed is more serious and may require attention in an office or emergency department. Although the blood loss appears significant, it is rare to need a blood transfusion secondary to a nosebleed.
Regardless, you will want to know how to stop a nosebleed when it happens. Here are my top tips to help:
What to do if you have a nosebleed:
1. Pinch the end of your nose (not where glasses would sit but toward the very tip of your nose) and lean slightly forward. Do not tilt your head back! This causes blood to run down your throat and makes you cough.
2. Soak a tissue or cotton ball with a nasal decongestant spray (Afrin/Sinex/oxymetazoline or Neo-Synephrine/phenylephrine) and place this inside the bleeding nostril. Reapply pressure, firmly, for at least 5 minutes.
3. Release pressure, remove tissue/cotton ball and re-evaluate. If still bleeding repeat steps 1-2 as needed.
4. Apply a soft ice pack (or bag of frozen peas) across the bridge of your nose and hold ice cold water in your mouth. This helps vasoconstrict (tighten) the blood vessels and reduce bleeding/ encourage clotting.
5. If still bleeding after 15-20 minutes, call your medical provider or proceed to the emergency department for further evaluation.
Ways to prevent nosebleeds:
1. Make sure you are drinking enough water/staying hydrated especially when in higher altitudes or during flights.
2. During colder months, and when heating systems are on, the air has less humidity so you may want to consider using a humidifier in your bedroom during that time.
3. Moisturize the front of both nostrils nightly with a saline gel (Ayr is one OTC brand)-use a “pea-size” amount on your fingertip and apply gently to the front of the nose.
4. Avoid picking at scabs or crusts.
5. Ensure allergies are controlled.
6. If you can, hold any nasal steroid or antihistamine sprays you are using for 3-5 days (Flonase/fluticasone, Nasonex/budesonide, Astelin/azelastine, etc).
