Epistaxis a.k.a. Nosebleeds

In the United States, one out of every seven people will develop a nosebleed some time in their lifetime. The nose is an area of the body that contains many tiny blood vessels (or arterioles) that can break easily. Nosebleeds can result from several factors, including dryness, nose picking, allergic rhinitis, chronic sinusitis, blood thinner use, common cold, drug use, and certain systemic diseases. They can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years. Less commonly, benign or malignant tumors can cause recurrent nosebleeds. Since the root cause of most nosebleeds is the drying of the nasal membranes, it’s more common this time of year.

There are different ways to prevent for chronic nosebleeds from nasals sprays to humidifiers. Saline nasal spray will moisturize, thus reducing the chances of chronic nosebleeds. For optimal results, I recommend to patients 2 sprays in each nostril 5 times daily for at least one month. For patients who have recurrent nosebleeds in the winter, saline spray should be used on a regular basis during the winter months. The regular application of lubricants, such as petroleum jelly or antibiotic ointment, works best when the ointment is applied to each side of the nose twice daily for one to two weeks. To prevent future nosebleeds, place a humidifier near the bed to maintain optimal humidity. In the case of severe or recurrent nosebleeds, patients may need to temporarily stop taking blood-thinning medications such as aspirin, warfarin, or Plavix®. Patients should avoid these anticoagulants and discuss stopping medications with the prescribing physician. Lastly, nose picking should be avoided. Children’s nails should be kept short and parents should discourage nose-picking behavior.

However, nosebleeds will sometimes happen despite those measures. My recommendation to patients to stop a nosebleed…

  • Using the thumb and index finger, pinch all the soft parts of the nose firmly.
  • 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.
  • If readily available, spray nasal decongestant, such as Afrin, directly into the side of the nose that is bleeding. Alternatively, spray a small piece of cotton with the medication and then place the cotton in the nose. Hold pressure for 15-20 minutes.
  • Hold the position for 15-20 minutes. If bleeding continues, hold it again for an additional 20 minutes.
  • If bleeding does not stop after 30-40 minutes, consult a physician.

If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope. Two of the most common treatments are cautery and packing the nose.

If you have patients with chronic nosebleeds, we can help.