Nose Bleeding

Nasal bleeding is usually the result of a breakdown in the normal health of the nasal mucous membrane (link) of the septum. The moist tissue covering the septum is often the source of bleeding because it is the first tissue that must deal with whatever environment we are living in. It is also the narrowest spot in the airway and the mucosa is rich in blood supply.

The mucosa is also thin and must cover whatever the septal cartilage, no matter what its shape. The shape of the septum is important because, if it asymmetric, the inhaled air becomes turbulent and tends to dry certain parts of the mucosa more than others. Once the mucosa becomes dry, it can crack and rupture its blood supply.


Causes:  There are a number of conditions which increase the risk of inflamming and drying the nasal septal mucosa.

  • Low-humidity (dry) environments whether natural or a consequence of indoor heating; air-conditioning or a long airplane flight (< 40% humidity)
  • The use of certain nasal sprays (particularly steroids)
  • The use of certain drugs and/or radiation therapy
  • Equipment used to treat snoring and sleep apnea.
  • The use of oxygen therapy, especially when introduced through nasal prongs.
  • Being a smokers or exposure to second-hand smoke
  • Air-born particles and chemical pollutants
  • Aging – due to a drop in the amount of nasal secretions
  • For children, increased nose bleeding is likely due to hormonal changes (which stimulate the growth of new nasal blood vessels)

Treatment:  Nasal bleeding can be simply annoying, but it can also be scary and difficult to manage.  Our office can help to stop nosebleeds, but also teach you methods to prevent them too.

If your nose is bleeding,

  • TRY TO RELAX. Remaining calm helps to keep the blood pressure normal and allows bleeding to stop more rapidly. Most nosebleeds look much worse than they really are.
     
  • LEAN FORWARD:Sit up to lower the blood pressure and lean forward to allow the blood to flow towards the front of the nose. Many people, including physicians, recommend leaning back, but to lean back promotes blood flow to the back of the nose and into the throat. You want to avoid swallowing blood because it is likely to cause nausea, vomiting, and diarrhea. Leaning forward is also a good position for spitting out, perhaps into a pan, any blood in the back of your throat.
     
  • PINCH. Pinch the entire soft lower portion of the nose firmly (everything below the hard upper nasal bone including the whole nostril) and maintain that pressure for 15 to 20 minutes. Resist loosening your fingers to see if the bleeding has stopped. It will only allow fresh blood flow. Your objective is to use body’s natural ability to clot blood and this process takes about 10-15 minutes to occur. If you allow fresh blood to flow, it will wash away the clot as it is forming. It is also a common belief that you should pinch the hard upper portion of the nose, but this pressure is not transferred to the site of the bleeding. You need to pinch and close both nostrils as tightly as you can stand it.
     
  • PACKING. If pressure alone fails, make a small packing from a piece of cotton or tissue, flattened and shaped like a pea pod. This thin packing should be able to slide easily into the nose about one inch and remain within reach. Finger pressure should still be applied until bleeding stops. If the bleeding stops, it is wise to leave the packing in place for several hours until your body develops a strong scab over the bleeding site.  An alternative is the commercial nasal packing, Nasal Cease.


 

To improve effectiveness of the packing, the cotton can be moistened with a topical decongestant (Neosynephrine or Afrin). The decongestant will cause the blood vessels to constrict and will slow or stop most bleeding. Decongestants must be used cautiously by those people with a history of high blood pressure since it can raise it further and make the heart work harder. These medicines are extremely effective for treating nose bleeds, but should not be used on a frequent basis.
 

ICE is another possibility. It also causes blood vessels to constrict and therefore helps to form a blood clot. It should be most effective when applied for 10 to 15 minutes across the bridge of the nose.

If the bleeding stops, rest quietly in a bed or chair for a while. Open your mouth when sneezing and avoid blowing or wiping your nose vigorously.

If you cannot stop the bleeding, you will need to call our office or, if at night, visit an emergency facility.

 

 

 

 

 

 

CAUTERIZATION: If your nose continues to have episodes of bleeding, you should make an appointment for cauterization of your nose. This procedure can be very helpful and is usually not uncomfortable. We provide a topical numbing medicine which makes it easy and quick. We can perform this on child and adults.

Prevention: 

 

Alliance ENT     Main Office: 845 North Main St., Providence, RI 02904     Phone: (401)331-9690 Fax: (401) 331-9609
Email: Office@alliance-ENT.com ~ Please Note, this is for general information only, not medical emergencies