LINDA J.
DINDZANS, MD Office: 414-536-7000
JODI M.
KORNAK, MD Fax:
414-536-7001
NOSEBLEEDS
Most nosebleeds are caused by chapping of the mucous
membrane over the surface blood vessels in the front of the nasal cavity. This is commonly caused by dry air
(especially during sleep), or by too much picking or rubbing inside the
nose. Occasionally a nosebleed comes
from deep inside, and tends to run down the back of the throat. Colds, high blood pressure or a blood
clotting disorder can make the problem worse.
In many cases, medication or dietary supplements can
greatly worsen nosebleeds by inhibiting blood clotting: avoid
aspirin, ibuprofen
(Motrin, Advil, Nuprin), naproxen (Aleve, Naprosyn), ketoprofen
(Orudis) and most other non-steroidal
anti-inflammatory drugs
if possible. Tylenol should not affect
bleeding. Avoid vitamin E and the supplements gingko, garlic, gingseng, and ginger.
These are all blood-thinners.
Alcohol is also a blood thinner.
The prescription drugs coumadin and plavix always tend to make nosebleeds worse, but check with your
doctor before discontinuing.
To stop a nosebleed:
1. Remain
calm. A nosebleed is rarely
life-threatening.
2. Sit upright
and avoid lying flat.
3. With a
forefinger, squeeze the bleeding nostril shut by applying steady firm pressure
on the side of the lower nose, pushing it against the middle wall of the nose
for 15 minutes. For better results,
spary Afrin decongestant nasal spray into the bleeding nostril twice,
then soak a cotton ball with the Afrin and place it in the bleeding nostril and
pinch it shut again for 15 minutes.
Afrin and similar sprays are available over the counter. They help by shrinking blood vessels
temporarily.
4. If bleeding
continues, or is severe, or if large amounts of blood are going down the back
of the throat, contact your doctor or go to an emergency room. A nasal packing or cautery may be needed.
If the doctor places a nasal pack: The packing
will prevent you from breathing through your nose. It may cause dry mouth and sore throat. Avoid lying flat. Keep your head elevated when lying down. Good oral hygiene including mouthwash may be
used to reduce mouth odors. Drink plenty of cool or lukewarm fluids. Do no be alarmed at small amounts of
blood-tinged nasal discharge. A small
folded guaze taped under the nostrils may be worn and changed as needed for any
oozing. This is better than frequent
dabbing at the packed nostril with tissues.
Leave the nasal packing itself alone.
The doctor may prescribe an antibiotic to be used while the packing is
in place.
After-care of nosebleeds to prevent re-bleeding:
For several days or more after a nosebleed or nasal cautery, it is
important to avoid stress on your nose, and to heal any chapped areas inside.
1. Keep the
inside of your nose moist with plenty of salt-water
(saline) nasal spray;
use several squirts in each nostril at least 4 times daily to help heal chapped
areas inside. Many brands are available
at your pharmacy without a prescription.
If possible, put a vaporizer in the bedroom for extra moisture at night.
2. Coat the
skin inside each nostril with Vaseline twice daily, especially at
bedtime. This will soften any crusting
and filter irritating dust. Use your
little finger (not a Q-tip, which can irritate).
3. Avoid
stooping, straining, bending over, or any other exertional activity that would
make you turn red in the face. If you
are constipated, try a mild laxative or stool softener to help avoid
straining. Avoid hard nose-blowing or
sniffing. You may gently cleanse loose
buildup inside your nose with moisturizing nose spray (see #1 above). If you must sneeze, do so with your mouth
open.
4. Avoid
picking your nose or placing anything in it, including Q-tips and dry
Kleenex. (You may use a moist cotton
ball with Afrin as described above for first aid for an active nosebleed). For children, keep nails trimmed.
5. Avoid
blood-thinning medications and supplements for about 2 weeks after your last
nosebleed. This includes those
substances listed in the first paragraph of this information sheet. Even a single baby aspirin is a powerful
blood thinner lasting 10 days after it is taken. But if you are on coumadin, aspirin or another
blood thinner for important medical reasons, make sure it is okay with your
primay physician before stopping it.