John R. Bennett, MD
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020
22 South 900 East, Salt Lake City, Utah 84102
There are two categories of nosebleeds. “Anterior” bleeds originate in the forward part of the nose and are the most common. Although blood may run down the back of your throat (particularly if you pinch your nose or tip your head back) or even out of both nostrils, anterior bleeds initially bleed on one side and out the front of the nose. The other category of nosebleed is called a “posterior” bleed. These are less common and usually seen in older people, and are more dangerous because they tend to be associated with greater blood loss and are more difficult to control. Posterior bleeds tend to bleed down the back of the throat, although there will be blood coming out the front of the nose as well.
Common causes of nosebleeds include: trauma (punched or picking), dry nose (from dry air or medicines that dry you out such as antihistamines), bleeding problems (blood thinners, excessive aspirin or anti-inflammatory drugs, systemic disease), high blood pressure, infection, twisted septum, septal perforation, overuse of over-the-counter nasal decongestant sprays (more than 3 days in a row can break down the nasal lining), cocaine, etc.
How to Stop the Bleeding
The easiest way to stop a nosebleed is pressure:
- Gently blow your nose to clear out all the blood clots (there may be some big ones).
- Use a decongestant nasal spray (like Afrin or Neosynephrine), which will quickly squeeze down the blood vessels.
- Place tissues under the nose, and pinch your nose by placing your thumb and index finger on either side of the soft lower half of your nose. Feel for the bony step-off and place the pads of your fingers just beneath.
- Do not pack tissue into the nose, as this irritates the nasal lining, setting you up for future bleeds. It also rips the clot off the bleeding area when you pull out the tissue plug, re-starting the bleeding.
- Apply firm but gentle pressure by squeezing the nostrils together for 10-20 minutes.
- An ice pack laid across the bridge of the nose as you pinch the lower nose is helpful.
- If this doesn’t fix the problem or the bleeding comes back later, please call us.
Office Procedures to Stop the Bleeding
To stop nosebleeds in the office, we can use silver nitrate chemical “sticks,” an electric cautery, or a variety of nasal packs. The nose is first sprayed with Afrin to squeeze the vessels and Lidocaine to numb the nose. This will drip down the back of the nose, so you will notice a bad taste and a numb throat for about an hour. If we need to use an electric cautery, we will give you a numbing shot as well.
After the Bleeding Stops
If your nose was cauterized:
- Take it easy for a few days. Strenuous activity (yard work, lifting, weightlifting) or even just bending over at the waist can increase your chances of bleeding again.
- Sneeze with your mouth open so that the air will pass through your mouth instead of your nose. Try not to sneeze through the cauterized side, and don’t blow that side of your nose.
- Place Vaseline or an antibiotic ointment such as Bacitracin, Neosporin, or Bactroban just inside the nostril three times a day with a Q-tip or your fingertip for a week. Gently place the ointment just inside the nostrils, not higher. It will melt with your body temperature and coat the lining of your nose.
- Spray nasal saline mist in the nostrils every 1-2 hours while awake for about a week.
- A humidifier next to the bed at night for a week will help keep your nose moist and help it heal.
If your nose was packed:
- Take your antibiotic as directed to avoid sinus infection or even toxic shock syndrome.
- Take your pain medicine as needed. Do NOT use aspirin or ibuprofen, as both of these thin the blood.
- Come back in 3-4 days and we will remove the packing. Removing the packing before then may result in bleeding again.
- Do NOT pull the packing out yourself. If it seems to be slipping out, press it back in place and call our office. If it seems to be slipping backwards, call our office or go to the emergency room.
- Please call the office with any fever, visual problems, or headache not relieved with your pain medicine.
One or two brief bleeds after cautery is okay, but if you continue to have significant bleeds, please come back for further treatment.
Please call our office immediately at 801-328-2522 or proceed to the emergency room if you have sudden, severe bleeding, or notice excessive bleeding down the back of your throat. Nosebleeds can cause a large volume of blood to be lost in a relatively short amount of time. Some people even need a transfusion if the bleeding is heavy enough or goes on for a prolonged period of time. If you feel lightheaded or faint when you sit up or stand, please contact the office or proceed to the emergency room for evaluation.