Nose Bleed

Nose and the adjacent areas of face are richly supplied by blood. Consequently, nose bleed is one of the most common complaints of patients coming to us. Almost 60% of all individuals experience such a bleed once in their life time. There is slight preponderance to children and the elderly.

Common Reasons for Nose Bleeds:

1. Dry weather conditions
2. Cold and rhinitis
3. Sinusitis
4. Inserting objects inside the nose
5. Low pressure / High altitudes
6. Cocaine abuse
7. Nasal polyps
8. Injury to nose
9. Pregnancy
10. Sticking fingers into the nostrils (mainly children)
11. Dust and pollution
12. Bleeding disorders (which affect the clotting of blood)
13. Elevated blood pressure
14. Thickening of blood vessel walls due to atherosclerosis
15. Blood thinner use for cardiac ailments
16. Tumor in the nasal cavity

What to do if you suffer nose bleed in your house?

Nose bleeds are not always very serious but nevertheless, we must try to stop it. If you encounter a nose bleed, immediately sit down and lean slightly forward. This is to prevent blood from flowing back into the throat. Pinch your nose with thumb and index finger of your dominant hand. Do not panic. Breathe through the mouth as your nostrils are closed tightly. Ask someone nearby to bring some ice cubes and keep them over either side of the nose and over the bridge of the nose. Keep pinching the soft part of the nose for 5-10 minutes and after that check if the bleeding has stopped. This will arrest the bleeding in most of the cases. If the bleeding has not stopped repeat the procedure.

In some cases when the bleeding doesn’t stop you can spray Oxymetazoline or Xylometazoline nasal sprays (they de-congest the nose) and resume pinching. Subsequently, once the bleeding stops, do visit an otolaryngologist so that you can check the cause for bleeding. Even after the bleeding stops you will be asked to take some precautions to prevent it from occurring again.

If the bleeding is enormous or does not stop you will need to call emergency. Similarly if you are having breathing difficulty or severe vomiting along with the nose bleed, you must call the emergency. If you get recurrent bleeds or you are on blood thinners, you should get an ENT check up to check for the cause of bleeding. If you are a child and get bleeds often then also go to an otolaryngologist.

Treatment Options available for Nose Bleeds

1. Nasal packing – packing can be absorbable and non-absorbable. The absorbable ones need not be removed and can be left inside the nasal cavity.
2. Cauterization – After a diagnostic nasal endoscopy to look into the nasal cavities, the bleeding point is cauterized using Silver Nitrate/Tricarboxylic Acid/Electrocautery. In some cases, general anesthesia might be needed for the procedure.
3. Control of Blood Pressure – in a few hypertensives who bleed due to a spurt in their BP, adequate control of BP will achieve hemostasis.
4. Medications – some medicines are available which help reduce the bleeding like tranexamic acid, ethamsylate and hemocoagulase.
5. Ligation – in certain recalcitrant cases one might have to ligate the blood vessel. This is done under anesthesia in an operating room under endoscopic visualization.
6. Septal correction surgery – in some cases a deviated nasal septum causes recurrent bleeds and correction of the same will achieve control
7. Endoscopic Sinus Surgery – sinonasal surgery to remove polyps, maintain sinus drainage cum ventilation or remove intra-nasal growths and tumors will also stop nose bleeds.

Prevention of Nose Bleeds

1. Avoid blowing nose forcefully
2. Cough and sneeze with open mouth so that there is less pressure over the nose
3. Do not insert anything inside the nose
4. Don’t pick the nose / Keep your child’s fingernails trimmed
5. Instill a few drops of saline nasal drops few times daily to prevent dryness (saline nasal sprays are OTC in most of the countries)
6. Use a room humidifier and keep the room air moist especially during winters
7. Do not go out in smoke, dust or pollution, try wearing a mask
8. Use vaseline or liquid paraffin a couple of times daily to lubricate the nasal lining.
9. Quit smoking
10. If using blood thinners (aspirin, clopidogrel) take special care
11. Wear head gears if doing contact sports
12. If you are allergic take particular care to avoid allergens

If you get a nose bleed, do not worry. Not all bleeds are serious. Follow the measures we have suggested and keep calm. Do not panic. Your bleed will stop in a few minutes with these measures. If you need to discuss anything or get help regarding nose bleeds, we are just a phone call away.