Nosebleeds

Almost everyone has experienced a nosebleed. For most, it’s only an occasional nuisance, but for some, it can be life-threatening. Fortunately, most nosebleeds are benign and self-limited. They occur more often in the winter, with the onset of dry heat in the colder climates.

 

The nose is designed to function optimally with moist mucous membranes; when dried, crusts begin to form and the soft delicate tissues, particularly in the front part of the nasal septum, called Kisselbach’s plexus. This is an area supplied by three major blood vessels that come from three different directions, and mesh into a mesh of small capillaries that are extremely friable to trauma and desiccation. Even a slight touch of the nose or a gentle nose blow can aggravate this condition.

 

Allergies can also aggravate nosebleeds by causing inflammation. Inflammation aggravates increased blood flow and swelling of the thin capillaries, which makes it susceptible to rupture and bleeding.

 

Once it starts, the normal protective clotting mechanisms kick in and the bleeding usually stops within a few minutes. One way of speeding up the clotting process is to pinch the soft part of the lower nose with your fingers for 5-10 minutes, thereby compressing Kisselbach’s plexus directly. Keep the head up, as it decreases blood pressure within your nose. Try not to swallow any blood that trickles into your throat, as it may make you nauseous and vomit. For recurrent nosebleeds, try spraying some OTC decongestant spray, such as Neosynephrine or Afrin. These medications decongest the nose and constrict the blood vessels long enough for your body’s clotting mechanism to occur. If you have allergies, try taking an OTC allergy medication.

 

In the winter, try using a humidifier next to your bed. Don’t ask me if you should get a warm or cold mist humidifiers—this is a big area of controversy. For most people, this may be enough. During the day, you can spray some OTC saline nasal spray every few hours to keep your nasal membranes moist.

 

There are new OTC nosebleed clotting agents that just came out. One of these is called Nasal-cease, which is a cotton-like material that you placed a plug-shaped portion in your nostril, and it promotes clotting. We use this technology in the operating room for better clotting.

 

If you’ve tried all of the above, and still are experiencing nosebleeds, you need to see an ENT doctor (me).

Otolaryngology – Head & Neck Surgery

(212) 315-9058