Causes

Most common nose bleeds are due to local factors, such as drying of membranes or irritation from frequent blowing or itching.

Treatment

1. Keep the head elevated. Specifically, don't bend over. This only worsens the bleeding. Apply pressure to the nostril on the side of the bleeding. Pressure should be maintained for 10-15 minutes. When active bleeding has stopped, gently blow the nose with both nostrils open to force all clots out of the nose. Squirt four generous puffs of Asfrin nasal congestant into the nostril, and hold your head back. This spray causes the blood vessels to shrink, and will usually result in control of bleeding. It is very important to keep your head elevated. Sit upright in a reclining chair or lie back on three or four pillows. Do not put your head down below your heart or between your legs. This just dilates blood vessels and will likely prolong bleeding.
2. If bleeding continues, crushed ice chips may be placed into a moist towel and applied over the bridge of the nose. Continue ice and pressure for up to 30 minutes. Repeat four puffs with Afrin nasal spray if bleeding continues beyond 20 minutes.
3. When all active bleeding has stopped, resume using the salt water irrigations. This will keep the membranes moist and reduce crusting. Excessive crusting is often what causes the bleeding. I prefer the over-the-counter saline nose sprays, but irrigation with a bulb syringe and bowl of saline is fine (see below).

Frequency for use of saline sprays: 2-3 puffs in each nostril 6-8 times per day for two weeks.

Recipe for Home Salt Water Solution

To make 1 Gallon:

• 1 gallon of water
• 8 teaspoons of salt
• 8 teaspoons of baking soda
• To make One Pint:
• 1 pint of water
• 1 teaspoon of water
• 1 teaspoon of baking soda

IMPORTANT: The temperature of the water should be body, not room temperature.

Prevention

When bleeding has stopped, we enter the preventive phase for nose bleeds. In general, these steps should be continued for two weeks beyond the last traces of blood in the nasal drainage.

1. Use salt water nose spray mists, such as Ocean or Nasal or Ayr. Generic saline sprays are fine, but they should be mist sprays. Otherwise, the drops just go down the back of the throat. Frequency for use of saline sprays: 2-3 puffs in each nostril 6-8 times per day.
2. Use an emollient (moisturizer) such as Vaseline ointment. Apply with a Q-tip just inside the nostril twice per day for two weeks. Circle the inside of the nostril to spread the ointment around the entire opening. It will melt and coat the inside of the nose. Frequency: apply twice per day.

When two weeks have passed without bleeding or traces of blood in drainage, the above measures may be stopped - unless there is a long history of bleeding or you are taking blood thinners, such as Coumadin or aspirin. All patients taking blood thinners should use salt water nose drops on a long-term preventive basis.

1. Long term prevention: Squirt saline sprays twice per day, or use the Vaseline in the morning and night. Especially during the dry winter months.
2. Turn up your humidifier, especially when the heater is on. Consider installing a unit on your furnace for winter use if you experience frequent nose bleeding.

It is much easier to prevent nose bleeding than to treat it after the fact. If you continue to experience problems despite these measures, please schedule an appointment.

Continued Bleeding

If bleeding can't be controlled, and our office is closed, go to the emergency room at Baptist Hospital East or Suburban Hospital for further care. If your bleeding is excessive and does not respond to simple measures described above, you will need to be seen by a health care provider.