Dear Dr. Dave and Dr. Dee,
I woke up this morning with what I thought was the sniffles, but turned out to be a bloody nose. I put a wad of tissue in my nose and lay down, but it kept bleeding. I had to keep changing the tissue, as it got soaked with blood. Finally, after about an hour, it stopped. When I was a kid, decades ago, I used this same technique and my nose stopped bleeding after a few minutes. So, why would my technique not work now? I am 52 years old and in pretty good health. What is the best way to stop a nose bleed?
Bothered by blood,
Dear Bothered by blood,
First, the best way to stop a nosebleed is to sit up, not lay down. In addition, there are several reasons why your nose kept bleeding and your remedy did not work now that you are older such as age related issues, bleed location, diet or medications that stop the blood from clotting.
BEST WAY TO STOP A NOSEBLEED
Sit up and pinch your nostrils shut very firmly for 10 minutes. Use your thumb and forefinger and keep squeezing continuously for the entire 10 minutes. This will stop the flow of blood so that a scab can form over the erosion in the nasal mucosa (membrane lining the nasal cavity).
Sitting up is best because it keeps the head above the heart, and a nose will bleed less. In addition, while sitting, if you are swallowing blood, then tilt your head forward a little to prevent the blood from going down your throat.
Although the first instinct is to keep the head tilted up or to lie down to stop the bleeding, these are not optimal because it drains the blood down your throat, and people may feel nauseous from swallowing the blood.
Do not put a tissue up your nostril because this keeps the blood flowing into the tissue and prevents clotting that is needed for a scab to form over the erosion in the mucosa. Also, when the tissue is removed it may tear the scab off, and the bleeding will begin again.
REMEDY FOR PERSISTENT NOSEBLEED
If the nosebleed does not stop after 10 minutes, then try this method that uses a nonprescription nasal decongestant. A nasal decongestant with oxymetazoline (i.e. Afrin) is a vasoconstrictor (narrows blood vessels) that will help close down the blood vessel.
1. Blow your nose to get out any blood clots in order to make the medication more effective.
2. Immediately spray your affected nostril 4 times with the nasal decongestant, keeping your head straight, while using a finger to close the unaffected nostril.
3. Then immediately insert a cotton ball or wad of gauze that has been soaked with the nasal decongestant and rolled into a shape to fit into the nostril. Keep the cotton or gauze saturated; do not wring it out.
4. Pinch nostrils firmly for 10 minutes.
If the nosebleed still persists, then call your doctor or go immediately to the emergency department. Chemical cauterization or nasal packs may be needed to stop the bleeding.
REASONS NOSEBLEEDS MAY BE DIFFICULT TO STOP:
1) Aging: Bodies change as one ages. For example, high blood pressure is more common in older than younger folks. Sinuses can become dried out, i.e. women after menopause.
2) Nosebleed location: Anterior nosebleeds (blood comes from the front of the nose near the nostrils) are the most common and easiest to stop. Posterior nosebleeds (from the back of the nose) are less common and much more difficult to stop.
3) Anticoagulant medications: nosebleeds are more difficult to stop when using anti-clotting medications such as aspirin, ibuprofen, naproxen, warfarin (Coumadin), or clopidogrel (Plavix).
4) Natural Anticoagulants in diet: Some juices (purple grape, pomegranate, and tomato), have anticoagulant properties. Other natural anticoagulants are vitamin E, ginkgo biloba, turmeric, and fish oil.
5) Vitamin K deficiency: vitamin K is needed for normal blood clotting. Vitamin K can be found in dark green leafy vegetables.
Frequent nosebleeds from low humidity (i.e. home heating in winter, dry cold air, hot dry climate), can be prevented by applying a little antibiotic ointment just inside the nose with a cotton swab, using a humidifier or nonprescription nasal saline spray.
Many things can trigger a bloody nose such as trauma, foreign bodies, humidity, sinus infection, drugs, alcohol, allergies, high blood pressure, vitamin C and K deficiencies, platelet and clotting abnormalities. For recurrent and difficult to stop bloody noses, consult with a physician for the best treatment plan or go immediately to your emergency department.