Nosebleed
Nosebleed
17 Hints to Stop the Flow
There's nothing like a nosebleed to give you some idea about the sheer quantity of blood you routinely carry around in your head. Vast amounts circulate through capillaries in the nose alone.
Even Holden Caulfield, the memorable cynic of The Catcher in the Rye, knew enough to be impressed. The knockout punch his roommate delivered to his nose didn't dazzle him half as much as the sight of blood streaming down his face.
"You never say such gore in your life," said the mouthy young hero. "I had blood all over my mouth and chin and even on my pajamas and bathrobe. It partly scared me and it partly fascinated me. All that blood and all sort of made me look tough."
Tough guy that he was, Caulfield picked an unusual home remedy: a game of canasta with Ackley next door. Our experts have more practical ideas.
The tips they give can help almost any nosebleed—whether it's from a nose made brittle by winter dryness, a side effect of high blood pressure or atherosclerosis, or a curious child putting a finger where it doesn't belong.
MEDICAL ALERT
When Your Nosebleed Needs a Doctor You've packed your nose with cotton, applied pressure, and waited the allotted time. But you're still bleeding. What do you do next? Go to an emergency room or head straight to your doctor's office. Nosebleeds can kill you if they go on long enough. In rare instances, continuous bleeding indicates the presence of a tumor. If you're a senior citizen and you've got hardening of the arteries, you won't want to wait more than 10 minutes before you seek a physician's help. Also head to the emergency room if you find yourself bleeding from the back of the nose. That's probably the case if you pack your nose and find the blood running down the back of your throat. Posterior nosebleeds often have to be packed through the mouth and require professional skill to do it right. |
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Blow the clot out. Before you try to stop your nosebleed, give your nose "one good, vigorous blow" says Alvin Katz, M.D., an otolaryngologist in private practice in New York City and surgeon director at the Manhattan Eye, Ear, Nose, and Throat Hospital. That removes any clots that are keeping the blood vessel open. A clot acts like a "wedge in the door," explains Dr. Katz. "Blood vessels have elastic fibers. If you can get the clot out, you can get the elastic fibers to contract around that tiny opening."
This "really, really helps," adds John A. Henderson, M.D., a San Diego otolaryngologist and allergist and assistant clinical professor of surgery at the University of California, San Diego, School of Medicine. "It saves you a lot of nonsense."
Sometimes, blowing the nose and applying a little pressure is enough to stop the bleeding pronto.
Plug the bleeding side with wet cotton. What do you wet the cotton with? Several of our experts mentioned over-the-counter decongestants like neo-Synephrine and Afrin Nasal Spray.
But Jerold Principato, M.D., an otolaryngologist in private practice in Bethesda, Maryland, and associate clinical professor of otolaryngology at George Washington University School of Medicine and Health Sciences, favors white vinegar. The acid in the vinegar cauterizes gently, he says. Decongestants give only temporary control; if you abuse them, you can hurt the nasal lining.
Plain gauze works, too. If you don't have cotton handy, use plain sterile gauze, says Christine Haycock, M.D., a private practitioner in Newark, New Jersey, and professor of clinical surgery at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School. Wet the gauze before putting it in your nose. (When it's time to take it out, cup your hands together, fill them with water, and wet the gauze. This should loosen it enough to take it out.)
Pinch the fleshy part of your nose. As soon as you've blown your nose and packed it with cotton or gauze, use your thumb and forefinger to squeeze shut the soft part of the nose. Apply continuous pressure for 5 to 7 minutes. If the bleeding doesn't stop, apply fresh packing and pinch again for another 5 to 7 minutes. The bleeding should stop by the time you're through.
"Leave the cotton in another 20 minutes before you take it out," advises Mark Baldree, M.D., a Phoenix, Arizona, otolaryngologist and staff member in the Division of Otolaryngology, Department of Surgery, at St. Joseph's Hospital there.
Sit up straight. If you lie down or put your head back, you'll just swallow blood, says Dr. Katz.
Try an ice pack. "Sometimes an ice pack can help quite a bit," says Dr. Haycock. The cold encourages the blood vessels to narrow and reduces bleeding
Don't pick. It takes seven to ten days to completely heal the rupture in the blood vessel that caused your nose to bleed. Bleeding stops after the clot forms, but the clot becomes a scab as healing continues. If you pick your nose during the next week and knock the scab off, you'll give yourself another nosebleed, says Dr. Principato.
Apply an anitbiotic/steroid ointment. "If you apply a little bit inside your nose two or three times a day, it will destroy any staph bacteria," says Gilbert Levitt, M.D., a Puget Sound, Washington, otolaryngologist and clinical instructor of otolaryngology at the University of Washington School of Medicine. This will stop the itching and prevent the crusting of mucus that might tempt you to pick.
The Ringside Remedy In a professional boxing match, you've got exactly 1 minute between rounds to stop a nosebleed. Angelo Dundee, a Miami Beach, Florida, trainer to 11 world champion boxers, including Muhammad Ali and Sugar Ray Leonard, has his technique down pat. What does he do? "You don't ever put a Q-Tip up there," says Dundee. "I take a piece of cotton and make a wick out of it. I dip it into Adrenaline 1:1000 and screw it into the nasal passage. Then I put pressure on that side of the nose. "If you've got bleeding on both sides, I screw a cotton wick into each nostril and tell the kid, 'Breathe from your mouth and give the blood a shot to congeal.' Then I'll take a gauze pad and squeeze hard on the dead meat right in the middle of the nose. You know, the place where the nostrils meet down at the bottom of the nose? You can press as hard as you want. It won't hurt. That seems to stop it." Adrenaline 1:1000 is available by prescription only. Its primary ingredient is epinephrine, which is also a component of several OTC nasal products. |
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Take iron. If you're prone to nosebleeds, consider iron supplements to help your body rapidly replace the blood supply, says Dr. Levitt. Iron is a vital component of hemoglobin, a key substance in red blood cells.
Watch your aspirin intake. Aspirin can interfere with clotting. If you're prone to nosebleeds, experts advise that you not take unnecessary aspirin.
Watch your salicylate intake, too. Dr. Henderson advises his patients to avoid foods high in salicylates, an aspirinlike substance found in coffee, tea, most fruits, and some vegetables. Foods on that list include almonds, apples, apricots, all berries, mint cloves, cherries, currants, grapes, raisins, oil of wintergreen, bell peppers, peaches, plums, tangelos, tomatoes, cucumbers, and pickles.
Control your blood pressure. Folks with hypertension are nosebleed prone. So follow a low-fat, low-cholesterol diet, says Dr. Levitt. "If you have hypertension and a blood vessel breaks, better that it should break outside the cranial cavity than inside. That would cause a stroke. It's like God gave us a pop-off valve."
Humidify the air. When you breathe, your nose has to work to make sure that the air that reaches your lungs is well humidified. So it follows that when your surroundings are dry, your nose has to work harder. A good humidifier, particularly one that takes several gallons to fill, can help.
Dr. Katz recommends that you fill the humidifier with distilled water to protect yourself from impurities in tap water. Also, be sure to clean the unit properly, according to the manufacturer's instructions, at least once a week. Fill it with equal parts of water and vinegar and run it for 20 minutes.
Get your fair share of vitamin C. Vitamin C is necessary for the formation of collagen, a substance essential to the health of your body tissue, says Dr. Henderson. The collagen in the tissues of your upper respiratory tract helps mucus stick where it's supposed to, creating a moist, protective lining for your sinuses and nose.
Be careful in choosing oral contraceptives. Estrogen influences mucus production. Anything that changes the estrogen balance in your body—including menstruation, for women—can make you more prone to nosebleeds. Certain oral contraceptives also alter the balance. If nosebleeds are a problem for you, be sure to discuss this with your doctor when you choose your birth control pill.
Don't smoke. You want to keep the nasal cavity moist. Smoking really dries it out, says Dr. Baldree.
PANEL OF ADVISERS
Mark Baldree, M.D., is an otolaryngologist in private practice in Phoenix, Arizona. He is a staff member in the Division of Otolaryngology, Department of Surgery, at St. Joseph's Hospital in Phoenix.
Angelo Dundee, of Miami Beach, Florida, is a boxing trainer and has been a trainer for 11 World Heavyweight boxing champions, including Muhammad Ali and Sugar Ray Leonard.
Chrisitne Haycock, M.D., maintains a private practice in Newark, New Jersey. She is a professor of clinical surgery at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School in Newark.
John A. Henderson, M.D., is an otolaryngologist and allergist in private practice in San Diego, California. He is also assistant clinical professor of surgery at the University of California, San Diego, School of Medicine.
Alvin Katz, M.D., is an otolaryngologist in private practice in New York City and surgeon director of the Manhattan Eye, Ear, Nose, and Throat Hospital there. He is past president of the American Rhinologic Society.
Gilbert Levitt, M.D., is an otolaryngologist in practice with Group health Cooperative in Puget Sound, Washington. He is also clinical instructor of otolaryngology at the University of Washington School of Medicine in Seattle.
Jerold Principato, M.D., is an otolaryngologist in private practice in Bethesda, Maryland. He is associate clinical professor of otolaryngology in the Department of Surgery at George Washington University School of Medicine and Health Sciences in Washington, D.C. He is also an instructor at the American Academy of Otolaryngology.
