Nosebleed Questions

June 15, 2009 6:00 AM

Nosebleed filter: My husband has been having very severe nose bleeds. We are going to an ent specialist today (hopefully) but would like community information about how to get these nose bleeds to stop, what causes them, and - if they can't be stopped - any tips for managing them well while mobile in public on holiday.

We are from Scotland but are on a two week holiday visiting family in several cities in the US and Canada. My husband has had nose bleeds all his life, but they are generally very mild and infrequent, happening every 6 to 8 weeks. Starting on the plane from Heathrow to Canada, he got a nose bleed (from the right nostril) that just gushed. Like, tea cups full of blood gushing. It took a half hour or so to stop. He got another one in Toronto and my grandparents freaked out and we went to the emergency room. Resident and the attending there both said that there was no visible tear or lesion after a specular inspection and there is no way to really fix it, it just has to heal.

Since then, yesterday he has had four episodes, each lasting a half hour or more.

We are wondering the following:

1) Can this be cauterised or something to make it stop? If so will he need admitted to hospital?
2) Is the blood loss dangerous over time? He has no dizziness or other symptoms.
3) If the ent says that we should wait until our return to get this treated, should we cut the holiday short? We are both falling down from stress and really need this holiday but health trumps this of course.
4) If we are to stay on holiday does anybody have any tips on how to manage the bleeds more effectively? We are carrying tissues, baby wipes and disposable cups to catch blood, and my husband is willing to overcome his shame and alarm when it happens so he can stay out in public and continue holiday events, but don't worry, our fun and enjoyment is a low priority compared to health and we will not be forcing this issue.
5) What about the airplane? If we need to move the flight up and get him home should we have some sort of doctor note or special seating request or what on the plane? Or should we stay here for the full treatment process, even tho it is expensive and we would get free health care at home?

posted by By The Grace of God to health & fitness (19 comments total)

I'm not going to answer anything except for immediate stoppage...

On your nose, if you start at the bottom, pinching on both sides, you'll feel the squish of cartilage. Moving up a little you'll feel bone. At the very base (nostril side) of that bone there's sort of a space where you can feel the cartilage ridge at the top but it's soft on the side. That's where you want to pinch, NOT just holding the nostrils shut. That might not make a ton of sense, but really look for the first space beneath the bone you can sqeeze, and squeeze there. It will NOT block the nostrils, just the bloodflow. That's where you want the clot. Pinch here while tilting the head slightly FORWARD. Not back. You don't want that yuck running down his throat into his stomach. You'll also mitigate bloodloss this way.

Past that, obviously decrease activity to reduce BP and pulse rate, and consider icing the back of the neck for a few minutes.

Sit down, but don't lay down.

Hope that helps.
posted by TomMelee at 6:11 AM on June 15

I can offer information on a few of those points.

I used to have frequent nosebleeds as a preschooler (many, many moons ago). Once the offending blood vessel was cauterized, I probably haven't had more than a dozen nosebleeds in all the intervening years. The cauterization was done in the doctor's office, although I seem to recall going in to see him during a nosebleed so he could pinpoint the location.

Blood loss is probably not a serious issue overall: people routinely donate a pint of blood at a time. The American Red Cross sets a lower weight limit of 110 pounds or thereabouts, and you can bet they are being very conservative. The larger the person, the greater the blood volume. Whether the blood loss is via a nosebleed or a needle in the arm shouldn't matter at all.

It seems quite possible to me that the flight from Heathrow may have touched off this latest bout of nosebleeds, between the air pressure and dryness (and God knows what else) on the plane.

So, bottom line: Seeing the doctor is a good idea, and you probably have nothing much to worry about.

Good luck, and I hope you enjoy the rest of your holiday!
posted by DrGail at 6:38 AM on June 15

Disposable cups to catch the blood?

I get nosebleeds all the time, and never once has it occurred to me to make tea with the stuff. What you want to do is *instead of letting the blood go out the nostril*, do the pinch that TomMelee described *right away*.

Don't let go of that spot (but don't pinch it with a death grip, either) until at least 15 minutes have passed. Even if you're pretty sure that everything will be fine. Just accept it as a15 minute or more penalty.

Leaning forward, sitting, icing the neck are also useful things.


Now, some pharmacies sell what are called [I wish they weren't] nasal tampons. They are little nose-sized cylinders or stick-like objects that expand on contact with blood. They will let you walk around and pretend to be civilized [as long as being civilized = having a thing sticking out of your nose] in the case of an emergency. Some pharmacies will have a selection of available brands. Other pharmacies will have no idea what you're talking about and you end up looking like some kind of a nose-pervert for asking. Just roll with it.
I first found out about them at a swimming pool. The lifeguard had a whole case of them in the interest of not having a red pool. They have always given me lots when I asked.


and re: cauterization: I've thought about it for years, but I've heard too many stories wherein people lost part of their sense of smell/taste. Tasty food trumps blood loss a million times over for me, so I'm not going to do it.


good luck!
posted by Acari at 7:03 AM on June 15

like Dr.Gail I, too had a vein in my nose cauterized as a child. Before that, the nosebleeds were terrible, came on suddenly, lots of blood, and nothing I did would stop it. I would just stand over the sink and bleed.

After the cauterization, the nosebleeds stopped completely. Never have had a bad one since. And no loss of smell or taste or any side effect at all.
posted by pinky at 7:06 AM on June 15

Ask your husband if his nose is particularly dry. The transition from the dampness of the UK to the dryness of North American could be the trigger (airplanes are also notoriously dry).

Lots of people use vasoline to keep the nasal lining moist and prevent cracking. I don't know if this is a good practice or not but you may want to give it a shot for your holiday at least.
posted by srboisvert at 7:27 AM on June 15

Is the inside of his nose dry? I often get nosebleeds when I fly long haul and they persist if I've gone somewhere hot or without much humidity like Las Vegas.

I carry a Saline Nasal Spray, and use it often.
posted by IanMorr at 7:27 AM on June 15

Make that KY not vasoline...
posted by srboisvert at 7:29 AM on June 15

I had frequent nosebleeds during a period where I was taking a lot of ibuprofen for back pain. When I stopped taking lots of ibuprofen daily, my nosebleeds went away.
posted by Liver at 7:58 AM on June 15

That sounds distressing. Probably not hazardous in terms of amount of blood, but distressing -- absolutely!

I do think seeing a doctor soon is a good idea, given how this has been a sudden increase in how often and how much it happens.

Have an ENT check out the nose on the inside, just to look for any abnormalities of structure, surface blood vessels, etc. The other thing to consider is whether it's less nose-related and rather blood-related. Taking aspirin could do it if he's already prone to bleeding (although low-dose aspirin doesn't usually cause bleeding to that extent in an otherwise healthy person not taking other blood thinners). It might be worth having a doctor do a quick blood test to look for clotting abnormalities if the nose mucous membranes themselves look normal, just to see if anything is going on in terms of easy bleeding issues.

In terms of whether losing that blood is problematic, it probably shouldn't be as long as he feels fine. But if it happened 4 times in one day and keeps happening with that much volume, yes, that could add up to be a problem. Hopefully you can get it all worked out quickly.

Good luck, and certainly best wishes as you travel back on the next flight.
posted by davidnc at 8:24 AM on June 15

My SO has had a couple of severe nosebleeds, so it happens that I have some recent experience with this. Her situation is complicated by the fact that she takes Coumadin (an anticoagulant) due to a history of blood clots, which made it an emergency situation necessitating a trip to the Emergency Room. In the ER, in regard to the acute bleeding, the recommendations were pressure (as described in previous posts) and Afrin for its vasoconstrictive effect. Didn't really help in this case, but, again, coumadin was a complicating factor, so you guys might want to give Afrin a try. The source of bleeding was determined to be a papilloma (malignant in RARE cases; this one was benign), aka a nasal polyp. It was cauterized and packed and has caused no further problems. This was in December 2008.

In May 2009, another massive nosebleed, this time on the opposite side. Went to an urgent care center where they attempted to stop the bleeding with a balloon kind of thing which resulted in blood coming out her EYES. This was less alarming than it looked; apparently the blood got backed up and came out the tear ducts; it stopped when the balloon thing was removed. Again, pressure and Afrin were used in an attempt to stop the acute bleeding, unfortunately to no avail in this case, and we ended up getting sent to the ER again. This time they said there was too much blood for them to be able to see the source of the bleeding, so they put one of the tampon things (as mentioned in previous posts) in and sent her home. She went back in for cauterization (a quick outpatient procedure) of, once again, a nasal polyp; unfortunately, this cauterization did not "take" for some reason. Back to the ER a few days later with some moderate bleeding that ended up stopping on its own. We begged them to cauterize again, but this time they said there was NOT ENOUGH bleeding for them to be able to determine the source. Frustrating, needless to say -- even more so when we were sent home and massive bleeding began again shortly thereafter. Back to the ER, packed again, sent home, and then, a few days later, cauterized again (as before, a quick outpatient procedure). She was also prescribed some estrogen-lanolin to apply topically inside the nose, and she has been FINE for several weeks now.

A couple of things: She found the packing VERY painful every time it was done. The tampon thing seemed somewhat less painful. I did not know they were available over the counter, so that might be worth a try for you guys. My partner has said nothing about any change in taste or smell post cauterization.

One ENT doc (a resident) recommended saline nasal spray; another (the attending physician) recommended AGAINST it, saying he felt it tended to dry the mucous membranes out too much, making them prone to cracking. Thus the estrogen-lanolin cream to help keep things moist (and apparently the estrogen has some kind of vasoconstrictive effect). Just another data point on saline sprays, obviously YMMV.

FWIW, I totally understand what you're going through. A nosebleed SEEMS like it should be a trivial thing, and yet it can be SO disruptive. In your case, given that it is probably (IANAD) more inconvenient and upsetting than life-threatening, I wouldn't think it mandatory to return home immediately, but would understand if that's what you decided to do. You have my sympathy, and I wish you the best of luck with this. Please feel free to MeMail me if you want more information.
posted by littlecatfeet at 8:42 AM on June 15

When I was a teenager, my nosebleeds were especially bad: when I took too much aspirin for shinsplints, and when I drank *way* too much caffeine. (One night those two factors combined and I soaked a pillow in blood before I woke up: ugh.)

Amy chance he needs to cut down on one or the other?
posted by wenestvedt at 9:16 AM on June 15

I happened to overhear someone the other night talking about putting an ice pack on the back of the neck as a remedy for nosebleeds. I have never tried it so I have no idea if this actually works.
posted by rabbitrabbit at 9:23 AM on June 15

I've had bad nosebleeds all my life. They come in waves (no pun intended) - once I get one, I'll have several in the space of a week, and then nothing for a long while until something touches it off again.

What's been explained to me and seems to have held up to my own experience is that I have really weak and/or close-to-the-surface blood vessels in my nose and they can rupture with all that attendant drama. They called me "bloody boogers" in elementary school, I kid you not. So after I have a nosebleed I try to minimize irritating my nose, and allow it to heal.

Once the initial bleeding stops (seems to have been covered upthread so I'll spare you) I try to take very good care of my nose, in terms of keeping well hydrated, avoiding coffee, alcohol, and ibuprofen or asprin or other blood-pressure increasing or blood-thinning things. I try to avoid dust or looking into the sun (makes me sneeze), dairy foods (stuffs me up), or dehydrating environments (airplane, insane air-conditioning or heating). Also, cats, 'cause I'm allergic and they make me sneeze, irritating my nose.

Whatever you do regarding stopping the blood when it's flowing, I have learned not to tip my head back. If you let the blood flow down your throat you'll get a blood clot and most likely cough it up, which is really not fun. let it all come out into a tissue or handkerchief.

As for cauterization, I had that done twice as a child. I recall it as one of the most painful and unpleasant experiences ever, and it was explained to me that it was a longer-term solution - it took a long time to heal. I would try lots of other things before letting someone swab acid around the inside of my nose again.
posted by gyusan at 9:38 AM on June 15

When I played varsity soccer in high school, we always used OB tampons in the nose to control bleeding. I remember finishing a game with a broken nose once and the tampon stopped all the bleeding.

Nthing what everyone has said about avoiding things that affect his blood pressure and keeping the humidity up. Above all, remember to enjoy the holiday.
posted by schyler523 at 10:31 AM on June 15

Get some NosebleedQR; it's a powder sold with applicator in some drug stores. You usually have to ask the pharmacist. There's also "UrgentQR" for small wounds. It's manufactured by Biolife LLC. You just swab it in the nostril and pinch closed for a few moments. It doesn't hurt at all. It's never failed to work for me.
posted by lazydog at 10:32 AM on June 15

well, we just had it examined and he had it cauterised and has gone out to get some nose spray!
posted by By The Grace of God at 10:51 AM on June 15

Just to come at it from a slightly different angle: has he been evaluated by a hemotologist for an underlying bleeding disorder? Has he ever had any other bleeding episodes (besides the nosebleeds), or tendency toward bruising easily?
posted by scody at 10:54 AM on June 15

Sinus rinses (neti pot or the like) have helped me as a preventative measure. My bleeding is a byproduct of dryness caused by sinus medication.
posted by chairface at 11:24 AM on June 15

As a child I suffered from very bad nosebleeds; one was so profuse and lasted so long my parents took me to the ER, and even there it took another hour or so for the doctor to somewhat stem the bleeding. (Even though I was young, I can still remember that night, and him stuffing long lengths of gauze up my nose with tweezer-like things, and pulling the gauze out completely soaked with blood. I also remember that he took a look at my long fingernails and then told my parents that I picked my nose too much. I didn't do that at all, the very idea grossed me out to the point of gagging both then and now!! - but try being a third-grader defending yourself against a doctor. Anyway, I was sent home with my nose packed with gauze and taped shut and ordered to stay in bed for 48 hours. I had my nose cauterized twice as a child, and it didn't seem to help much. By the time I got to high school, the frequency of the nose bleeds had diminished quite a bit (once or twice per year), but when I got them, they were severe.

Flash forward a lot of years, and I was diagnosed with Lupus along with Sjogren's Syndrome. Sjogren's causes extreme dryness of the mucous membranes. I have no proof, but since today I suffere from extremely dry nasal passages, I wonder if those nosebleeds of childhood were a foreshadowing of this condition. (I also had an excessive amount of cavities, even though I brushed regularly; Sjogren's can also cause this due to the decrease in saliva.) Saline nasal spray and nasal gel applied at night before bed have improved the situation a good 80% or so.
posted by Oriole Adams at 12:22 PM on June 15