One of the most common emergency calls I receive is for nosebleeds. Although anyone can have a nosebleed, most of my patients are in the 50-year-plus club and often are on aspirin or blood thinners.
“Why?” patients will often ask me. “Why am I having a nose bleed? I’ve NEVER had nose bleeds!” Of course, one response is that the first time you have a problem is always the first time you have had the problem. Sounds silly, but there it is.
Almost always, nosebleeds are because the lining tissue of the nose (called the mucosa) dried and cracked. Basically, a chapped nose. If it cracks over a blood vessel, then away you go. Once it stops, that means there is now a scab on the spot. If the scab gets knocked off by blowing or rubbing or sneezing or picking, it will bleed again. Even if we are careful not to do any of that, it may get dislodged.
So, why does it tend to happen more the older we get? Several factors go into that.
First, the mucosa gets slowly thinner as life goes by. Just like the skin all over our bodies. Next, the mucous itself gets thinner and runnier as we age, and that more watery mucus is less moisturizing than thicker mucous. It is just like when we have chapped lips – if you lick the lips, they get more chapped.
Our blood vessels also are stiffer as we get older, so if something does crack, it will tend to bleed more. Also, the little irregularities of the cartilage of the septum (the wall between the two sides of the nose) tend to get more pronounced, as the aging cartilage continues to grow. (Have you ever noticed that old people have big noses and big ears?!) Those irregularities make places that dry more with breathing.
In addition to all these things, many people are taking aspirin or blood thinners, which of course will worsen bleeding. Being on oxygen or using a sleep apnea CPAP mask will also be drying (even if you use the humidifier gizmo).
Okay, so what is the solution? The most important thing for avoiding nosebleeds is MOISTURIZATION. Just like we use lip balm to moisturize our lips, we can use moisturizers for our nose.
To work, the moisturizer has to have some oil in it. Saltwater or saline nose drops are NOT moisturizing, any more than licking your lips is moisturizing. In fact, they will make it worse. Steroid nose sprays are also NOT moisturizing. You can use a small dab of ointment like Vaseline before bed. It does not take much, just a dab. Just in the front of each nostril in the middle. Don’t shove it in with a cotton swab as that will rough things up and can even cause more bleeding.
One of my favorite moisturizers is a natural over-the-counter drop called Ponaris® Nasal Emollient. It has menthol along with eucalyptus and peppermint oils. Heck, rumor has it Ponaris was included in NASA’s medical space kit!
Back on earth, Olive oil is also actually pretty good.
So, what if my nose is bleeding right now? Sit up straight, pinch the nostrils together tightly just below the bone, and push the finger and thumb doing the pinching straight back into the face. HARD. You are putting pressure on the vessels feeding the nose. Hold that position for ten minutes or until your hand cramps up. Don’t release pressure to check. If you have some Afrin® Nasal Spray handy, spray that in before you start the pressure. If all that fails, you will need to be seen by a doctor.
Some then ask, “What about cautery?” A lot of people get the idea that cauterizing the nose is some sort of magical permanent fix. It is not. It just means burn, and that burn puts a scab on the bleeding point. It does not change the underlying problems of irregular cartilage, runny mucous and aging mucosa. It may be needed to stop acute bleeding, but does not change the fact that moisturization is needed long term. If cautery does not stop the acute bleeding, then some sort of packing is used.
Rarely, I have to take a patient to the operating room to control acute bleeding. Just know very few people have enough problems with recurrent bleeding that straightening the septum surgically is worth it.
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