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DESCRIPTION
Epistaxis (or a nosebleed in plain English) is the relatively common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils.
The nose is a very vascular area of the body that contains many arterioles (tiny blood vessels) that can bleed easily. Nosebleeds occur more frequently in the winter when heated indoor air can dry the membranes of the nose. Also, air moving through the nose can also dry out the membranes and can form crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose. Occasionally, nosebleeds may indicate other disorders such as high blood pressure, or hardening of the arteries (arteriosclerosis). Other underlying illnesses include malaria, scarlet fever, sinusitis, and typhoid fever are all known to cause nosebleeds, some of which can be serious and result in significant blood loss. Conditions that cause increased bleeding tendencies, such as hemophilia, leukemia, thrombocytopenia (a below-normal concentration of platelets in the blood), aplastic anemia, or liver disease, also may be implicated in nose bleeds.
Nosebleeds are much more common in children than in adults. This is no doubt largely due to the fact children are prone to inserting their fingers and other objects into their nostrils. In addition, children's tissues, including the mucous membranes lining the nose, are thinner than those of adults and therefore more susceptible to damage.
NOSEBLEED AT A GLANCE
Nosebleeds are common due to the location of the nose on the face, and the large amount of blood vessels in the nose.
The most common cause of nosebleeds is drying of the nasal membranes and this can be prevented with proper lubrication of the nasal passages and not picking nose.
Most nosebleeds can be stopped at home.
Consult a health care provider for a nosebleed if bleeding cannot be stopped, there is a large amount of blood lost, or you feel weak or faint.
A health care provider may use nasal packs to stop nosebleeds when conservative measures fail.
Do not take aspirin or other blood thinning products when you get a nosebleed (if they are health care provider prescribed, consult your health care provider before stopping any medication).
TYPES OF NOSEBLEEDS
There are two classifications of nosebleeds, depending on where in the nose the blood is coming from: anterior (the most common), and posterior (less common, more likely to require medical attention). Bleeding most commonly occurs in one nostril only and are due to minor irritations or colds. The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose, forming crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose. A nosebleed can be frightening for some patients, but rarely life threatening.
- Anterior epistaxis, in the anterior two thirds of the nose, is visible on the septum, and is the most common type of nosebleed. The overwhelming majority of nosebleeds are anterior nosebleeds in which bright-red blood flows from the front part of the nose. Most often they are a result of some type of trauma to the nasal tissues. If the person stands or sits, the flow of blood comes out of one or both nostrils. If the person lies on his or her back, the blood may flow backward, into the throat. This type of nosebleed can be frightening, and it may look as if there is a lot of blood, but in reality it is not usually serious and very little blood is actually lost. Anterior bleeding can often be resolved by pinching the cartilaginous part of the nose.
- Posterior epistaxis from the posterior third of the nose accounts for 10 percent of nosebleeds. Bleeding is profuse because of the larger vessels in that location. Posterior epistaxis usually occurs in older patients and primarily afflict the elderly people and those with high blood pressure. These individuals have fragile vessels because of hypertension, atherosclerosis, coagulopathies, or weakened tissue. In this type of nosebleed, blood comes from the rear of the nose and runs down the back of the mouth into the throat, no matter what position the person is in. The blood is usually dark red in color, although it can be bright red. If the bleeding is severe, blood can flow from the nostrils as well. Posterior bleeds require aggressive treatment and hospitalization.
Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting. It accounts for only 0.001 percent of all deaths in the U.S.
Epistaxis typically originates from the nasal septum when the nasal mucosa overlying a dilated blood vessel is injured. Epistaxis may, however, signal an underlying condition such as a coagulation disorder, so the treating physician must be alert for signs of serious illness or condition such as coagulopathy or cancer. Sports-related trauma and various other causes make epistaxis a common condition in active-and apparently healthy-people. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip. Some require anterior nasal packing. A few arise from posterior arteries and require anterior-posterior nasal packing and a referral. Health care providers must not only be adept at pinpointing the site of bleeding and stanching the flow, but also must be alert to potentially serious causes.
SIGNS & SYMPTOMS
Bleeding from the nose (Epistaxis) is a loss of blood from the tissue lining the nose. Bleeding most commonly occurs in one nostril only.
Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa. Rupture may be spontaneous or initiated by trauma. An increase in blood pressure (eg due to general hypertension) or local blood flow (for example following a cold or infection) will increase the likelihood of a spontaneous nosebleed. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as their blood vessels are less able to constrict and control the bleeding. The vast majority of nose bleeds occur in the anterior (front) part of the nose from the nasal septum. This area is richly endowed with blood vessels (Kiesselbach's plexus). This region is also known as Little's area. Bleeding further back in the nose is known as a posterior bleed and is usually due to rupture of the sphenopalatine artery or one of its branches. Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth.
CAUSES
The nose is a part of the body rich in blood vessels (vascular) and is situated in a vulnerable position as it protrudes on the face. The blood supply to the nose originates from two sources: the internal and external carotid arteries. It is profuse and diffuse, with many arterial and venous anastomoses. The vast majority of nosebleeds originate from the nasal septum and erupt when the relatively thin nasal mucosa overlying a dilated septal vessel dries, scabs, and falls (or is picked) off.
Trauma is the second most common cause of nosebleeds and trauma to the face can cause nasal injury and bleeding. In this situation, even a minor trauma could result in significant bleeding. A force sufficient to deform the nasal skeletal structures can cause mucosal disruption and bleeding anteriorly on the septum, laterally along the nasal walls, or, with Le Fort's fracture, posteriorly at the sphenopalatine or superiorly at the ethmoid vessels. The bleeding may be profuse, or simply a minor complication.
Posterior epistaxis, though rare, is the third most common type of nosebleed. Its etiology is still debated.
The cause of nosebleeds can generally be divided into two categories, local and systemic factors, although it should be remembered that a significant number of nosebleeds occur with no obvious cause.
A GENERAL LIST OF COMMON CAUSES OF NOSEBLEEDS
- Allergic and non-allergic rhinitis due to a cold or infectious disease (runny, inflamed nasal tissues). Inflammatory reaction such as an acute upper respiratory tract infection and chronic sinusitis.
MoonDragon's Health & Wellness: Allergies
- Repeated sneezing.
- Blowing the nose very hard.
- Overuse of decongestant nasal sprays. Nasal sprays, particularly prolonged or improper use of nasal steroids.
- Chemical inhalant and environmental or chemical irritants.
- Very cold or very dry air. Low relative humidity of air breathed occurring especially during winter seasons. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home results in drying and changes in the nose which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons.
- Nasal prong O2 (oxygen through a nasal tube with a forked prong on the end that goes in the nose) which tends to dry the nasal mucosa.
- Foreign bodies. An object stuck in the nose. Small children are known to stick objects in the nose (and ears and other strange places!).
- Narcotics, particularly insufflated cocaine.
- Trauma (usually a sharp blow to the face) including a broken nose.
- Nose picking trauma, including self-induced by nose picking.
- Barotrauma (sudden change in barometric pressure). Otic barotrauma from descent in aircraft or scuba diving.
- Anatomical deformities, such as septal spurs. Frequent nosebleeds may also be a sign of hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome).
- Less common causes include tumors. Intranasal tumors (Nasopharyngeal carcinoma in adult, and nasopharyngeal angiofibroma in adolescent males).
- Surgery on the face or nose (such as septoplasty and endoscopic sinus surgery).
- Blood thinning drugs or anti-inflammatory drugs such as Aspirin, Fexofenadine/Allegra/Telfast, warfarin (Coumadin), ibuprofen, clopidogrel, isotretinoin, desmopressin and others may cause or worsen nosebleeds. Taking large doses of aspirin or blood-thinning medicine make people more susceptible to bleeding if they are taking medications which prevent normal blood clotting.
- Bleeding (vascular) disorders, blood dyscrasias, such as hemophilia and others. Repeated nosebleeds may be a symptom of a bleeding disorder. Hematologic problems are diseases of the blood-forming organs. In most cases, this involves diseases of the bone marrow, but it might also involve the spleen and/or the liver. A blood dyscrasia is a pathological condition of the blood, usually involving disorders of the cellular elements of the blood. Bleeding problems due to poorly functioning platelets or decreased platelets, or loss of certain body proteins called "clotting factors", poorly functioning red blood cells or decreased numbers of red blood cells and poorly functioning white blood cells or decreased numbers of white blood cells.
- Inherited bleeding problems. von Willebrand's disease (vWD) is the most common hereditary coagulation abnormality described in humans, although it can also be acquired as a result of other medical conditions. It arises from a qualitative or quantitative deficiency of von Willebrand factor (vWF), a multimeric protein that is required for platelet adhesion. It is known to affect humans and dogs. There are four types of hereditary vWD. Other factors including ABO blood groups may also play a part in the severity of the condition.
- Alcohol use or abuse (due to vasodilation). Alcoholics have frequent nosebleeds because alcohol dilates blood vessels, including those in the nose and nasal cavities making them more prone to bleeding. Alcoholism and heavy alcohol use can also create problems with blood clotting because the toxic effects of the alcohol on the liver and bone marrow. Alcohol also raises blood pressure and dehydrates the body, increasing the risk for nose bleeds. Do not abuse alcohol. If you drink alcoholic beverages, drink moderately.
- Hypertension (high blood pressure). Repeated nosebleeds may be a symptoms of hypertension.
- Heart failure (due to an increase in venous pressure).
- Anemia and nutritional deficiencies. Recurrent nosebleeds may cause anemia due to iron deficiency.
- Connective tissue disease.
- Envenomation (snake bite) by mambas, taipans, kraits, and death adders.
- Pregnancy. High estrogen levels increase the flow of blood from the mucous membranes in the nose. This is why nosebleeds are more common during pregnancy. Oral contraceptives can also contribute to nosebleeds.
COMPLICATIONS
A persistent nosebleed. Inability to stop bleeding resulting in excessive blood loss.
Shock from blood loss.
Anemia from blood loss.
MEDICAL MANAGEMENT & INTERVENTION
The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure applied by pinching the soft fleshy part of the nose. This applies pressure to Little's area, the source of the majority of nose bleeds and promotes clotting. Pressure should be firm and be applied for at least 10 minutes while keeping the head in the neutral position and spitting out any blood which flows into the mouth. There is no benefit to pinching the bridge of the nose or to tilting the head backwards or forwards. Swallowing excess blood can irritate the stomach and cause vomiting. Local application of an ice pack to the forehead or back of the neck or sucking an ice cube has seen widespread practice, but has been shown to not have any statistically significant effects on nasal mucosal blood flow. In the past, it was commonly thought that the ice would help by promoting constriction of local blood vessels and thus reducing blood flow to slow down the bleed. Do not pack the nose with tissues or gauze.
The local application of a vasoconstrictive agent has been shown to reduce the bleeding time in benign cases of epistaxis. The drugs oxymetazoline or phenylephrine are widely available in over-the-counter nasal sprays for the treatment of allergic rhinitis, and may be used for this purpose.
Other products available promote coagulation include Coalgan (in Europe) or NasalCEASE (in the US). These are a calcium alginate mesh that is inserted in the nasal cavity to accelerate coagulation.
If these simple measures do not work then medical intervention may be needed to stop bleeding, possibly by an otolaryngologist (ENT practitioner). In the first instance this can take the form of chemical cautery of any bleeding vessels or packing of the nose with ribbon gauze or an absorbent dressing (called Anterior nasal packing). Such procedures are best carried out by a medical professional. Chemical cauterization is most commonly conducted using local application of silver nitrate compound to any visible bleeding vessel. This is a painful procedure and the nasal mucosa should be anesthetized first, preferably with the addition of topical adrenaline to further reduce bleeding. If bleeding is still uncontrolled or no focal bleeding point is visible then the nasal cavity should be packed with a sterile dressing, which by applying pressure to the nasal mucosa will tamponade the bleeding point. Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated by endoscopic evaluation of the nasal cavity under general anaesthesia to identify an elusive bleeding point or to directly ligate (tie off) the blood vessels supplying the nose. These blood vessels include the sphenopalatine, anterior and posterior ethmoidal arteries. More rarely the maxillary or external carotid artery can be ligated. The bleeding can also be stopped by intra-arterial embolization using a catheter placed in the groin and threaded up the aorta to the bleeding vessel by an interventional radiologist. Continued bleeding may be an indication of more serious underlying conditions.
Chronic nosebleeds resulting from a dry nasal mucosa can be treated by spraying saline in the nose three times per day, lubricating the nose with ointment/creams like vaseline and installing a humidifier in the bedroom.
Application of a topical antibiotic ointment to the nasal mucosa has been shown to be an effective treatment for recurrent nosebleeds. One study found it to be as effective as nasal cautery in the prevention of recurrent epistaxis in patients without active bleeding at the time of treatment (both had a success rate of approximately 50 percent.)
Nosebleeds are rarely dangerous unless prolonged and heavy. Nevertheless they should not be underestimated by medical staff. Particularly in posterior bleeds a great deal of blood may be swallowed and thus blood loss underestimated. The elderly and those with co-existing illnesses, particularly of blood clotting should be closely monitored for signs of shock.
PREVENTION
TIPS ON PREVENTING NOSEBLEEDS
The most common cause of a nose bleeds is drying of the nasal membranes. If you are prone to recurrent nosebleeds, it is often helpful to try lubricating the nose with an ointment of some type. This can be applied gently with a Q-tip or your fingertip up inside the nose, especially on the middle portion (the septum). Many patients use A&D ointment, Mentholatum, Polysporin/Neosporin ointment, or Vaseline. Saline mist nasal spray is often helpful.
A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Counteract the drying effects of indoor heated air by using a humidifier at night in your bedroom or by placing pans of water on radiators. Nasal saline spray and water soluble jelly can help prevent nosebleeds, especially during the winter months. Nose Irrigation Solution Recipe:
Irrigate your nose with warm water or use a dilution of 1/4 teaspoon of sea salt to 1/2 cup of water. See Holistic Recommendation further down on this page for more suggestions.
If you are active in sports, take precautions to prevent injuries to the face, such as a helmet or other protective gear.
Patients with nosebleeds should not to take aspirin or any other blood thinning products. If patients are already taking these medications when the nosebleed is noticed, they should consult their health care practitioner.
Keep children's fingernails short to discourage nose picking.
Quit smoking. Smoking dries out your nose and also irritates it.
Open your mouth when you sneeze.
The risk of serious nosebleeds increases with hemophilia, Hodgkin's disease, rheumatic fever, vitamin C deficiency, or the prolonged use of nose drops or nasal sprays.
TREATMENT
DIAGNOSIS & TESTS
YOUR HEALTH CARE PROVIDER OFFICE VISIT
The health care provider will perform a physical examination. In some cases, you may be watched for signs and symptoms of hypovolemic shock. The practitioner will ask you questions about your nosebleeds, including:
- Is there a lot of bleeding?
- Do the nosebleeds stop quickly when you press on the nostrils?
- Did they begin recently?
- Do they occur frequently or repeatedly?
- Does the bleeding always occur on one or both sides?
- What other symptoms do you have?
- Is there blood in the stools?
- Are you vomiting blood?
- Do you bruise or bleed easily?
- Are there tiny red or purple spots on the skin (petechiae)?
- Are you taking blood thinners (Coumadin) or aspirin?
LAB WORK AND OTHER TESTS
The following lab studies are recommended in the presence of major bleeding or if a coagulopathy is suspected:
Hematocrit, Type & Cross: Obtain these if a history of persistent heavy bleeding is present. The hematocrit is the percent of a person's blood composed of oxygen-carrying red blood cells. Type & Cross gives you your ABO blood type (Type A, B, AB or O) and usually your Rh factor (Type D). A "type and cross" determines compatibility between patient serum and donor red blood cells. This is valuable if you ever need to be given blood. Everyone should know their blood type in case of emergency and pregnancy.
Complete Blood Count (CBC): Obtain if a history of recurrent epistaxis, a platelet disorder, or neoplasia is present. A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells , white blood cells , and platelets. A CBC helps your health professional check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders. A CBC test usually includes:
- White blood cell (WBC, leukocyte) count. White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly. The number of white blood cells is sometimes used to find an infection or to see how the body is dealing with cancer treatment.
- White blood cell types (WBC differential). The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immature neutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxic reaction to medicines or chemicals, and many conditions, such as leukemia.
- Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.
- Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present.
- Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body.
- Red blood cell indices. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. These numbers help in the diagnosis of different types of anemia. Red cell distribution width (RDW) can also be measured which shows if the cells are all the same or different sizes or shapes.
- Platelet (thrombocyte) count. Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis).
- Your health care provider may order a blood smear test to be done at the same time as a CBC but it is not part of the regular CBC test. In this test, a drop of blood is spread (smeared) on a slide and stained with a special dye. The slide is looked at under a microscope. The number, size, and shape of red blood cells, white blood cells, and platelets are recorded. Blood cells with different shapes or sizes can help diagnose many blood diseases, such as leukemia, malaria, or sickle cell anemia.
Bleeding Time: An excellent screen if suspicion of a bleeding disorder is present. Bleeding time is a crude test of hemostasis (the arrest or stopping of bleeding). It indicates how well platelets interact with blood vessel walls to form blood clots.
Prothrombin (PT): Prothrombin time is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.
International Normalized Ratio (INR)/Activated Partial Thromboplastin Time (aPTT): Obtain if the patient is taking warfarin (Coumadin) or if liver disease is suspected. The International Normalized Ratio (INR) is used to monitor the effectiveness of blood thinning drugs such as warfarin (Coumadin). The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the "intrinsic" (now referred to as the contact activation pathway) and the common coagulation pathways. Apart from detecting abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin, a major anticoagulant. It is used in conjunction with the prothrombin time (PT) which measures the extrinsic pathway. Blood is collected, by a phlebotomist, with oxalate or citrate which arrest coagulation by binding calcium. This specimen is delivered to the laboratory. In order to activate the intrinsic pathway, phospholipid, an activator (such as silica, celite, kaolin, ellagic acid), and calcium (to reverse the anticoagulant effect of the oxalate) are mixed into the plasma sample. The time is measured until a thrombus (clot) forms. This testing is performed by a medical technologist. The test is termed "partial" due to the absence of tissue factor from the reaction mixture.
Nasal endoscopy (examination of the nose using a camera).
Imaging Studies: X-rays of the skull. Sinus films (rarely).
Other Tests: CT scan and/or nasopharyngoscopy if a tumor is the suspected cause of bleeding.
Angiography (rarely). Angiography or arteriography is a medical imaging technique in which an X-ray image is taken to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers.
CONVENTIONAL MEDICAL TREATMENT
NOSEBLEED FIRST AID
A nosebleed can be scary to get or see but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.
If you get a nosebleed, the best thing to do is to sit down and lean slightly forward. Keeping your head above your heart will make your nose bleed less. Do not lay down flat or put your head between your legs. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean or tilt your head backwards, you could potentially lead to the blood running back into your sinuses and throat, causing gagging, inhaled blood or swallowing the blood. This can cause nausea, vomiting and diarrhea.
Use your thumb and index finger to squeeze or pinch together the soft portion of your nose to stop the nosebleed. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Pinch all the soft parts and press firmly, but not painfully toward the face, compressing the pinched parts of the nose against the bones of the face. Breathe through your mouth. Keep holding your nose until the bleeding stops. Do not let go for at least 5 minutes. If it is still bleeding, hold it again for 10 minutes straight. Repeat as necessary until the nose has stopped bleeding.
Once the bleeding stops, do not do anything that may make it start again, such as bending over or blowing your nose. Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.
You can also place a cold compress, crushed ice (frozen peas in a bag make a good cold compress) or an ice pack (wrapped in a towel) across the bridge of your nose, neck and cheeks. This can be done both as you apply pressure (see above) and afterward.
If the bleeding does not stop, place a cloth or piece of cotton moistened with water or an over-the-counter decongestant spray into the nasal cavity. Hold your nostrils together tightly for about 5 minutes.
To help stop a nosebleed, try rolling a piece of cotton or gauze and place it in the top part of your upper lip, under the gum. An artery supplying blood to the nose is located in this region. Applying pressure in this manner may help constrict the blood flow.
If you suspect a posterior nosebleed, consult your health care provider or go to the emergency room. This type of nosebleed requires the care or a medical practitioner.
PREVENTING THE NOSE FROM BLEEDING AGAIN
- Go home and rest with head elevated at 30 to 45 degrees.
- Try to keep your head higher than the level of your heart.
- Do not blow your nose for at least 12 hours after a nosebleed stops or put anything into it. Doing so may dislodge the blood clots that stanch bleeding. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
- Do not strain during bowel movements. Use a stool softener (for example, Colace).
- Do not strain or bend down to lift anything heavy. Refrain from any energetic physical activity for a few hours and any vigorous exercise for at least two days.
- Do not smoke.
- Stay on a soft, cool diet. No hot liquids for at least 24 hours.
- Do not take any medications that will thin the blood such as aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or warfarin (Coumadin). If these have been prescribed by your health care provider, you need to contact them regarding stopping these medications.
- Your health care provider may recommend some form of lubricating ointment for the inside of the nose.
- If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can temporarily use a nasal decongestant spray, such as Afrin or Neo-Synephrine. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction and do not use if you have high blood pressure.)
- Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the health care provider and/or visit to the emergency room.
See your health care provider if:
- The bleeding goes on for more than 15 minutes.
- The bleeding was caused by an injury.
- You get nosebleeds often.
Most nosebleeds are not a medical concern and are not necessary to be handled by your health care provider. Most nosebleeds occur in the front part of the nose and stop in a few minutes. A few nosebleeds stem from large vessels in the back of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, atherosclerosis, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed.
You will need to get medical attention if a nosebleed goes on for more than 15 minutes or if it occurs after an injury, such as a punch in the face, especially if you think you may have a broken nose. A nosebleed after a fall or car wreck could be a sign of internal bleeding.
Frequent nosebleeds may mean you have a more serious problem. For example, nosebleeds and bruising can be early signs of leukemia. Nosebleeds can also be a sign of blood clotting disorders and nasal tumors (cancerous and non-cancerous).
MEDICAL TREATMENT FOCUS
Treatment is usually focused on the cause of the nose bleeds, and may include:
- Controlling blood pressure.
- Closing the blood vessel using heat, electric current, or silver nitrate sticks.
- Nasal packing.
- Reducing a broken nose or removing a foreign body.
- Reducing the amount of blood thinners or stopping aspirin.
You may be referred to an ear, nose, and throat (ENT) specialist to diagnose and treat the condition.
MEDICAL MANAGEMENT OF A NOSEBLEED
If you have tried to use the First Aid Method for stopping a nosebleed (above) and the method has been applied at least twice before seeking medical treatment, see your health care provider. He or she will try to find out where the bleeding is coming from in your nose. He or she will probably ask you some questions and examine your nose. If the bleeding does not stop on its own or with pressure applied, your health care provider may cauterize the bleeding vessel or pack your nose to stop the bleeding.Cauterization involves using special solutions or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.
Packing the nose involves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding.
The clots should be cleared by suction or blowing the nose.
After visualizing the bleeding site, a typical treatment would be:
- A wad with 0.25 percent phenylephrine nose drops is applied.
- A wad with 1 percent lignocaine with 1:1000 epinephrine is applied.
- A wad with 1 percent cocaine is inserted (Cocaine is the most potent topical vasoconstrictor).
- The insertion of a small piece of gelatin sponge (Gelfoam) or topical thrombin over the bleeding site can be tried.
For prevention, a daily application of antibiotic ointment by cotton bud until five days have passed without a nosebleed and then weekly for one month. In dry climates, humidification of the air may be of use. Avoid aspirin or other medications that trigger bleeding. Avoid vigorous nose blowing. Blood loss always looks greater than the actual amount lost.
Usually correct home treatment reduces nosebleeds to an insignificant problem. In the unusual situation where bleeding from the back of the nose occurs, referral to an Ear, Nose and Throat (ENT) specialist is necessary. If severe and repeated bleeding occurs, then surgery may be needed.
ANTERIOR EPISTAXIS MEDICAL TREATMENT
Epistaxis can usually be managed with a step-by-step approach (see above). The vast majority of spontaneous or traumatic nosebleeds in people who have no underlying coagulopathy stop on their own with or without ice to the forehead, pressure to the upper lip, or pinching of the nostrils against the septum. Those that continue to bleed after 3 or 4 minutes can be controlled by one of two approaches.
The easiest is applying pressure to the bleeding site with anterior nasal packing. To do this, the health care provider topically vasoconstricts and anesthetizes the nasal mucosa. Bacitracin or a similar ointment is applied to one of the commercial anterior nasal packs.
The nasal tampon is inserted with a firm grasp, using a hemostat or bayonet forceps. The tampon will swell and compress the bleeding site. Layered, 1/2-inch gauze with petrolatum is a rough but effective alternative to the tampon.
A second approach is to stop the bleeding with vasoconstrictors such as topical oxymetazoline hydrochloride, cocaine, or epinephrine 1:100,000, and then to cauterize the bleeding site with silver nitrate or electric cautery.
Materials Needed for an Anterior Nasal Pack
- Layered 1/2-inch gauze with petrolatum.
- Expandable cellulose intranasal tampons.
- Gelfoam pledget.
- Gelfoam pledget wrapped in Surgicel.
- Collagen hemostat.
- Nasal tampon (e.g., Rhinorocket, Fast-Pak).
POSTERIOR EPISTAXIS MEDICAL TREATMENT
The rare and more serious posterior nosebleed requires an anterior-posterior (AP) pack and referral to an otolaryngologist.
Commercial balloons such as the Epistat (Xomed, Inc) and Nasostat (Sparta, Pleasanton, California) are the most commonly used devices. A Foley balloon catheter with anterior gauze packing is also effective.
The most secure AP pack is a 4-inch x 4-inch gauze sponge pulled against the posterior choana with a transnasal, 0 silk suture, combined with anterior layered gauze packing, though it is the most difficult and messy to insert. The list below shows the contents of a complete epistaxis tray.
Epistaxis Equipment
- 4-inch x 4-inch gauze sponge.
- 1 x 6 cm cottonoids (neurosurgical gauze patties).
- Merocel nasal packing with airway.
- Gelfoam pledget.
- Expandable cellulose intranasal tampons.
- Surgicel.
- Nasal speculum.
- Frazier suction cannula.
- Intranasal balloon (e.g., Epistat, Nasostat).
- 0 silk suture.
- Layered 1/2 inch gauze with petrolatum.
- 10-mL syringe.
- Bayonet forceps.
- #16 Foley balloon catheter.
KEEPING ALERT FOR THE UNUSUAL
Most nosebleeds are controlled with direct pressure to the glabella, nasal alae, or upper lip and columella. More persistent anterior nosebleeds are controlled with commercially available balloons and tampons. The occasional severe nosebleed requires anterior-posterior tamponade and referral to a specialist. The sports medicine practitioner must remain vigilant for the uncommon underlying coagulopathies and tumors.
EMERGENCY DEPARTMENT CARE
Upon initial arrival to ED, instruct patients to grasp and pinch entire nose maintaining continuous pressure for at least 10 minutes.
Gowns, gloves, and protective eyewear should be worn. Adequate light is best provided by a headlamp with an adjustable narrow beam. Patient should be positioned comfortably, holding a basin under chin.
As always, address ABCs. Severe epistaxis may require endotracheal intubation. Rapid control of massive bleeding is best secured with an epistaxis balloon or Foley catheter, as outlined below.
Patients with significant hemorrhage should receive an IV line and crystalloid infusion, as well as continuous cardiac monitoring and pulse oximetry. Patients frequently present with an elevated blood pressure; however, a significant reduction usually can be obtained with analgesia and mild sedation alone. Specific antihypertensive therapy rarely is required and should be avoided in the setting of significant hemorrhage.
Insert pledgets soaked with an anesthetic-vasoconstrictor solution into nasal cavity to anesthetize and shrink nasal mucosa. Soak pledgets in 4 percent topical cocaine solution or a solution of 4 percent lidocaine and topical epinephrine (1:10,000) and place them into nasal cavity. Allow them to remain in place for 10-15 minutes.
If a bleeding point is easily identified, gentle chemical cautery may be performed after adequate topical anesthesia. The tip of a silver nitrate stick is rolled over mucosa until a grey eschar forms. Only one side of septum should be cauterized at a time, to avoid septal necrosis or perforation. In order to be effective, cautery should be performed after bleeding has been controlled.
If attempts to control hemorrhage with pressure or cautery fails, nose should be packed. Alternatives include traditional nasal packing, an epistaxis balloon, or a prefabricated nasal sponge.
Traditional (Vaseline Gauze) Packing: This is the traditional method of anterior nasal packing. It commonly is performed incorrectly, using an insufficient amount of packing placed primarily in the anterior naris. Placed in this way, the gauze serves as a plug rather than a hemostatic pack. Health care providers inexperienced in proper placement of a gauze pack should consider use of a nasal tampon or balloon. The proper technique for placement of a gauze pack is as follows:
- Grasp gauze ribbon, about 6 inches from its end, with bayonet forceps. Place in the nasal cavity as far back as possible, ensuring that the free end protrudes from the nose. On the first pass, the gauze is pressed onto the floor of nasopharynx with closed bayonets.
- Then grasp ribbon about 4-5 inches from nasal alae and reposition nasal speculum so that lower blade holds the ribbon against lower border of nasal alae. Bring a second strip into nose and press downward.
- Continue this process, layering gauze from inferior to superior until naris is completely packed. Both ends of ribbon must protrude from naris and should be secured with tape. If this does not stop bleeding, consider bilateral nasal packing.
Compressed Sponge (Merocel): Trim Merocel foam to fit snugly through naris and place it along floor of nasal cavity. Once wet with blood or a small amount of saline, it expands to fill the nasal cavity and tamponade bleeding.
Anterior Epistaxis Balloons: Balloons come in anterior (single balloon) or anterior-posterior (double balloon) models. Cover an anterior catheter with antibiotic ointment, insert it along floor of nasal cavity, and inflate slowly with sterile water until bleeding stops.
Posterior Epistaxis Balloons: After passing through the naris and into posterior nasal cavity, inflate balloon with 4-5 mL sterile water and gently pull forward to fit snugly in posterior choana. After bleeding into posterior pharynx has been controlled, fill anterior balloon with saline until bleeding completely stops.
Avoid over inflation because pressure necrosis or damage to septum may result. Record the amount of fluid placed in each balloon.
If a Foley catheter is used, place a 12-16 French catheter with a 30 cc balloon into the nose along floor of nasopharynx, until the tip is visible in the posterior pharynx.
Then slowly inflate balloon with 15 mL saline, pull it anteriorly until it firmly sets against posterior choanae, and secure it in place with an umbilical clamp. Use a buttress clamp with cotton gauze to avoid pressure necrosis on nasal alae or columella. Finally, an anterior nasal pack should be placed.
Consultations: Manage bleeding requiring posterior packing with ear, nose, and throat (ENT) consultation. Due to multiple possible complications, admission is required, usually in a monitored setting.
MEDICAL FOLLOW-UP
Further Inpatient Care: Admit patients with posterior packing. Elderly patients or patients with cardiac disorders or chronic obstructive pulmonary disease (COPD) should receive supplemental oxygen and should be admitted to a monitored setting. Significant or uncontrolled bleeding from a posterior site may require operative management. At most centers, selective arterial embolization has become treatment of choice for severe epistaxis.
Further Outpatient Care: Patients discharged with anterior packing should receive follow-up with ENT within 48-72 hours. Nasal packing prevents drainage of sinuses. Your health care provider many not remove the nasal packing for 3 to 5 days.
Consider placing patients on a penicillin or first-generation cephalosporin. Oral analgesics also should be prescribed.
Inform patient to avoid aspirin, aspirin containing products, or NSAIDs.
Give patient specific written follow-up instructions.
TREATMENT CONCERNS
Posterior nasal packing is particularly uncomfortable for the patient and promotes hypoxia and hypoventilation. Failure to admit and appropriately monitor all patients who require posterior packing may result in significant mortality.
Attempts at nasal packing may result in significant slowing but not cessation of hemorrhage. Failure to completely control hemorrhage is an absolute indication for ENT consultation in the ED.
Tumors or other serious pathology are infrequent causes of epistaxis. However, all patients who present with epistaxis should have follow-up care arranged with an ENT surgeon for a complete nasopharyngeal examination.
POSSIBLE COMPLICATIONS
- Sinusitis.
- Septal hematoma/perforation.
- External nasal deformity.
- Mucosal pressure necrosis.
- Vasovagal episode.
- Balloon migration.
PROGNOSIS
Excellent, with proper treatment.
MEDICATIONS
Patients discharged with anterior packing should receive follow-up with ENT practitioner within 48-72 hours. Nasal packing prevents drainage of sinuses. Consider placing patients on a broad-spectrum antibiotic to cover all likely pathogens in the context of the clinical setting.
Oral analgesics should be prescribed to assure quality patient care.
THE EFFECTS OF MEDICATIONS
Aspirin and pain relievers with salicylic acid thin blood and keep it from clotting, so they actually may encourage nosebleeds. If you have frequent nosebleeds, take acetaminophen or ibuprofen instead whenever you need pain relief. Blood thinners and anticoagulants may also contribute to frequent nosebleeds.
HOLISTIC, NUTRITIONAL & HERBAL RECOMMENDATIONS
NUTRITION & SUPPLEMENTS
Eat a diet high in vitamin K (unless you are on prescribed anti-coagulants - consult with your health care provider if you are taking blood thinners). Vitamin K plays a central role in the complex clotting process, integral to halting nosebleeds. Good food sources that contain a measurable amount of this vitamin are alfalfa, broccoli, cauliflower, egg yolks, kale, liver, spinach, and all green leafy vegetables, blackstrap molasses.
"Green Drinks" made from the vegetables listed above are very beneficial and healthful. Drink one of these a day for vitamin K and other essential clotting factors. See Juicing for more information.
Vitamin C works with bioflavonoids to repair and regenerate connective tissue in the body. It also aids iron absorption when iron has been depleted through bleeding and must be replaced. To help ensure adequate intake, include in your diet foods rich in Vitamin C, such as citrus fruits, strawberries, beet greens and broccoli. Supplement your intake with a minimum of 1,000-2,000 mg of vitamin C daily. Take bioflavonoids, such as Rutin and Quercetin along with the Vitamin C for optimal benefits. Note: During pregnancy, increased blood volume may cause the capillaries in the nasal passages to rupture, causing a nosebleed. Lack of Vitamin C and bioflavonoids may contribute to the risk, which normally disappears after delivery.
Herbal Remedies: Source Naturals Activated Quercetin Bioflavonoid Complex, 50 Tabs
Source Natural Quercetin Bioflavonoid Complex is a unique bioflavonoid derived from plant sources. In human cell culture studies, quercetin has been shown to inhibit histamine release.
Herbal Remedies: Antioxidant Formula Supplement, All Natural, Nature's Way, 100 Tabs
Nature's Way Antioxidant Formula supplement is 100% Natural.
If you have high blood pressure, you may be prone to frequent nosebleeds. Avoid caffeine, which may raise blood pressure. A low-fat, low-cholesterol diet is recommended for keeping blood pressure under control.
Avoid foods high in salicylates, which are aspirin-like substances found in tea, coffee, most fruits, and some vegetables. Foods to avoid include apples, apricots, almonds, all berries, cloves, cherries, cucumbers, currants, grapes, mint, oil of wintergreen, bell peppers, peaches, pickles, plums, raisins, tangelos, and tomatoes.
REPLACING IRON
Excessive blood loss due to frequent nosebleeds can deplete your body of iron, vital for producing hemoglobin in red blood cells. Lack of iron can lead to anemia, in which a shortage of hemoglobin or red blood cells mean an often severe energy deficiency. If you have chronic nosebleeds, lower the risk of anemia by eating iron-rich foods such as almonds, rolled oats and lean meats. Take iron supplements only under a health care provider's direction.
Herbal Remedies: Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood. Along with manganese and copper it is necessary for healthy blood chemistry and is essential for recovery from illness.
Herbal Remedies: Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood. Along with manganese and copper it is necessary for healthy blood chemistry and is essential for recovery from illness.
Herbal Remedies: Iron Complex With Vitamins & Herbs, Vegetarian, NOW Foods, 250 Tabs
Now Foods utilizes the superior Albion Labs patented Ferrochel iron chelate which research has shown to be highly absorbed, well tolerated, and non-constipating at recommended levels.
Herbal Remedies: Anemia Supplements & Products
NATURAL HEALING TECHNIQUES
KEEP NASAL TISSUES MOIST: If the mucous membranes in the nose are dry, they tend to bleed more easily than if they are moist and elastic. Keep moisture in your rooms with a humidifier or place pans of water on radiators or simmer a pot of water on the kitchen stove. Irrigate your nose with warm water or use a dilution of saline solution consisting of 1/4 teaspoon of sea salt to 1/2 cup of water. Inhalation with herbs or essential oils, such as Orange and Eucalyptus Oils, will also keep nasal passages moist and less susceptible to nosebleeds.
COLD WATER & VITAMIN E: After a nosebleed, place ice or cold washcloths on the nose and neck. Once the bleeding has stopped, apply a small amount of Vitamin E Oil gently on the inside of the nose. Petroleum jelly or A&D Ointment will work well, too, if Vitamin E is unavailable. If you need to, pack the nostril with gauze to prevent leakage.
NASAL IRRIGATION: The tannins in Tormentil and White Oak Bark firm and strengthen the nasal mucosa and the surface vessels. Boil 2 teaspoons each of Oak Bark and Tormentil in 1 cup of water for 15 minutes. Strain. Several times daily, draw the cooled infusion up into the nose, letting it flow down your throat. For acute nosebleeds, dip gauze plugs in the tea, and place in the nose.
VINEGAR PADS: If packing the nose with gauze or cotton is necessary to stem the flow of blood, some medical authorities recommend moistening the packing material with white vinegar. They contend that the acid in white vinegar has a mildly cauterizing effect on broken blood vessels, which may help stop bleeding. Mix 1 teaspoon of water with 1 teaspoon of vinegar, dip a cotton ball in the mixture, and use it to block the nose.
HERBS
Alfalfa is a good source of vitamin K. It can be taken in tablet form, eaten in a natural form, such as alfalfa sprouts, or in liquid form as a concentrated liquid nutritional supplement.
Herbal Remedies: Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps
Chlorophyll is a unique substance found in all green plants and is sometimes called the blood of plant life. Identified as sodium-copper chlorophyllin, this water soluble extract is derived exclusively from alfalfa through a natural process.
Herbal Remedies: AlfaMax Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Nature's Way Alfa-Max Alfalfa Extract capsules is a 10X extract of fresh green Alfalfa leaves.
Herbal Remedies: Alfalfa, NOW Foods, 650 mg, 500 Tabs
NOW Food's Alfalfa tablets deliver excellent health benefits. Alfalfa is a rich natural source of chlorophyll, vitamins, minerals and protein which supports a healthy colon.
Herbal Remedies: Alfalfa Tincture, 100% Organic, 2 fl. oz.
Alfalfa (Medicago sativa) is Useful to generate energy and endurance; a tonic for the whole body, due to its highly nutritive value.
Herbal Remedies: Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps
Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.
Herbal Remedies: Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.
Alfalfa Powder is a supplement which can be blended into vegetable juices or used in baking or in vegetarian dishes. It is 20% protein and 15% fiber; plus it contains 16 amino acids, 13 trace minerals and 13 vitamins. Alfalfa Powder is a whole food supplement highly valued for its nutrition.
If your nasal membranes become sore from dryness, use Aloe Vera gel, Calendula Ointment, or Comfrey Ointment as needed.
Mountain Rose Salves: Comfrey-St. John's Wort Compound Super Salve & Injur Heal Balm with Calendula
Herbal Remedies: Aloe Vera Gel, NOW Foods, 32 oz.
NOW Foods Aloe Vera Gel is made from organic aloe vera juice. Based on its soothing, cooling properties, many refer to Aloe Vera simply as the medicine plant.
To promote healing, rub a small amount of Calendula Ointment from NatureWorks into each nostril once the bleeding subsides. Repeat as needed.
Herbal Remedies: Calendula Cream (Marigold), NatureWorks, 4 fl. oz.
Calendula Cream blends natural calendula extract in a base of avocado, jojoba and natural Vitamin E to moisturize, soften and protect your skin against environmental influences.
Herbal Remedies: Calendula Cream, Nelson's Bach, Organic, 1 oz.
Nelsons Bach Calendula cream is a soothing multi-purpose skin cream, specially prepared from the Calendula which offers soothing relief for rough, dry, irritated or chapped skin.
Herbal Remedies: Calendula Gel, Califlora, First Aid & Sunburn Relief, Homeopathic, Boericke & Tafel, 2.75 oz.
Califlora Calendula Gel is the ideal pain reliever for a wide variety of skin conditions including sunburns.
Comfrey Leaf Ointment, Nature's Way, 2 oz.
Comfrey Leaf Ointment is 100% all-natural, mild scented, herbal ointment. Comfrey Leaf Ointment has long been a favorite for herbalists in its topical applications.
INFUSED CALENDULA OIL RECIPE
1/2 Cup Calendula Flowers (dried & powdered)
1 Cup Olive Oil
Infuse Calendula flowers into the olive oil and soak for 14 days. Strain well and refrigerate. (Be sure to buy Calendula and not the American Marigold, Tagetes.)
HOMEMADE CALENDULA OINTMENT
If you prefer a salve instead:
1 Ounce Beeswax
1/2 - 3/4 Cup Infused Calendula Oil
1/2 Cup Calendula Flowers
1. Shave or cut the beeswax into small chunks. In a saucepan, warm the infused Calendula Oil and the Beeswax.
2. Heat the ingredients over low heat until the Beeswax is just melted. Don't allow the ingredients to boil.
3. Remove from heat, and add the Calendula Flowers. Then pour the salve into sterilized containers, and store in a cool, dark place for up to 1 year.
Cocoa Butter may be added to this mixture for extra skin softening and healing properties. Can be used for chapped and irritated skin problems.
QUICK & EASY HEALING SALVE RECIPE
1/2 Cup All-Vegetable Shortening (At Room Temperature)
10 Drops Tea-Tree Essential Oil
10 Drops Calendula Absolute Oil
In a small bowl, whip ingredients together, using a small whisk or spatula, until thoroughly blended. The salve should have the look and feel of fluffy, orange butter-cream frosting. Store in a labeled plastic or glass container in a cool place for up to 3 months, or refrigerate for up to 1 year.
For more information about making your own Healing Salves and Ointments, see Calendula Ointment and Healing Wound Salve.
A snuff made from finely ground White Oak Bark is soothing and healing.
Herbal Remedies: White Oak Bark, Nature's Way, 480 mg, 100 Caps
White Oak Bark is one of the strongest natural astringent herbs available. (For using as a snuff, open a capsule and use the powder inside.)
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for those over the age of 18 years. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
NOSEBLEED / EPISTAXIS SUPPLEMENTS & PRODUCTS
Information, products and supplements for nosebleeds which occur when there is bleeding from the internal blood vessels of the nose.
Alfalfa, NOW Foods, 650 mg, 500 Tabs
NOW Food's Alfalfa tablets deliver excellent health benefits. Alfalfa is a rich natural source of chlorophyll, vitamins, minerals and protein which supports a healthy colon.Alive! Whole Food Energizer Multi-Vitamin & Mineral with 18 mg of Iron Added, Nature's Way, 90 Tabs
Nature's Way Alive multi-vitamin with mineral is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands. No other supplement contains more life-giving nutrients than ALIVE, which is just the way it will make you feel.Alive! Whole Food Energizer Multi-Vitamin & Mineral with Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way ALIVE! It is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Arnica Gel, Arniflora Homeopathics, Boericke & Tafel, 2.75 oz. Topical Gel
Arniflora is a modern pharmaceutical preparation containing 8% tincture of Arnica montana. Relieves: Pain, Swelling, Stiffness, Bruising, Pain relieving gel for bumps, bruises, sprains, sports injuries, over-exercising, and more.Arnica Montana Tincture, 100% Organic, 2 fl. oz.
Arnica Montana is used primarily to relieve the after-effects of falls, blows, sports injuries and overexertion.Bumps & Bruises Wellness Oil, 100% Organic, 2 fl. oz.
Bumps & Bruises Wellness Oil, when massaged into the skin or held onto the injury with a cloth, will help reduce swelling and bruising. The swelling and unsightly bruising that comes after a bump or fall can almost be worse than the pain of the original impact. When moments like this happen - and we all have them - it's important to act relatively quickly. The sooner you address bruising and swelling, the shorter the duration will be. You can also speed up the healing process by applying ice to the bruise. This oil is a great one to have stored in the medicine cabinet, as bumps happen all the time - it's great to have a natural treatment at the ready! Ingredients include unrefined grapeseed oil, and an essential oil blend of lavender, geranium, & black pepper.CAL/MAG/ZINC, Calcium Magnesium Zinc Supplement, 90 Tablets
This unique Calcium Magnesium Zinc Supplement formula perfectly balances calcium, magnesium, and zinc with over 70 minerals and trace elements found in ConcenTrace for maximum absorption and utilization by the body.Cayenne Pepper Supplement, Nature's Way, 450 mg, 180 Caps
Cayenne Pepper supplement is a blood warming herb that has an invigorating effect on several body systems.Cell Rejuvenator, Peter Gillham's Natural Vitality, 8 oz.
Cell Rejuvenator is a precisely engineered formula designed to give cells the exact nutrients they need to rejuvenate quickly and in the best condition possible.Chlorofresh Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels
Chlorofresh, Chlorophyll Supplement, is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence. Chlorophyll is rich with vitamin K, needed for blood clotting.Comfrey Leaf Powder, 4 oz. Bulk
One of the most well-known healing plants, especially for its ability to heal tissue and bone.Daily Two Iron-Free Multi-Vitamin Supplement, 100% Natural, Nature's Way, 100 Tabs
This iron free multi-vitamin supplement was developed for the protection growth and maintenance of body systems as they age.Ester C with Bioflavonoids, Nature's way, 1000 mg, 90 Tabs
Nature's Way Ester C with Bioflavonoids offers enhanced Retention. Ester-C is 100% natural Vitamin C (calcium ascorbate) with enhanced cellular uptake and retention.Hylamist Nasal Mist With HA, Hyalogic, 1.5 oz.
Hylamist is hyaluronic acid for nasal administration, designed to sooth and moisturize dry, stuffy noses.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system. Calcium and magnesium are essential for blood clotting.MSM (Methylsulfonylmethane), Pure Lignisul, With Vitamin C, 875 mg/100 mg, 120 Caps
MSM with Vitamin C offers support for allergies, connective tissue, joint flexibility, immune function, arthritis, osteoporosis, digestive disorders, circulation, bruising, carpal tunnel syndrome, and antioxidant protection.Multi-Vitamin Without Iron, Nature's Way, 100 Caps
The vitamins and minerals in this Multi Vitamin without Iron play many important roles in the body: antioxidants to protect fats, cells and DNA, coenzyme precursors for energy production and metabolism, and cofactors for hormones and enzymes which regulate body processes.Nettle Herb, 435 mg, 100 Caps
Nettle herb from Nature's Way is wild harvested, gently dried and ground to a usable form and encapsulated. Nettle herb contains no chemicals, additives or artificial coloring. Nettle is a good source of iron and vitamin K.Nettle Tincture, 2 fl. oz.
Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.Nutribiotic Nasal Spray, With Grapefruit Seed Extract, 1 fl. oz.
Nasal Spray is useful to aiding many conditions. During allergy season it helps to re-moisturize the nasal passages and clean them of dust, dirt, dander and other allergens. The nasal spray is also useful during a bout of sinusitis, or inflammation and infection of the sinus passages.Shepherd's Purse Tincture, 2 fl. oz.
Shepherd's Purse is mainly used to stop bleeding of all kinds.Sinus Relief Spray, Homeopathic Sinus Nasal Spray, 0.5 fl. oz.
Similasan Sinus Relief homeopathic nasal spray is a unique Active Response Formula that quickly stimulates the body's natural ability to relieve sinus congestion and inflammation of nasal passages while soothing dryness and irritation.Throat Spray GSE, 4 fl. oz.
This natural formulation is designed to promote healthy conditions in the mouth and throat. NutriBiotic Throat Spray provides protection from sore throat due to germs.Ultimate B (Vitamin B Complex Formula), 60 Tabs
Superbly formulated, Ultimate B, vitamin B Complex Formula, is a synergistic blend of herbs, superfoods, and enzymes made of 33% food ingredients for easy absorption.Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Vitamin B-12 Helps to maintain a healthy nervous system, and helps in the prevention of pernicious anemia. Folic Acid should be taken by all females of child bearing age to help prevent neuro-tube birth defects. Folic acid is also linked to heart health.Vitamin C 1000 with Bioflavonoids, 100% Natural, 1000 mg, 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin C 500 with Rosehips, 100% Natural, 500 mg, 250 Vcaps
Nature's Way Vitamin C with Rosehips offers a rich whole plant source of vitamin C and provides antioxidant protection for many of the body's important enzyme systems.Witch Hazel Tincture, 100% Organic, 2 fl. oz.
Witch Hazel can be taken internally for diarrhea and hemorrhage.Yarrow Flowers Herb, Nature's Way, 325 mg, 100 Caps
Yarrow Flower Herb may be helpful for Nosebleeds, fevers, colds, sore throat, indigestion, heartburn, inflammation, menstruation, dysmenorrhea, high blood pressure, muscle spasms, urinary tract infections, and minor injuries.Yarrow (Achillea Millefolium) Tincture, 100% Organic, 2 fl. oz.
Yarrow is well-known for its use as a remedy for cold, flu and fever and also for its skin wound healing and antibiotic properties.
Herbal Remedies: Bloody Nose / Nosebleed / Epistaxis Information
Herbal Remedies: Bloody Nose / Nosebleed / Epistaxis Supplements, Information & Products
Herbal Remedies: Hemophilia Information
Herbal Remedies: Hemophilia Supplements, Information & Products
SEEK MEDICAL CARE OR GO TO THE EMERGENCY ROOM IF...
Bleeding cannot be stopped after 20 minutes or keeps occurring.
Bleeding is rapid, or if blood loss is large.
You feel weak or faint, presumably from blood loss.
Nose bleeding occurs after an injury to the head. This may suggest a skull fracture and x-rays should be taken.
Your nose may be broken (for example, it is misshapen after a blow or injury).
You or your child has repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.
The nosebleed persists or is recurrent, see your health care provider, who may then recommend stopping the bleeding with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble) or application of a topical medicine called thrombin that promotes local clotting of blood. Blood tests may be ordered to check for bleeding disorders. If bleeding is still persistent, the health care provider may place nasal packs, which compress the vessels and stop the bleeding. In rare situations, you may be admitted to the hospital or require surgical treatment or a procedure where material is used to plug up the bleeding vessels in the nose (angiographic embolization).
IF YOU HAVE NASAL PACKS PLACED IN YOUR NOSE:
Nasal packs are used when less conservative measures fail (see above). These packs are frequently placed in both sides of the nose. The packs are usually made of a material called "Merocel" which is a compressed sponge-like material used to help compress the area of the nose that is bleeding. The health care provider usually does not remove them for several days (two to three days or longer). This requires a follow-up appointment.
You will need someone to drive you and bring you home after the nasal packs are removed. During this time, you may be prescribed antibiotics and pain medications as needed.
It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. Your health care provider may permit you to clean your nostrils with hydrogen peroxide soaked Q-tips. Finally, you should consider the prevention methods described above to help to avoid bleeding again.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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