Care and Prevention of Nosebleeds

Care and Prevention
Most nosebleeds are mere nuisances, but some can be frightening and a few are even life threatening. Physicians classify nosebleeds into two different types.

  • Anterior Nosebleed
    The nosebleed that comes from the front part of the nose and begins with a flow of blood out one or the other nostril if the patient is sitting up or standing.
  • Posterior Nosebleed
    The nosebleed that comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting up or standing.

If the patient is lying down, the anterior nosebleeds seem to flow in both directions, especially if the patient is coughing or blowing his nose. Nevertheless, it is important to try to make the distinction since posterior nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in the elderly, people with high blood pressure and in cases of injury to the nose or face.

Nosebleeds in children are almost always of the anterior type. Anterior nosebleeds are common in dry climates or during the winter months when the dry air parches the nasal membranes causing the membranes to crust, crack and bleed. This can be prevented through the use of lubricating cream or ointment applied inside the nose, especially on the middle portion (the septum).

Many physicians suggest any of the following lubricating creams or ointments which can all be purchased without a prescription: A and D Ointment®, Mentholatum®, Vicks Vaporub®, and Vaseline®. Up to three applications a day may be needed, but usually each night at bedtime is enough.

If the nosebleeds persist, you should see your physician, who may recommend cautery to the blood vessel that is causing the trouble.

To Stop an Anterior Nosebleed
If you or your child has an anterior nosebleed, you may be able to care for it yourself using the following steps:
  1. Pinch all the soft parts of the nose together between your thumb and fingers.
  2. Press firmly toward the face, compressing the pinched parts of the nose against the bones of the face
  3. Hold for 5 minutes
  4. Keep head higher than the level of the heart-sit up or lie with head elevated
  5. Apply ice (crushed in a plastic bag or held in a washcloth) to nose and cheeks

To Prevent Re-bleeding After Bleeding Has Stopped
  • Do not pick or blow nose (sniffing is all right).
  • Do not strain or bend down to lift anything heavy.
  • Keep head higher than the level of the heart.

If Re-bleeding Occurs
  1. Clear nose of all blood clots by sniffing in forcefully
  2. Spray nose four times on both sides with decongestant spray, such as Afrin®, Duration® or Neo-Synephrin®
  3. Pinch and press nose into face again, as in first three steps under To Stop an Anterior Nosebleed
  4. Call your physician

When To Call the Physician or Go To A Hospital Emergency Room
  • If bleeding cannot be stopped or keeps reappearing.
  • If bleeding is rapid or if blood loss is large.
  • If you feel weak or faint, presumably from blood loss.
  • If bleeding begins by going down the back of the throat rather than the front to the nose.