My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Nosebleeds (Epistaxis)

Overview

Nosebleeds (also known as epistaxis) are common and are generally temporary. Most nosebleeds can be controlled within 10 to 30 minutes and can be cared for at home.

Bleeding can occur on one, or both, sides of the nose. Your blood might flow out of your nose and/or down the back of your throat. Bleeding can last for a few seconds or a few minutes or longer and range from a few drops to a rapid flow.

Nosebleeds usually stop when a blood clot forms. The blood clot is loosely attached to the mucous membranes. An increase in blood pressure can loosen the clot and your nose will start bleeding again.

Contact us immediately or go to the Emergency Department if you have a severe nosebleed. If your nosebleed lasts longer than 30 minutes, or if you see blood rushing or pulsing out of one or both nostrils, you are dealing with something more serious than a common nosebleed. We will want to examine you as soon as possible to determine causes and to intervene, as necessary. Sometimes a severe nosebleed signifies an underlying condition, such as bleeding disorders, high blood pressure, or hardening of the arteries.

Causes

Your nosebleed might be associated with:

  • Infection or respiratory problems, like an allergy, cold, or sinus problems.
  • High blood pressure (hypertension) or traveling to a high altitude.
  • Trauma or injury.
  • Picking your nose.
  • A sign that a blood thinner medication dosage is too high.

Your nosebleed might be caused by dry air:

  • When heaters are turned on in the winter.
  • When air conditioners are used in the summer.
  • After nasal and/or sinus surgery has been performed.

Dry air causes the nasal mucous membranes to become dry and irritated. The cilia (hair cells lining the membrane of the nose) may dry so that nasal secretions are not swept to the back of the nose for swallowing, but stay in the nose and become crusted and scabbed. 

As the nasal mucous membrane dries, it becomes thin and develops cracks, which expose underlying nasal blood vessels, particularly the front of the septum (the wall that divides the nose into two sides). An increase in blood pressure from coughing, sneezing, blowing, straining, or just turning over in bed, can cause a blood vessel wall to rupture and a nosebleed results. 

Risk factors

Certain medications may cause or increase your nosebleeds:

  • Antihistamines or decongestants can dry your nose and increase the risk for nasal crusting and bleeding.
  • Caffeine (coffee, tea, soda drinks) will dry the body including the nasal mucous membranes, increasing the chance of bleeding.
  • Steroid nasal sprays (Flonase, Nasarel, etc.) should be used only under your physician's direction, as these can cause drying of the nasal mucous membranes with subsequent bleeding.
  • Frequent use of over-the-counter nasal sprays (Afrin, Dristan, etc.) can dry and irritate your nasal mucous membranes. Prolonged use can lead to nasal blockage and inflammation that can cause nosebleeds. Use these sprays sparingly: not more than twice a day and not for more than 3 days in a row.
  • Blood thinners, like Aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs) or ibuprofen (Advil, Motrin) might increase the possibility of prolonged bleeding. It might be harder to stop your nosebleed, since blood thinners increase the time it takes for blood to clot.

Home Remedies

How to stop a nosebleed

Most nosebleeds can be treated at home. If you have an active nosebleed, sit down, relax, and breathe through your mouth. Pinch your nostrils closed firmly with your thumb and finger. Do this for at least 5 to 10 minutes. If this doesn't stop the bleeding, lightly blow the blood out of your nose and continue to apply constant pressure for another 10 minutes. If the bleeding continues for 30 minutes, call us right away. If you get dizzy, faint, vomit blood, or if blood is spurting or gushing from your nose, please go directly to the Emergency Department.

How to moisten the air to prevent a nosebleed

If you have had surgery or have a history of nosebleeds, you can reduce nosebleeds by moistening the air you breathe and changing or reducing some of the medication you take. This can help reduce nasal dryness, crusting and scabbing in your nose and can eventually eliminate nasal bleeding. Here are the steps we recommend to moisten the air:

  • Breathe steam through your nose, 2 to 4 times a day, or more. Turn on the hot water in the sink or shower, or use a vaporizer and inhale the moist air.
  • Use normal saline (salt water) drops in your nose 2 to 4 times a day. You can make your own saline rinse by putting ½ teaspoon of salt in a 12 oz. glass of water. You can purchase saline solution without a prescription at our pharmacy or from drug or grocery stores. 
  • Apply ointment to your nose (Vaseline, A & D ointment, or an antibiotic ointment such as Polysporin or Bacitracin) inside each nostril 2 to 4 times a day. 
  • Place a piece of cotton in the nostril that has been bleeding. This prevents air from passing into the nasal cavity and further drying and irritating the bleeding area. Change the cotton when it becomes bloody or dirty. Remove the cotton when your symptoms have improved or resolved. 
  • Drink enough water, juices, or other liquid with no caffeine so your urine is either transparent (like water) or pale yellow. Dark yellow urine signifies your whole body, including your nose, is too dry. 

Treatment

Cauterization

During your visit, your doctor may look into your nose. Occasionally, your doctor may use a scope with a camera to look into the back of your nose.  This is not a painful procedure, and is not done with every visit. 

If your doctor finds prominent blood vessels on your septum, s/he may cauterize these vessels for you in clinic to help prevent further nosebleeds. This is not a painful procedure. It involves touching the vessels or bleeding area in your nose with silver nitrate.  Silver nitrate is a chemical that burns away the small spot. A scab will form there, so it is very important to moisturize the nose (described above) well for at least 2 weeks to prevent re-bleeding.

Occasionally, you may need to come back to cauterize the other side of the nose if prominent vessels are found on both sides of the nose.

Additional References:

Related Health Tools:

Interactive Programs
Podcasts

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.