My Doctor Online The Permanente Medical Group

Causes

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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

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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

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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.

Your Care with Me

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If you cannot control severe bleeding by applying pressure to your nose, call 911 or go to the nearest Emergency Department.

Most nosebleeds can be managed at home by following the steps described in Home Remedies. If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history. I will discuss your history of nosebleeds with you and give you pointers on how to apply pressure to your nose to stop them. I may perform an exam, using a flexible scope with a lens to look into the back of your nose. This is not a painful procedure and is not done with every visit. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you have prominent blood vessels on your septum (the tissue that divides the two nostrils), I may cauterize these vessels for you to help prevent further nosebleeds. If you have active bleeding, I may need to insert packing into the nose to stop the bleeding.

Sometimes blood tests will also be ordered if you have unusual bleeding episodes.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the Radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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