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Dr. Stanley Thawley
I am having frequent nosebleeds that can last for 30-45 minutes, what can I do to control them?
A sudden nosebleed can be quite alarming. It can arise from a small grouping of blood vessels on the front part of the septum, the wall that separates the right and left sides of the nose. This area of the nose is the first to receive the inhaled air, causing dryness to develop and producing crusts that can lead to bleeding.
However, in middle-aged and older adults, a nosebleed may also begin deeper in the nose's interior. The origin of this nosebleed is much less common -- it may be caused by hardened arteries or high blood pressure. This type of nosebleed begins without warning and is often difficult to stop – it requires a specialist's help.
Most nosebleeds are from the front part of the nose, the immediate treatment is to put pressure on that area of the nose. This is accomplished by holding the nose closed with firm pressure using the thumb and index finger. The blood will usually clot in 8-10 minutes, so apply the pressure for that long, keeping your head higher than the level of your heart. Sitting upright will reduce the blood pressure to the veins of the nose. Spraying the interior of the nose with a decongestant spray decreases the size of the blood vessels, helping to control bleeding. Repeating the spray and pressure every 10 minutes should control most nosebleeds. If you are taking anticoagulant medications – including aspirin – this will lengthen the clotting time.
Cold, dry winter air can aggravate the situation. Keep in mind that forceful blowing of the nose should be avoided. Packing of the nose may be necessary to control bleeding if other measures are not successful. Moisturizing gel ointments and saline sprays may be helpful. The common practice of picking at crusts within the nose should be avoided as this traumatizes the delicate lining -- producing more crusts and scars. This habit may even lead to a hole in the septum, further worsening the nosebleeds. There is also the risk of introducing bacteria into the nose that can lead to infections.
Other less common causes of nosebleeds are excessive use of nose sprays, cocaine, nasal surgery, tumors, infections, systemic diseases, blood clotting disorders and trauma.