Epistaxis (Nosebleed): Prevention Tips, Home Remedies, Ayurvedic Treatment

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Most of the preventive measures and home remedies can be used interchangeably in case of management of Nosebleed (epistaxis).

Preventive Measures

First Aid approach in nasal bleeding
The below said measures should be done immediately as a part of first aid measure to prevent further bleeding and also to check the bleeding –

• Sit Straight and Lean forward – Sit straight and lean forward slightly with head tilted forward. If you lean back or tilt the head backwards, blood will run back into the sinuses and throat and cause gagging or inhaling of blood.
• Spit out any blood that may collect in your mouth and throat. If you swallow the blood it may cause nausea, vomiting or diarrhea.
• Pinch – Use your thumb and forefinger to firmly pinch the soft part of your nose shut. This helps in clotting of blood and stops bleeding. Press firmly the pinched parts of the nose against the face bones. Apply pressure for 5-20 minutes depending on the quantity of bleeding. Repeat pinching until the nose has stopped bleeding.
• Sit quietly – Sit quietly. Keep your head higher than the level of heart. Do not lay flat. Do not put your head between your legs.
• Apply Ice – Apply ice wrapped in a sterile towel to nose and cheeks.
• Avoid lifting or straining – after a nosebleed
• Petroleum Jelly (Vaseline) – helps to keep the nasal passages moist
• Antibiotic ointment or saline (saltwater) nasal drops or spray – helps keep the nasal passages moist
  Read related: Epistaxis (Nose Bleeding): Causes, Treatment, Modern Concept
  

Other Preventive Measures
Have a humidifier – If you are prone to have nosebleeds, have a humidifier in your home, especially during winter, in cold and dry climates. Humidify your homes, especially the bedrooms, when the air is dry. Keep the heat low in the sleeping areas.

Don’t pick or blow – Avoid picking or blowing your nose vigorously, do not put your fingers often in your nose to remove crusts. Also do not rub your nose often.

Treat the underlying condition – If the nosebleed is related to an underlying condition (e.g. liver disease, chronic sinus condition etc), seek the help of medical practitioner or doctor and promptly address the causative conditions causing epistaxis

Head elevation – Elevate your head by using one or two pillows beneath your head while sleeping
Sit straight – Sit straight and tip your head slightly forwards, this helps to check bleeding
Ice pack – Apply ice pack to your nose and cheeks
Naso-Gel – Apply a thin layer of saline or water based nasal gel, such as Naso-Gel to the inside of your nose

Read and follow instructions on the label of your medicines and Be careful with the below said medicines –

• Limit use of aspirin and NSAIDs
• Use prescription blood thinners such as warfarin, enoxaparin and clopidogrel as instructed by your doctor
• Do not use – antihistamines, decongestants or medicated nasal sprays (overuse of cold and allergy medications) if not prescribed. Their overuse may dry your nasal mucosa and cause nosebleeds.

No drugs – Do not use illegal drugs like cocaine or amphetamines
No smoking – Keep away smoking as it slows down the healing

Control your high BP – Keep your blood pressure under control if you have a history of high BP. This will help decreasing the risk of getting nosebleeds.
Don’t strain – Do not strain during bowel movements. Use stool softener. Do not strain or bend down to lift anything heavy.

Eat cold, No hot – Eat cold and soft foods and beverages. Avoid taking hot liquids for at least 24 hours after bleeding.
Keep Hydrated – Drink plenty of water and keep self hydrated

Absorbent gauze – Absorbent cotton or gauze should be kept in the nose so as to coat the interior of nostrils with a gel or petroleum jelly and keep the nose moist

Sneeze with open mouth – To keep the undue pressure from building in the blood vessels supplying the nose, children and adults should be taught to sneeze with their mouths open (these 2 age groups are more prone to suffer from nosebleeds)

Trim fingernails – Those who have a habit (and all others too) of digging their nose, should cut and trim their fingernails
Avoid Air-conditioning – Air-conditioning can remove humidity from the air and dry it out completely leaving you more susceptible to nosebleeds. Therefore it is best to avoid AC as far as possible.

Avoid caffeinated beverages – Coffee or caffeinated beverages like soda and energy drinks extracts moisture from the mucous membranes present in nasal passages, which makes the nasal passages dry, irritated and inflamed, thus making the blood vessels more prone to injury. Thus they are responsible for nosebleeds.
Read related: Nose Bleed: Ayurvedic Understanding, Treatment

Home Remedies

As already mentioned, many preventive measures can by themselves be considered as home remedies.
Nose pinch and Cold compress as immediate measures – Follow the first aid approach mentioned above (in prevention of nosebleed), i.e. among which pinching the nose and cold compress, maintaining position of head so as to check bleeding are important

Apple Cider Vinegar – protects the body from excessive blood loss. It also helps to seal up the broken blood vessel walls. Soak a small cotton ball in apple cider vinegar. Place it lightly into the nostril. Leave it in place for at least 10 minutes. Bleeding will stop. Alternatively distilled white vinegar can be used. This remedy can also be used to prevent frequent nosebleeds. Mix 2 teaspoons of raw, unfiltered apple cider vinegar in a glass of warm water and drink it thrice daily.

Cayenne – regulates the pressure of blood flow. It removes the heavy pressure from the bleeding area. It also allows and aids quick coagulation. Add 1 teaspoon of cayenne powder to a cup of warm water and drink it. Cayenne capsules can be taken 2-3 times per day in case of severe nosebleeds. Eat foods added with cayenne pepper on regular basis.

Onion – is a good clotting agent. The fumes of onion help in blood clotting. Cut 1 onion into thick slices. Press 1 slice under your nose and inhale the fumes. Alternatively put 2-3 drops of fresh onion juice into each nostril.

Saline Water – Add a pinch of salt to half cup water. Stir well. Put few drops of this solution into your nose. This moistens the inner lining of the nasal passages. Alternatively few drops of saline nasal spray can be used. This is effective in winter, in cold and dry climate when the mucosa tends to get dry.

Nettle – promotes clotting and checks bleeding owing to its astringent properties. It strengthens the capillaries and is good for allergies. Inhale dry and powdered nettle leaves to check bleeding. Juice extracted from few nettle leaves can be instilled (few drops) in each nostrils. Alternatively drink 1-2 cups of nettle tea daily.

Coriander – prevents bleeding due to its cooling and soothing nature. It is a natural antihistamine. It helps to keep away many allergies and also cures them. This prevents nosebleeds. Put few drops of coriander oil or fresh coriander juice into the inner nose lining. Paste of coriander leaves may alternatively be applied over your forehead.

Holy Basil (Tulsi) – Basil leaves soothe the nerves and help in checking nosebleed. Few leaves of basil may be chewed. 2 drops of juice of basil leaves may be put in each nostril to stop bleeding.

Petroleum Jelly – A small amount of petroleum jelly may be put on the tip of your finger and applied to the inside of your nose. This shall be done several times a day. The jelly will keep the nose moist and prevent nosebleeds. This is very useful during dry months.

Baking Soda – It is good for nasal irrigation and can stem the flow of blood from the nose. Make a solution with water and baking soda and spray 2-3 puffs of it on the nose.

Vitamin rich foods and bio-flavonoids – Eat plenty of foods rich in vitamin K, vitamin C and bio-flavonoids. Dark green leafy vegetables are highly rich in vitamin K, which is essential in blood clotting. Bioflavonoid supplements include grape-seed extract, pine-bark extract, pycnogenol or proanthocyanins etc

Include iron and zinc in food – Increase intake of iron in your diet (helps to increase hemoglobin) and zinc based foods like brown rice, whole wheat bread and air-popped popcorn to maintain the blood vessels and their health

Avoid spices and fried foods – People suffering from or susceptible to get nosebleeds should avoid taking spicy and fried food items

Ice – stops bleeding, constrict blood vessels and reduce inflammation, and are easily available. Place crushed ice into a plastic zipper bag and cover it with sterile towel or cloth. Alternatively a bag of frozen vegetables also can be taken. Place the compress on the bridge of the nose and hold until bleeding stops and few minutes after the stoppage of bleeding.

Oranges and Orange Juice – Eat plenty of oranges and drink lot of orange juice. They contain vitamin C which helps in stopping the breakage of blood vessels, forms collagen which helps to create a moist lining in your nose. Similarly any vitamin C rich foods and drinks can be taken.

Drink adequate Water – Drink 8-10 glasses of water per day. You can drink more than that in dry season and in dry places.

Salt – Mix ¼ to ½ teaspoon of salt with similar quantity of baking soda into the 1 to 1 ½ cups of lukewarm water. Test the temperature. Suck the contents using a bulb (ear) syringe and squirt the saline solution into one nostril while holding the other nostril closed. Lower your head over the sink and gently blow out the water. Repeat this alternating the nostrils until the water is gone. This irrigation gets rid of nasal passages of its mucus, dust and gunk, also soothes and keeps moist the irritated nasal membranes.

Take steam – Breathe steam from a mini steam bath or sauna. Boil half pot of water and put it on sturdy surface. Place a towel over your head. Lean forward and gently breathe the steam. Try a mini steam bath twice daily.

Vitamin E – Apply vitamin E and keep your nasal mucosa moisturized several times a day. Break one capsule of Vitamin E and coat your finger or a sterile cotton swab with the contents. Gently wipe it just into your nostrils. A before-bed application will help.

Goldenseal – It is good for nosebleeds owing to its potent astringent and antimicrobial properties. It also prevents recurrence. It is an effective antiseptic and keeps away nasal infections. The cooling and soothing properties help in relaxing and sealing the broken blood vessels. Heat water in a pot and add a teaspoon of goldenseal into it. Steep it for few minutes. Sniff the fumes. Repeat the same several times a day.

Lemon Juice – It helps reducing flaking and infections. The high acid content of the juice stops nose bleeding whereas the vitamin C content of the juice strengthens the delicate blood capillaries present inside the nose. Use a clean dropper to trickle few drops of fresh lemon juice inside both nostrils while keeping your head tilted back.

Essential Oils – Add 2-3 drops of lavender oil or cypress essential oil to a cup of water. Dip the paper towel in this mixture. Wring out the excess water and place it on the nose. Press gently for a couple of minutes. Alternatively you can directly apply a drop or two on the outer side of the bleeding nostril.

Witch Hazel – Soak a piece of cotton in the witch hazel extract and place it in the nostril. Remove the cotton after couple of minutes.

Take healthy diet –

• Take healthy and balanced diet.
• The food should contain and should be rich in iron, vitamin C, vitamin K and zinc. Examples of such foods rich in these nutrients are red meat, egg yolk, spinach, oranges, avocados, brown rice, guava, chicken, raisins, coriander, lemons, Brussels sprouts, Whole wheat bread, canola oil etc
• Iron rich foods – Red meat, spinach, liver, prunes, raisins, oysters, turkey, chickpeas, beans, pulses, soybean, chicken giblets, scallops, clams, collards, artichokes, egg yolks, etc
• Vitamin C rich foods – oranges, lemons, cauliflower, strawberries, Chinese gooseberries or kiwis, guavas, red peppers, green peppers, mustard greens, broccoli, papayas, kale garden cress, tangerines, Brussels sprouts, parsley, thyme etc
• Vitamin K rich foods – soybean or canola oil, green onions, Brussels sprouts, broccoli, beef or pork liver, cabbage, spinach, collard greens, kale, lettuce turnip greens, parsley, endives, mayonnaise, avocadoes, etc
• Zinc rich foods – brown rice, whole wheat bread, popcorn, etc
• Potassium rich foods – bananas, avocados, tomatoes
• Balanced diet – of complex carbohydrates such as buckwheat, wholesome proteins such as soy products, green leafy vegetables such as spinach and kale and other foods such as celery, bamboo shoots, seaweed, bananas, honey, mung beans, sunflower seeds, lotus root, cassia seeds etc

Yoga for Nosebleed
An ancient Yoga practice called Jala Neti or Sutra Neti (nasal cleansing) is considered good for nosebleed or epistaxis.

Jala Neti – is an ancient Yoga technique to clear the nasal passages as well cures infections. It is a simple technique to clear nasal passages with the help of Neti Pot which is filled with warm saline water. It treats nasal mucus blocks, bleeds and infections.

Method of doing Jala Neti –

• Take a Neti pot. Fill it with warm salted water with 1 teaspoon salt for half liter water ratio. Keep your head over a bowl or sink.
• Place the cone of neti pot into your right nostril. Pour the water slowly through the nostril by slightly tilting your head. Allow the water to come out from the left nostril until the water comes to half.
• During the procedure take slow breaths through mouth. After half of saline water is used up (from the pot), remove the pot from the right nostril. Keep your head straight. Now blow out the air slowly through the nostrils. This expels the excess water out of the nostrils.
• Repeat the same procedure with the left nostril. Use the remaining half of saline water.
• After the procedure with both nostrils has been completed, dry the nose. Bend forward and keep your nose facing the floor. Exhale excess water from the nostrils with mild blows for about 15-20 times. Inhale with your mouth closing the right nostril. Exhale with left nostril. Repeat the same with the other nostril too.
• Repeat this process around 10-12 breaths to both nostrils. Come to the normal relaxing position.

Dugdha Neti – This is same as Jala Neti but in this procedure diluted milk is used instead of saline water. It also cures chronic nosebleeds.

Sutra Neti – is also an effective method in clearing the nasal passages and cleansing the excess mucus blocks as well as treating nasal bleeds. This treatment should be done under supervision of an expert Yoga tutor. It involves passing of a tube or cloth through the nostrils.

Method of doing Sutra Neti –

• Take a cotton thread or rubber catheter. Sterilize and clean it with warm water. Pull the cord from one nostril gently till the other end comes out of the mouth. The cord or thread should be gently handled through the nostrils.
• When the cord or cloth comes out into the throat opening, smoothly pull the same with the help of index and middle fingers.
• Grab the cord and gently pull it towards the mouth and slowly move in and out so that the nasal cavity is completely cleared without any infections or mucus blocks.
• Now remove the cord or cloth from the nostril. Repeat the same with the other nostril. If any irritation or pain occurs, stop the procedure immediately.

Pranayama (Deep Breathing) – This is essentially a breathing exercise which moves the breath in unique ways allowing for different effects on the nervous system. At night, practicing calm breathing, even breathing in a 1:1 ratio and then eventually building up to 1:2 allowing the exhale to lengthen more than the inhale. You can also try inhaling while blocking one nostril and alternating nostrils with each breathe, which can help calm the nervous system.

Caution
If preventive measures and home remedies to stop the bleeding do not work and if bleeding continues for more than 20 minutes, or if the nosebleed resulted from an injury to the face, see a doctor. Something else may be wrong. Do call on a doctor if nosebleed recur 4 or more times in 1 week after you have tried prevention measures or if nose bleed becomes more severe or more frequent.

Ayurvedic Treatment

Nosebleed or Epistaxis is compared to a condition called as Nasagata Raktapitta which means flow (bleeding) of contaminated blood (blood contaminated with vitiated pitta) through nostrils. Nasagata Raktapitta is a type of Urdhwaga Raktapitta, i.e. Raktapitta having upward course.
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