Minor bleeds are a common occurrence in everyday life for all age groups. Bleeding occurs when a blood vessel has been broken. It can also be a common side effect for patients who are on medications that thin the blood, also known as anticoagulants. Minor bleeds usually resolve quickly on their own and with minimal treatment. Below is a list of causes, treatment, and prevention for common bleeds.
Nosebleeds
The nose contains many small blood vessels. When one of these blood vessels rupture, it causes the nose to bleed. The bleeding normally resolves within 5-10 minutes after applying pressure, but for those on blood thinners, the bleeding may last up to 15 minutes.
Common causes:
- Cold or dry air
- Excessive nose blowing
- Injury or impact to the nose
- High blood pressure
Treatment:
- Grab a napkin or tissue paper and cover your nose to catch the blood.
- Pinch your nose right below the bridge of the nose and lean forward slightly to prevent blood from going down your throat.
- Keep the nose pinched for 5-10 minutes. If the bleeding does not stop, resume pinching your nose for another 5 minutes.
- If the bleeding still has not stopped after 15 minutes, you can use 2 puffs of an Afrin nasal spray (generic name: oxymetazoline) in the affected nostril(s) and resume pinching your nose. At this time, you can also place an ice pack to the bridge of your nose or the back of your neck to help constrict the blood vessels.
- If the nosebleed has not stopped after 30 minutes, seek urgent care.
Prevention:
- You can prevent nosebleeds from occurring by being careful not to fall or have an object hit your nose.
- When the air is dry and cold, such as during the winter, you can use a saline nasal spray such as Deep Sea nasal sprays up to 4 times a day as needed. Alternatively, you can apply a thin layer of petroleum jelly such as Vaseline inside the nostrils. Do not apply petroleum jelly too deep inside the nostril and limit use to 1-2 days in a row to prevent the jelly from traveling down to the throat.
- Avoid taking extremely hot showers as this can dry out the nose.
- Use a humidifier in your bedroom at night to keep the air moist.
- Talk to your doctor if you have high blood pressure that is not well controlled.
Bruising
Not commonly thought of as a bleed, a bruise can indicate a blood vessel has been damaged and normally occurs after an injury to the area. Bruises may take a few days to a couple of weeks to heal. If you are on a blood thinner, you are more likely to develop bruises. One way to know if a bruise is healing is by the color – bruises are initially red, then after 1-2 days it starts to turn bluish or purple. After 5-10 days, the bruise should turn greenish or yellow and start to fade. If the bruise starts to grow, moves around your body, or does not change colors, then seek urgent care or an emergency department.
Common causes:
- Injury or impact to a part of your body
- Low blood platelet count
- Aging skin
- Blood thinning medications
Treatment:
- Most bruises do not need any treatment and will naturally heal by themselves.
- For large bruises, rest and raise the injured limb above heart level to reduce any swelling for 1-2 days. You can use pillows or cushions to elevate the limb.
- Apply an ice pack wrapped in a thin towel for 1-2 days immediately after the injury. Apply for 15 minutes at a time, and 3-4 times throughout the day. This is to reduce swelling and promote clotting of the ruptured blood vessel.
- Do not press on or apply pressure to the bruised area.
- If you notice very painful swelling around the bruised area, or the bruise is not getting better after a couple of days, then seek urgent care.
Prevention:
- Remove any tripping hazards from the floor. Falls, especially in older adults, can lead to serious bleeds, broken bones, or head injuries. The Center for Disease Control and Prevention (CDC) recommends older adults have their fall risk evaluated by a doctor or healthcare provider. For more information, see Reference 6.
- Make sure to turn on the lights or use a flashlight in dark areas to prevent falling or bumping into objects. Also have your eyes checked regularly by an optometrist.
- Add corner guards to tables edges.
- Do strength and balance exercises such as tai chi to improve balance.
Gum Bleeds
Gum bleeds can be due to multiple problems. Gum bleeds can occur whenever there is a change to your dental routine such as using a new toothbrush. These are usually not concerning and will resolve on their own. However, some concerning gum bleeds may be caused by gum diseases. Make sure to follow-up with a dentist regularly to ensure adequate hygiene and to prevent any infections.
Common causes:
- Brushing your teeth too hard or using a hard-bristled toothbrush
- Poor oral hygiene
- Smoking
- Gum diseases such as gingivitis
- Vitamin C deficiency or scurvy
- Hormonal changes
- Diabetes
Treatment:
- Gum bleeds that occur during routine brushing usually do not require treatment. Rinse your mouth well with water.
- If the bleeding does not stop within 10 minutes, apply pressure to the gum with a cotton swab or ice-cold gauze.
- If your gums are inflamed or your gums feel sensitive, swish and spit with salt water or hydrogen peroxide mixed with water (using equal parts) for at least 30 seconds to decrease inflammation. Then, seek follow-up with a dentist for further assessment.
Prevention:
- See a dentist every 6 months for oral care.
- Brush your teeth with a soft-bristled toothbrush.
- Floss regularly to promote healthy gums. Your gums may be sensitive to flossing at first and therefore bleed, but after a few days of regular flossing your gums should stop bleeding.
- Avoid smoking.
- Take vitamin C supplements if you have been diagnosed with a vitamin C deficiency such as scurvy.
Serious Signs of Bleeding
If you experience any of the following, seek medical attention immediately at an urgent care or emergency department as these could indicate serious internal bleeding or other illnesses that need to be addressed:
- A serious fall or substantial head injury. This could lead to serious bleeding.
- A sharp headache that is out of ordinary and described as “the worst headache you’ve ever felt.” This is a sign of a brain bleed.
- Blood in the urine – this may more likely be associated with a urinary infection but needs to be treated.
- Blood in the stool – black tarry stools are more concerning for internal bleeding; bright red stools may more likely be associated with straining while trying to pass stools, constipation, rectal bleeds, or hemorrhoids.
- Vomiting or coughing up bright red blood or dark clumpy blood that look like coffee grounds.
- Any heavy bleeding that does not stop after 30 minutes.
Resources:
- https://my.clevelandclinic.org/health/diseases/15235-bruises
- https://medlineplus.gov/ency/article/003062.htm
- https://my.clevelandclinic.org/health/diseases/13464-nosebleed-epistaxis
- https://sites.uw.edu/anticoag/education/patient-education/
- https://www.medicalnewstoday.com/articles/322742
- https://www.cdc.gov/falls/facts.html
Prepared by Emily Vo PharmD Candidate 2024
