What lifestyle modifications or preventive measures should I recommend to patients with a history of frequent nosebleeds?

Patients with a history of frequent nosebleeds should be advised on specific lifestyle modifications and preventive measures to reduce recurrence and promote nasal mucosal health. During an acute nosebleed episode, they should sit with their upper body tilted forward, keep their mouth open, and firmly pinch the soft part of the nose for 10–15 minutes without releasing pressure, breathing through the mouth to control bleeding effectively ¹. For 24 hours after a nosebleed, patients should avoid blowing or picking the nose, heavy lifting, strenuous exercise, lying flat, and consuming alcohol or hot drinks, as these actions can provoke re-bleeding ¹.

To prevent frequent nosebleeds, maintaining nasal mucosal hydration is crucial. Patients should avoid nasal trauma, including nose picking and excessive nose blowing, which can damage the delicate nasal lining ¹. The use of topical antiseptic nasal creams such as chlorhexidine and neomycin (Naseptin®) or mupirocin ointment can reduce crusting and inflammation, acting as a barrier to further trauma and preserving mucosal humidity, thereby decreasing the risk of recurrent bleeding ¹. Patients should be advised to check for allergies before using these preparations ¹.

Environmental factors such as dry air can exacerbate nasal mucosal dryness; therefore, using a humidifier in dry environments may be beneficial (Morgan and Kellerman, 2014). Avoiding irritants such as tobacco smoke and chemical exposures is also recommended to reduce mucosal irritation and fragility (Diamond, 2014). Additionally, managing underlying conditions that may contribute to epistaxis, such as allergic or vasomotor rhinitis, with appropriate nasal corticosteroids or antihistamines can help reduce nasal inflammation and bleeding risk ¹.

Patients with frequent nosebleeds should be evaluated for underlying causes, including coagulopathies or nasal anatomical abnormalities, and referred to ENT specialists if serious causes are suspected ¹. In some cases, nasal cautery may be considered to treat identified bleeding points, but this requires appropriate expertise and facilities ¹.