Post-Surgical Nasal Bleeding: Causes and Management

Q: Post-Surgical Nasal Bleeding: Causes and Management

Hello： Generally, blood clots appear dark red and do not continue to flow. <br>If they are bright red and in large amounts, it may indicate rebleeding. <br>The duration for complete evacuation depends on the extent of the surgery, and you may consult the surgeon for more informat

Nasal sinus residual blood drainage

Hello, due to an oral surgery (this time no nasal surgery was performed), which lasted about 9 hours, the doctor mentioned that postoperative bleeding could flow into the sinus cavities and would gradually be expelled.
Immediately after the surgery, I experienced a slow trickle of nasal bleeding and persistent blood-tinged sputum.
Three days later, I used saline to rinse my nasal cavity, and indeed, I expelled quite a bit.
However, on the morning of the fourth day, I started walking slowly, and perhaps I overexerted myself, as I experienced some nasal bleeding again at noon.
In the afternoon, after going out for a walk, I took a shower and unexpectedly had a significant nosebleed.
I used tissue to stop it, but it continued to flow heavily, and I also experienced some retrograde bleeding.
After about five minutes, I coughed up several mouthfuls of blood clots.
Initially, I thought it was a major hemorrhage, but I did not feel any pain at the surgical site.
I almost went to the emergency room, but fortunately, the bleeding slowed down.
For the next 7 to 8 days, I continued to have blood-tinged sputum, which was minimal but persistent.
I would like to ask how to determine whether it is residual blood or active bleeding? Additionally, how much blood can remain in the sinuses, and how long does it take to clear out? I have also experienced headaches and eye discomfort for several days post-surgery, which have gradually diminished; I wonder if this is related to blood retention in the sinuses.

Wu Bi, 50~59 year old female. Ask Date: 2015/09/25

Dr. Zheng Jueyi reply Otolaryngology

Hello: Generally, blood clots appear dark red and do not continue to flow.
If they are bright red and in large amounts, it may indicate rebleeding.
The duration for complete evacuation depends on the extent of the surgery, and you may consult the surgeon for more information.
Pain is related to the surgery and should be monitored.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/09/25

More Info

Post-surgical nasal bleeding can be a concerning issue, especially after extensive procedures involving the oral cavity and potentially affecting the nasal passages. Your experience of persistent blood-tinged phlegm and nasal bleeding following surgery is not uncommon, but it does warrant careful monitoring and management.

Understanding the Causes of Post-Surgical Nasal Bleeding
1. Surgical Trauma: Any surgical procedure, especially those involving manipulation of the jaw or surrounding structures, can lead to trauma to the nasal mucosa or blood vessels. This can result in bleeding that may initially appear as fresh blood or dark clots, depending on the age of the blood.

2. Residual Blood: After surgery, it is possible for blood to accumulate in the nasal cavities or sinuses. This residual blood can take time to be expelled, leading to intermittent bleeding or blood-tinged mucus as the body works to clear it out.

3. Increased Activity: Engaging in physical activity too soon after surgery can exacerbate bleeding. Increased blood flow and pressure in the head and neck region can lead to the rupture of fragile blood vessels, especially if the nasal mucosa is still healing.

4. Nasal Irrigation: While saline irrigation can help clear out mucus and blood, it can also disturb healing tissues, potentially leading to further bleeding if done too vigorously.

5. Underlying Conditions: Conditions such as hypertension, clotting disorders, or even chronic sinusitis can contribute to prolonged bleeding. If you have a history of such conditions, they may need to be managed concurrently.

Management of Post-Surgical Nasal Bleeding
1. Monitoring Symptoms: It is crucial to differentiate between residual blood and active bleeding. If the blood is dark and mixed with mucus, it is likely residual. Fresh, bright red blood may indicate active bleeding. Keeping a record of the frequency and amount of bleeding can help your healthcare provider assess the situation.

2. Rest and Activity Modification: It is advisable to limit physical activity, especially activities that increase blood pressure in the head, such as bending over or heavy lifting. Resting can help reduce the risk of further bleeding.

3. Gentle Nasal Care: If you are using saline irrigation, ensure that it is done gently. Avoid forceful blowing of the nose, as this can disrupt healing and lead to further bleeding.

4. Hydration and Humidity: Keeping well-hydrated and using a humidifier can help maintain moisture in the nasal passages, which may reduce irritation and promote healing.

5. Follow-Up Care: Regular follow-up with your healthcare provider is essential. If bleeding persists or worsens, or if you experience significant pain, it is important to seek medical attention. Your provider may perform a nasal examination to assess for any sources of bleeding or complications.

6. Possible Interventions: In some cases, if bleeding is persistent and significant, your healthcare provider may consider interventions such as cauterization of bleeding vessels or other surgical options to address the source of the bleeding.

Conclusion
In summary, post-surgical nasal bleeding can be a multifactorial issue, often related to surgical trauma, residual blood, and activity levels. Careful monitoring, gentle nasal care, and appropriate follow-up are key to managing this condition. If you have any concerns about the amount or nature of the bleeding, or if you experience new symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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