Septoplasty is a common surgical procedure performed to correct a deviated nasal septum, the wall of cartilage and bone dividing the nasal cavity into two halves. The nose has a rich blood supply, which helps warm and humidify air before it reaches the lungs. Because of this high vascularity, some degree of bleeding or bloody drainage is normal and expected following the surgery. This post-operative discharge is a predictable part of the initial healing process as the tissues recover from the incisions.
Expected Post-Operative Bleeding
Normal post-operative drainage is a light, watery discharge tinged pink or pale red, not a flow of bright red blood. This drainage is typically heaviest during the first 24 to 48 hours after the procedure. In the immediate hours following surgery, it may be necessary to change the gauze pad placed under the nose several times per hour to manage this mild discharge.
The volume of expected bleeding should be minimal, generally less than a teaspoon per hour, and should taper off significantly by the second or third day. As healing progresses, the drainage may become darker, thicker, or manifest as dried blood and crusting inside and around the nostrils. This crusting is a sign of normal healing and should not be mistaken for a fresh nosebleed. The presence of this mild, resolving blood-stained discharge indicates that healing is progressing normally.
Identifying Excessive Bleeding
While some blood loss is anticipated, a sudden increase in volume or change in the nature of the bleeding signals a problem requiring immediate medical attention. Excessive bleeding is defined as actively dripping or flowing bright red blood, not just a slow ooze. A concerning threshold is soaking through more than one large gauze pad or nasal drip pad every 15 to 20 minutes.
The appearance of large blood clots, especially those bigger than the size of a quarter, also indicates excessive bleeding. Bleeding that persists heavily for longer than one hour, even after attempting home care instructions, constitutes an emergency. Furthermore, any sudden, profuse nasal bleeding accompanied by severe, unmanageable pain, a high fever, or difficulty breathing suggests a complication that necessitates prompt contact with the surgeon or an emergency department visit.
Immediate Steps for Controlling Bleeding
Patients can take immediate steps to manage mild-to-moderate bleeding. The first action is to ensure proper positioning by sitting upright with the head elevated above the heart. Lying down should be avoided, as this can increase blood pressure in the head and worsen the flow.
Applying cold compresses, such as an ice pack, to the bridge of the nose and cheeks helps constrict blood vessels and slow the bleeding. Gentle pressure can also be applied by pinching the soft, fleshy part of the nostrils together for several minutes. If prescribed by the surgeon, a topical decongestant like oxymetazoline may be used, as this medication constricts blood vessels inside the nasal lining.
This should only be done if specifically instructed for heavy bleeding. It is important to avoid blowing the nose forcefully, which can dislodge forming clots, and to sneeze with the mouth open to relieve pressure. If these measures do not reduce the flow of blood within 30 minutes, or if the bleeding remains heavy, seek medical guidance.
Factors That Can Increase Bleeding Risk
Certain activities and substances can increase the risk of a post-septoplasty bleed. Any action that causes straining or increases blood pressure in the head, such as heavy lifting, bending over, or vigorous exercise, should be avoided for at least one to two weeks following surgery. Lowering the head below the heart or engaging in strenuous activities can put undue stress on the surgical site.
Accidental trauma, such as bumping the nose, can easily cause a new bleed by tearing the newly healed tissues. Patients must also avoid certain over-the-counter medications and supplements that thin the blood, including aspirin, ibuprofen, naproxen, fish oil, and certain herbal remedies like ginkgo biloba, as these interfere with the body’s natural clotting ability. Discussions with the surgeon beforehand are necessary to determine when it is safe to resume any blood-thinning medications.