Search for tag: "bleeding"

Interviewer: How to handle a bloody nose that doesn't seem to want to stop bleeding. Emergency room Dr. Troy Madsen, what should a person do?

Dr. Madsen: Bloody noses are a very common thing that we see in the emergency department and these can be very messy and, sometimes, really tough to stop. But the thing I tell people, the key is if you're at home, hold pressure on your nose. Don't hold it on the bony part of your nose. Hold it on the soft part of your nose on the outside and hold pressure for 15 minutes. You'll be really tempted after two or three minutes to let up and look, but just keep holding pressure.

If you look after 15 minutes and it's still bleeding, hold pressure for another 15 minutes. Look again, if it's still bleeding, another 15 minutes. So three times total. If it's still bleeding at that point, you may need to come to the emergency department, but 95% of the time, this is going to work. Most times, it's going to keep you out of the ER.

updated: February 22, 2021
originally published: January 25, 2019

Dr. Jones: Horrible periods are the burden of being a woman, right? But sometimes, really heavy periods are a sign of something serious, and you should get help. This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Well, as part of blood cancer awareness, we are looking at what could be signs of cancer that should seek medical attention and evaluation. Although heavy periods are common and there are many causes, some heavy periods can be a sign of blood cancer.

Recently, a study of 2,000 pre-menopausal women with leukemia revealed that 1 in 10 had heavy vaginal bleeding. For most of those women, they had heavy vaginal bleeding, heavy periods, for the months leading up to their diagnosis of leukemia. But other symptoms, such as fatigue or easy bruising or a fever, brought them to the doctor. But for about 1% of them, this was bleeding. It was this bleeding that brought them to the diagnosis of leukemia.

Although leukemia is a cancer of white blood cells, when the white blood cells multiply abnormally, they take over the bone marrow and displace the cells that make red blood cells. And more importantly, in this case they can replace the cells that make platelets. Platelets are these magic little pieces in our blood that help us make a clot.

Now, complicating this problem of low platelets in some blood cancers is that chemotherapy for leukemia often wipes out blood cells, good blood cells and bad blood cells, so that chemotherapy itself leads to the low platelets and heavy vaginal bleeding. Usually, though, the medical team knows about this risk in advance and gives women medications to stop their periods before chemotherapy.

Low platelets, or platelets that don't work is, is a common cause of heavy vaginal bleeding. It's one of the most common causes for vaginal bleeding that requires transfusion in teenagers.

Although leukemia can be a cause of low platelets, there are other blood problems that can cause low platelets, such as antibodies to platelets, called autoimmune thrombocytopenia, a big word, but when you break the word down, the autoimmune means that you're making immunities or antibodies to yourself, and thrombocytes are the cells that make thrombi, or clots, those platelets. And penia means you don't have enough of them. So, autoimmune thrombocytopenia. A blood test that shows low platelets will lead to more tests that can find out the cause and help with treatment.

So what is heavy menstrual bleeding? Women put up with a lot, and are often embarrassed to seek help, and figure that heavy periods are just a woman problem. Soaking more than two extra heavy pads or tampons each hour for several hours is too heavy. Passing clots bigger than a quarter for part of your period is too heavy. And but, of course, if you can't clot because you don't have enough platelets or clotting factors, then you won't clot, and that wouldn't be a sign. But anyway, heavy bleeding that's soaking through your protection for hours at a time is too heavy.

Of course, enough bleeding that you're now dizzy when you stand up means that you need to get help today. There are many causes of heavy menstrual bleeding, and some of them are part of a serious underlying medical problem. If you or your daughter or granddaughter or a friend have really heavy menstrual bleeding, you should get an evaluation. If that problem is in a young girl, she may be afraid to bring it up because of embarrassment or because she doesn't want a pelvic exam. In fact, for young women, the evaluation is usually by blood tests, and if a look at the uterus is necessary, ultrasound can be used.

For older women, the problem-causing heavy bleeding is more likely to be a uterine problem, such as uterine tumors, but everyone with really heavy periods gets an evaluation of their blood and their platelets and their clotting factors. Sometimes heavy vaginal bleeding can be a sign of liver or kidney disease, and other blood tests can be helpful.

Be aware that very heavy periods can be a sign of more than just a female problem and get help. Getting the right diagnosis can help with the treatment and make your periods better. And it may save your life. Thanks for joining us on The Scope.

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Interviewer: How do you know if a cut that you got requires stitches? Emergency room doctor Troy Madsen, how do you decide?

Dr. Madsen: The big thing I do to determine if something needs stitches is: Is this wound gaping or not? And by "gaping," I mean is it open? So you can touch the wound, you pull on, it pulls open, or it's on a part on the body where it's just going to keep popping open, say on a joint or on your arm. Those are things that needs stitches, because otherwise they're just not going to heal up well.

The other thing I always worry about is it on an area where there are cosmetic concerns? Is it on the face? And that's an area where I would be more likely to place stitches. Otherwise, if the wound is staying together okay, you can put a bandage on it, you can probably avoid a trip to the ER.

Interviewer: And would they be able to do stitches in an urgent care?

Dr. Madsen: Well, you know, if it's not actively bleeding, if you've controlled the bleeding you can go to an urgent care. They can get the stitches in, probably get you on your way more quickly.

updated: April 27, 2021
originally published: May 28, 2019

Interviewer: This is one of those Scope podcasts we hope you never have to use, but it's good information to have in case you find yourself in this situation. How do you stop severe bleeding? We'll talk about that next on the Scope.

Announcer: This is From the Frontlines, with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University Utah Healthcare. It's something you'll never have to do, but it could potentially save somebody's life, and buy medical experts the time they need if you have somebody who's bleeding severely, if you're able to slow that down. I'm in a situation where somebody is severely bleeding, what do I do?

Dr. Madsen: Well the number one thing to remember with severe bleeding is hold pressure. No matter what kind of bleeding it is. If it's oozing out, if it's spurting out, hold pressure on it, and just keep holding pressure. The biggest mistake I see with people is, let's say someone has, let's say a laceration on their arm from a knife or something they were working with.

People will want to keep looking at it. They'll say, "Wow, has it stopped?" They'll hold some pressure on there, or they'll put a bandage on it, and then they'll pull it off, 30 seconds to a minute later, they say, "Oh no, it's still bleeding." So they'll put it back on, and they'll say, "Oh no, it's still bleeding." They just keep looking at it.

The key is hold pressure on it, and just keep holding pressure. Don't keep pulling the bandage off to look at it. My recommendation is, if you're going to look at it, wait 15 minutes. Hold pressure on there, hold nice firm pressure. Make sure the pressure is firm, but also make sure it's also not cutting off circulation to their hand or their foot, or whatever might be below that laceration or that bleeding.

You want to make sure they can still move their fingers. Make sure their fingers still look pink. If you push on their fingernails it doesn't just turn white, and stay white, it turns pink again within about two or three seconds. So bottom line is, whatever it is, just hold pressure, and keep holding pressure.

Interviewer: All right, and then call somebody immediately.

Dr. Madsen: Yes. Call somebody immediately. Get in for medical attention, especially if we're talking about an arterial bleed. So the arteries are the vessels in the body that take the blood from the heart, so there you're seeing that pulsatile type bleeding where it's shooting out. That's definitely a more serious thing, and a person could lose blood very, very quickly with that. So that's something you want to call 911, get to a hospital quickly, so that can be addressed.

Interviewer: All right. But still, same thing, get like a cloth, a clean cloth, whatever, and hold pressure.

Dr. Madsen: Yes, exactly. One mistake sometimes you'll see too, maybe in a first aide class or scouts, Boy Scouts or something you learned about tourniquets. So you think to yourself, "Okay, this is an arterial bleed. I'm seeing this pulsatile bleeding shooting out, I'd better throw a tourniquet on this." The only time to use a tourniquet is when you expect that this person is going to lose whatever is below that tourniquet, whether it's their leg, it's their arm.

The only case I'd use a tourniquet, and the case I've used it, and I've seen it used would be someone who's been in say, some sort of motorcycle accident, something like that, and they've lost their lower leg. Basically, you're just trying to save their life. Their leg is pretty much lost, it's mangled, or it's pretty much gone. So you're just trying to control the bleeding into that area, and just assuming that everything below that tourniquet is gone.

Interviewer: Okay.

Dr. Madsen: So if you're going to put a tourniquet on, I would not recommend doing it. But the only scenario where you would do that would be where you just assume you're going to lose everything below that.

Interviewer: If I'm putting pressure on something like that, is their blood going to be getting out and around it? I mean, am I'm completely stopping the blood from escaping in most cases or not?

Dr. Madsen: With just putting pressure, or with a tourniquet?

Interviewer: Yeah. With putting pressure, what's that look like?

Dr. Madsen: So when you're putting pressure on something, you're just holding pressure directly over the wound, and you should have enough other arteries and veins, and everything running through there, you're still going to have blood flow to whatever is beyond that.

Interviewer: So it will bypass, it won't just continue to push past the pressure?

Dr. Madsen: Yeah. Exactly. Yeah, it's not like you just have one artery running down there that's then going to be blocked off, and everything's going to pool above it, or try to push back because so much pressure will build up where you're holding pressure.

Interviewer: It just reroutes.

Dr. Madsen: It will reroute, exactly. It's like a traffic jam where then everything goes on separate streets. Kind of same idea, but again, the key is just hold pressure, and avoid using some kind of tourniquet, or avoid tying something around the arm or leg that's going to cut off all the circulation down below there.

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Dr. Miller: Rectal bleeding. Could that be a hemorrhoid or what is that? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller for Scope Radio, and I'm here with Dr. Molly Gross. She's an Assistant Professor in the Department of Surgery, and she's also a colorectal specialist.

Tell me a little bit about rectal bleeding. If someone comes in and says, "Look, I had some blood that I saw on my stool or in the toilet bowl." Is that usually due to a hemorrhoid, or what should they think?

Dr. Gross: Everyone has hemorrhoids, and often it could be due to hemorrhoidal disease, bleeding from internal hemorrhoids. However, there are other things that can cause bleeding such as a fissure which is a skin tear in the skin by the anus.

Dr. Miller: Is that painful?

Dr. Gross: Yeah. That kind of bleeding usually is associated with pain with the bowel movement. People describe pooping a knife out sideways.

Dr. Miller: Now sometimes hemorrhoids can be painful and sometimes not. What's the difference there? Is there a problem with recognizing what's painful and what isn't in terms of hemorrhoids?

Dr. Gross: Internal hemorrhoids which are up inside usually aren't painful, and they just bleed. External hemorrhoids which is on the outside of the anus, those hurt when they have problems and when the blood vessels inside clot off or thrombose.

Dr. Miller: Is there a simple way to take care of those hemorrhoids, or does one always need to see a surgeon about that?

Dr. Gross: Rectal bleeding can also be concerning because it could represent cancer or a polyp which should be seen by a professional. Hemorrhoids, if you know that you don't have a cancer, and you just have hemorrhoids, the patient can first start to do some things at home to help with those.

Dr. Miller: And what might those things be?

Dr. Gross: The important thing is to have good formed bowel movements. I say have a bowel movement looking like a greased banana. So how do you get that greased banana? Fiber, fiber and fiber.

Dr. Miller: And so what is the best source of fiber? Should people purchase fiber at the store like Metamucil, or do they just up their diet in terms of vegetables and fruits?

Dr. Gross: It's really hard for the average person to eat enough fiber in the day. You'd be having to eat lettuce all day long to get 30 grams of fiber. So I recommend starting Metamucil, Citrucel, or the generic, Fibercon, Konsyl, any of these options. Start with one tablespoon once a day.

Dr. Miller: And then move up to maybe twice or three times a day depending on how it goes?

Dr. Gross: Correct.

Dr. Miller: Okay.

Dr. Gross: Also, the other thing is to not strain on the toilet. Don't bring your phone.

Dr. Miller: Don't sit and read the newspaper, if people are still reading newspapers.

Dr. Gross: Or your phone.

Dr. Miller: Or your iPad.

Dr. Gross: Yeah.

Dr. Miller: And then the other thing about that is what about over-the-counter remedies, Preparation H? Do those things actually work?

Dr. Gross: They can't hurt, but really what needs to happen is to have a better bowel movement and not strain. As long as you're having those troubles, you will continue to have some bleeding. But I also want to stress the importance of being seen by a health care professional to rule out other causes of bleeding like rectal cancer.

Dr. Miller: And so how would one determine if they had those more rare and serious causes of bleeding?

Dr. Gross: A colonoscopy is the best way to rule out other causes of bleeding.

Dr. Miller: So one must not necessarily assume that it's just due to a hemorrhoid. They actually need to see a physician or a health care provide that could actually send you to have a colonoscopy or a sigmoidoscopy to sort out the cause of the bleeding. Now, does everyone that has rectal bleeding need a colonoscopy to rule out the serious nature of bleeding?

Dr. Gross: Not everyone. However, if the bleeding continues despite treatment of the hemorrhoids, or the patient has a family history of colon and rectal cancer, or if they're above 50, they definitely need a colonoscopy.

Dr. Miller: What else would you say for patients that have painful hemorrhoids? Should they use a donut that you can purchase at the pharmacy? Does that work? Does that make any sense?

Dr. Gross: No, donuts really don't work. People who have painful hemorrhoids, like external thrombosed hemorrhoids, if they have a blood clot in them sometimes they get better just from lancing it in the first 24 to 72 hours after the clot has formed. Otherwise, we often recommend sitz baths, so that's filling your bathtub with a little bit of warm water and sitting in it.

Dr. Miller: That sounds like a home remedy. Does that really work?

Dr. Gross: It does work.

Dr. Miller: And if they do that what, once, twice, three times a day?

Dr. Gross: Once or twice a day and after bowel movements.

Dr. Miller: Now, there's something that I understand is called laparoscopic banding. Do you do that?

Dr. Gross: Rubber band ligation is a management, an office procedure to treat internal hemorrhoids that are bleeding. That is simple and easy to do in the office at the time of our initial consultation if we see large hemorrhoids that are causing some problems. Those are for internal hemorrhoids only.

Dr. Miller: Now, if I remember what you said, internal hemorrhoids are not necessarily painful, so banding them would not be painful either.

Dr. Gross: Correct. Banding shouldn't be painful. If it is painful, that can be concerning. Usually patients say it feels like they're sitting on a cue ball for a couple days. There's some pressure but no pain.

Dr. Miller: So the bottom line is if you have rectal bleeding it could be due to a hemorrhoid, but you have to assume that there are other things and perhaps some rare things that are very serious, and you need to have that checked out by a health professional, and certainly bleeding that's persistent needs to be looked at.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 7, 2019
originally published: January 6, 2016

Interviewer: So your periods are too much, too little, they're just weird. They're not normal or at least you think they're not normal. We'll find out if they really are or not next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones, she's the expert in all things woman. Dr. Jones, women everywhere have this question. "Is my period normal? Because I think I might be having too much bleeding down there, too little bleeding down there? How do you compare it to something?"

Dr. Jones: Right. And I'm sure you sit around with your girlfriends and talk about exactly what color it is, what it looks like, how many pads you've used.

Interviewer: Of course.

Dr. Jones: Well, anyway, so here's the scoop. At the beginning of reproductive life, meaning somewhere between the ages of 10 and 14 when you're starting, everything is normal because everything is weird. So they can skip a bunch, they can be one day of spotting, they can be 14 days of bleeding. It's totally unpredictable and when you get dizzy it's time for your mom to take you to the doctor.

Interviewer: So at that point, weird is normal.

Dr. Jones: Weird is normal.

Interviewer: Perfect.

Dr. Jones: At the end of reproductive life, meaning when people are going through the perimenopause, those years before the periods stop, abnormal is normal.

Interviewer: Okay.

Dr. Jones: You can have spotting for two days, you can have 10 days of flow, you can skip months. It's normal.

Interviewer: So at the start and the beginning.

Dr. Jones: Right.

Interviewer: Weird is normal.

Dr. Jones: Weird is normal. Now in-between times, it's different. So in-between times you are expected to kind of get into a rhythm. Except when you're pregnant or breastfeeding or using something for contraception, you should be using something for contraception if you don't want to make a baby. However, let's talk about what's normal. The time between periods from the first day to the first day should be about 21-35 days. Other experts say 24-38 days. I'm an inclusive woman, and an inclusive doctor, so I'll say 21-38 days. So if your periods come about 21-38 days apart, then they're normal.

It's not okay when you start having more than 20 days variation. That usually means you are kind of skipping some periods. Now that can be okay, but you may want to talk to your clinician about that. Now how much is too light? Less than two days is light. But there's usually not a problem with being too light, really, unless you're trying to get pregnant.

Interviewer: Right.

Dr. Jones: So light is good. Remember all bets are off when you're on some kind of hormonal birth control. These we're talking about are natural periods.

Interviewer: How about too heavy?

Dr. Jones: More than seven days can be too heavy. Some people say more than 10. Now we're talking about flow, not kind of spotting days. Now how much is too much? If you are passing clots that are as big as your fist, that is too much.

Interviewer: That feels painful. That sounds painful.

Dr. Jones: Yeah. Right. That's too much. If you are passing clots and soaking through heavy or heavy day's protection every two hours for several hours at a time, so you are soaking all the way through, that's too much. In terms of an amount, anything between 5ccs, which is like one-quarter teaspoon, to 80ccs, which is several ounces, is normal. But women don't really have a way to measure it. So if you're passing clots that are bigger than a finger and this goes on for several hours with your periods, then that's too much and you should talk to your doctor.

What color is okay? Everything from red to brown to black is okay. Now red means the blood is coming out flowing right out onto your protection, so it doesn't get a chance to spend any time in the vagina. But the normal healthy acids in the vagina make it turn dark. Some people say, "Oh, my blood is black or it's dark." That's okay. It just means you're not bleeding very much.

Interviewer: My mom, even still now, she tells me that when stuff comes out of you, it's your body's way of cleaning itself up. In a way, you should feel good that things are coming out. It's the most bizarre thing, but it's her way of making me feel better about myself.

Dr. Jones: Well, bless her heart. That's actually been the way many cultures interpret bleeding so bleeding is good. Some cultures isolate women during their periods. They have to go to a special hut. They can't sleep with their husband in the same bed. For some cultures and faiths, it's considered dirty. For some, it's considered cleaning. The reality is we don't know why evolution invented the period.

Interviewer: There's no scientific proof that this is my body cleaning itself?

Dr. Jones: No not really.

Interviewer: Cleansing.

Dr. Jones: Yeah, it's a good evolutionary guess, but then why don't other animals do it? So only primates, those are gorillas and chimpanzees and some monkeys and humans, have periods. Other animals may bleed a little bit, but so little you just don't see dogs walking around with pads on. In fact, when you go to the zoo, you don't even see gorillas walking around with pads on. So humans are kind of unique in how much they bleed, but we have a lot more sex than anybody else so maybe there's more to kind of fix up. As long as it's somewhere between 20 and 28 days, 21 and 28 days, and 2 to 8 days, and you're not passing big clots, it's probably okay.

Interviewer: So I'm weird, but that's a normal thing.

Dr. Jones: Yeah, you're pretty weird, but if it worries you, talk to your clinician.

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