Functional Endoscopic Sinus Surgery (FESS) is a common procedure performed to improve breathing, clear chronic infections, and restore proper sinus drainage. This surgical intervention involves working within the delicate and highly vascular lining of the nasal passages and sinuses. Consequently, bleeding is a universal and expected part of the recovery process as the body begins to heal the surgical sites. Understanding the typical duration and characteristics of this post-operative bleeding is important for a successful recovery.
Immediate Post-Operative Bleeding Timeline
The most significant bloody drainage occurs within the first 24 to 48 hours following the procedure, which is a natural response to the surgical alteration of the nasal mucosa. This initial flow is often a mixture of bright red blood and mucus, which may feel like a constant drip from the nostrils. To manage this, a small gauze dressing, often called a nasal drip pad or “mustache dressing,” is placed beneath the nose to absorb the discharge.
During the first day, the nasal drip pad may need to be changed frequently, sometimes as often as every hour, due to the volume of fluid draining. After this initial 24-hour period, the intensity and volume of the drainage should noticeably decrease, with the color often fading from bright red to a lighter pink or a reddish-brown. By the end of the second day, the need to change the pad becomes significantly less frequent, marking the end of the most active bleeding phase.
If absorbable nasal packing or splints were used during the surgery, they help minimize bleeding initially by applying gentle pressure. A temporary increase in bloody discharge is common when these materials naturally dissolve or are removed by the surgeon, typically around the one-week mark. This brief resurgence of bleeding is usually minor and is not cause for concern.
Managing Expected Post-Surgical Drainage
Controlling the expected flow involves specific techniques designed to minimize pressure on the healing tissues and allow for successful clotting. Maintaining head elevation, especially during the first three days, is an effective strategy for reducing congestion and the likelihood of excessive drainage. Sleeping in a recliner or propped up with two to three pillows helps leverage gravity to keep the head above the heart.
Applying a cold compress or ice pack to the bridge of the nose and the cheeks during the first 48 hours can also help constrict blood vessels, which serves to slow the drainage. Patients should strictly avoid any activity that increases pressure within the head or nasal cavity for at least one to two weeks. This includes bending over at the waist, engaging in heavy lifting, or straining during a bowel movement.
It is important to avoid blowing the nose forcefully, which can dislodge protective clots and restart a bleed. If a sneeze is unavoidable, opening the mouth widely allows the pressure to escape without directing force into the nasal lining. Additionally, patients must avoid blood-thinning medications like aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, as these can significantly increase the risk of post-operative bleeding.
Spotting and Scabbing During Healing
After the initial post-operative drainage subsides, a secondary phase of mild, intermittent spotting and discharge is expected as the body continues the recovery process. The nasal lining forms scabs and crusts over the surgical sites. As these scabs naturally loosen and are cleared, minor spotting can occur.
This discharge often appears dark brown, yellow, or pink, representing old blood and mucus being cleared from the sinus cavities. This can persist for up to two weeks, and sometimes longer, depending on the extent of the surgery. Saline nasal rinses are designed to moisturize the nasal passages and gently encourage the removal of these crusts and debris.
It is common to notice a small amount of fresh, pink-tinged blood mixed with the water immediately after performing a saline irrigation. This is not a sign of a new hemorrhage, but rather an indication that the rinse successfully dislodged a small piece of clotted material or a scab from the healing tissue.
Recognizing Signs of Excessive Bleeding
Excessive bleeding is defined as a persistent, heavy flow of bright red blood that cannot be easily controlled. A flow that saturates the nasal drip pad completely within a few minutes and continues at this rate without slowing down is a sign that immediate medical attention is necessary.
If heavy bleeding occurs, the immediate action should be to remain calm and sit upright, avoiding a lying position or tilting the head back. The patient should gently pinch the soft lower part of the nose between the thumb and forefinger for a sustained period of about ten minutes. If the bleeding continues to be profuse after this attempt, or if it is accompanied by symptoms such as dizziness, lightheadedness, or consistent blood running down the back of the throat, the surgeon’s office or an emergency department should be contacted immediately.
The use of an over-the-counter decongestant nasal spray containing oxymetazoline may be recommended by the surgeon as a temporary measure to constrict blood vessels and control an acute bleed. However, this should only be done under medical guidance. Acting quickly to seek professional help is the safest course of action.