Nosebleeds, also known as epistaxis, are quite common and usually not a cause for concern.
However, frequent or heavy nosebleeds can be a sign of a more serious underlying condition. They are rarely fatal.
In fact, nosebleeds are actually a common issue. Only 10% of nosebleeds are severe enough to warrant treatment/medical intervention.
In this article, we’ll go over risk factors for nosebleeds and what causes them.
I’ll also discuss how to stop them, how to prevent a nosebleed, and when to see a healthcare provider.
What is a Nosebleed?
A nosebleed is when bleeding is occurring from inside a person’s nose.
The nose is full of blood vessels, which is why minor injuries to the face can cause the nose to bleed. They may also occur without outside influence.
These may happen spontaneously, but often result from unseen factors.
For example, when the mucous membrane inside the nose dries, crusts, or cracks, it may bleed.
Nosebleeds are also common in people taking anticoagulants (which are blood-thinning medications, such as warfarin), as well as those with bleeding disorders.
Nosebleeds can happen at any age and most people will experience them every now and again.
Anyone can get a nosebleed, but they most often affect:
- Children between 3-10 years of age
- Elderly people
- Pregnant people
- People who take blood-thinning medication, such as aspirin, or anticoagulants, such as warfarin
- People with blood clotting disorders, such as hemophilia
Some other things that raise the risk are:
- Sinusitis, cold, and allergies
- A defect in the nose
- Bleeding or clotting problems
- Blood vessel problems in the nose
- Dry air
- Drugs, such as blood-thinners, aspirin, and nasal sprays
- Cocaine use
- Trauma to the nose such as nose picking
Are Nosebleeds Serious?
Seeing blood coming out of your nose can be a scary sight for many people.
The good news is that most nosebleeds are not serious and can be managed at home.
However, see your doctor or get emergency medical attention if you are losing a large amount of blood, if you cannot stop your nosebleed after 20 minutes of trying, or if you have had an immediate injury to your head, face, or nose.
You may also want to make an appointment to see your healthcare professional if you have frequent nosebleeds.
Picking your nose can damage the delicate blood vessels in the nostrils and cause them to bleed.
Infections and allergies
Bacterial, viral, and allergic rhinosinusitis causes mucosal inflammation and may lead to epistaxis.
Bleeding in these cases is usually minor and frequently manifests as blood-streaked nasal discharge.
Nosebleeds are a common result of trauma to the nose or face.
A blow to the nose can break blood vessels and cause bleeding. Improper nose blowing can also lead to epistaxis.
Allergic reactions to pollen, dust, and pet dander can dry out these membranes, leaving the blood vessels susceptible to bursting.
This means that it won’t take much to rupture them—a sneeze, cough, or even simply labored breathing could be enough to prompt a nosebleed.
A deviated septum is a condition in which the thin wall that separates your nostrils (the septum) is displaced to one side.
This displacement can irritate the delicate tissues of your nose, causing nosebleeds.
Frequent use of nasal sprays and medications to treat itchy, runny, or stuffy nose may be associated with nosebleeds.
These medications, including antihistamines and decongestants, can dry out the nasal membranes.
Changes in Altitude
Sudden changes in altitude can cause the blood vessels in your nose to rupture and bleed.
Going from a moist climate to a dry one, taking a cross-country flight, or living at a high altitude can cause a nosebleed. Sometimes a seasonal change can even bring on bleeding.
Snorting cocaine is a dangerous cause of nosebleeds.
Over-the-counter (OTC) decongestant use has also been linked to epistaxis.
Anti-inflammatory drugs (eg, aspirin, ibuprofen, naproxen), anticoagulants (eg, warfarin [Coumadin], rivaroxaban), antiplatelet agents (eg, clopidogrel), and antiepileptics (eg, valproic acid) have also been found to cause nosebleeds.
How to Stop a Nosebleed at Home
Here’s a look at several self-care tips to treat the occasional nosebleed in adults and children.
- Sit upright: Sitting in an upright position helps blood drain from your nose, and prevents it from dripping down your throat. Blood dripping down your throat can cause vomiting and nausea.
- Use cold therapy: Applying a cold compress to the bridge of your nose helps constrict the blood vessels in your nose, which can stop the bleeding.
- Blow your nose gently: This helps to remove any blood clots in your nostrils.
- Pinch your nose: Gently squeeze the soft portion of your nose for at least 5 minutes without letting go. The pressure on your nasal septum can stop the blood flow. Repeat as necessary for up to 15 minutes.
- Use a damp washcloth: Do not place gauze or tissue inside your nostril, or your child’s nostril. Instead, hold a damp washcloth over the nose to help absorb the blood.
Gauze, special nasal sponges, foam, or an inflatable latex balloon is inserted into your nose to create pressure at the site of the bleed.
The material is often left in place for 24 to 48 hours before being removed by a healthcare professional.
This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
A local anesthetic may be sprayed in the nostril first to numb the inside of your nose.
Epistaxis which is not controlled by anterior and posterior nasal packing may be treated by ligation or embolization of the arterial supply to the nose.
Other treatment options include:
- Medication adjustments: Reducing or stopping the number of blood-thinning medications can be helpful. In addition, medications for treating hypertension may be necessary. Foreign body removal if this is the cause of the nose bleed.
- Surgery: Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the nosebleed.
If you or your child has nosebleeds — perhaps due to sinusitis, allergies, or other known conditions — here are a few tips to decrease their frequency:
- Use saline nose drops as directed to keep your nasal passage moist
- Use a humidifier when allergies or the common cold cause a nosebleed
- Don’t blow your nose too hard
- Quit smoking (smoking can dry and irritate your nasal passage)
- Trim your child’s fingernails and discourage nose-picking
- Wear protective face gear when playing certain sports
- Open your mouth when sneezing to prevent injuring the blood vessels within your nose
When to See a Medical Provider
Most adults and children will have at least one nosebleed in their lives.
In most cases, the bleeding will stop after a few minutes of self-care. Other times, though, nosebleeds have symptoms that may warrant a call or trip to a doctor.
Understandably, a nosebleed in your child can invoke panic.
Keep in mind, though, that nosebleeds are common in children. Of course, this doesn’t mean you should ignore every nosebleed.
Some nosebleeds are minor and you’ll notice blood dripping or running from your child’s nose.
They might bleed from one nostril or both nostrils. Immediate home care helps stop the bleeding.
You should, however, talk with a doctor under the following circumstances:
- The nosebleed doesn’t stop after 20 minutes of direct pressure, especially if your child has an injury to their head or face. Serious injuries can affect the nose or skull.
- There’s an object stuck in your child’s nose.
- Your child has other symptoms such as dizziness, headache, tiredness, vomiting, or trouble breathing. This can indicate too much blood loss, or blood dripping down their throat.
Even if you’re used to having nosebleeds as an adult, you shouldn’t ignore certain symptoms:
- Similar to a child, call your doctor if a nosebleed doesn’t stop after 20 minutes of direct pressure, or if you lose a lot of blood (more than a cup).
- You should also talk with your doctor if you experience trouble breathing, gagging, or vomiting due to blood dripping down your throat.
- A serious injury to your head or that face causes a nosebleed also needs medical attention.
- If you’re bleeding from other parts of your body — ears or rectum, for example, this could indicate internal bleeding, blood clotting problems, or blood vessel disorders.
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Frequently Asked Questions
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The role of oral anticoagulants in epistaxis. (2018.)
Chronic Rhinosinusitis as a Multifactorial Inflammatory Disorder. (2011.)
Drug-Induced Epistaxis: An Often-Neglected Adverse Effect. (2018.)
Drug-Induced Bleeding. (2014.)
Antiplatelet Medications. (2022.)
Endoscopic management of posterior epistaxis: a review. (2014.)
Tranexamic acid for patients with nasal hemorrhage (epistaxis). (2018.)