Epistaxis (Nosebleed)
Bleeding from the lining of the nose
Quick Facts
- Type: Ear, nose, and throat condition
- Most common form: Anterior (front of the nose)
- Common triggers: Dry air, nose-picking, minor injury
- Seek urgent care: Bleeding that won't stop after 20 minutes
Overview
Epistaxis is the medical term for a nosebleed. The lining of the nose is rich in small, fragile blood vessels that sit close to the surface, so even minor irritation can cause bleeding. Most nosebleeds are harmless and stop on their own or with simple first aid.
Doctors divide nosebleeds into two types. Anterior nosebleeds, by far the most common, start near the front of the nasal septum (the wall between the nostrils) and are usually easy to control. Posterior nosebleeds come from deeper, larger vessels toward the back of the nose; they are less common, can be heavier, and more often need medical attention.
Symptoms
The main sign is blood coming from one or both nostrils. Other features can include:
- Blood dripping or flowing from the front of the nose
- A sensation of liquid running down the back of the throat, sometimes causing the person to spit or swallow blood
- Lightheadedness or a salty taste in the mouth with heavier bleeding
Bleeding that is very heavy, comes mostly from the back of the throat rather than the nostrils, or is accompanied by feeling faint may indicate a posterior nosebleed or significant blood loss and needs prompt evaluation.
Causes
Nosebleeds happen when the delicate vessels in the nasal lining are damaged or become more fragile. Common causes include:
- Dry air: Low humidity, indoor heating, and dry climates dry out and crack the lining.
- Trauma: Nose-picking, forceful nose-blowing, or a blow to the nose.
- Irritation: Colds, allergies, and sinus infections that inflame the lining.
- Medications: Blood thinners, aspirin, and overuse of nasal sprays.
- Structural issues: A deviated septum or foreign object in the nose, especially in children.
Less commonly, frequent or hard-to-control nosebleeds can be linked to high blood pressure, bleeding disorders, or abnormal blood vessels.
Risk Factors
- Living in a dry climate or using indoor heating
- Frequent colds, allergies, or sinus problems
- Use of blood-thinning or anti-inflammatory medicines
- A known bleeding or clotting disorder
- Frequent use of decongestant or steroid nasal sprays
- Children aged 2 to 10 and older adults are most prone to nosebleeds
Diagnosis
Most nosebleeds need no testing. When bleeding is recurrent, heavy, or hard to stop, a clinician may:
- Examine the inside of the nose with a light or a small scope to find the bleeding point
- Ask about medications, injuries, and any tendency to bruise or bleed elsewhere
- Check blood pressure and, in some cases, order blood tests to look for clotting problems or anemia
Treatment
For a typical nosebleed, simple first aid usually works:
- Sit upright and lean slightly forward so blood does not run down the throat.
- Pinch the soft part of the nose firmly and hold steady pressure for 10 to 15 minutes without releasing to check.
- Breathe through the mouth; a cold pack on the bridge of the nose may help.
If bleeding continues, a clinician may seal the bleeding vessel by cautery (using a chemical or heat) or pack the nose to apply pressure. Posterior or severe nosebleeds sometimes require specialist treatment. Treating an underlying cause, such as adjusting medication or controlling blood pressure, helps prevent repeats.
Prevention
- Keep the nasal lining moist with saline spray or a thin layer of petroleum jelly
- Use a humidifier in dry indoor air
- Avoid picking or forcefully blowing the nose
- Treat allergies and colds to reduce irritation
- Discuss recurrent nosebleeds with a doctor if you take blood thinners
When to See a Doctor
See a doctor for nosebleeds that happen often, are hard to stop, or follow a significant injury. Seek emergency care if:
- Bleeding does not stop after 20 minutes of firm, continuous pressure
- The bleeding is very heavy or you are swallowing large amounts of blood
- You feel faint, dizzy, or short of breath
- The nosebleed follows a serious head or face injury
Frequently Asked Questions
How do I stop a nosebleed?
Sit upright, lean slightly forward, and pinch the soft part of your nose firmly for 10 to 15 minutes without letting go to check. Breathe through your mouth. Leaning forward keeps blood from running down your throat.
Should I tilt my head back during a nosebleed?
No. Tilting back lets blood drain down the throat, which can cause gagging, coughing, or vomiting. Lean slightly forward instead so the blood flows out of the nostrils.
Are frequent nosebleeds a sign of something serious?
Most are caused by dry air or minor irritation and are not dangerous. However, frequent or hard-to-stop nosebleeds can sometimes reflect a bleeding disorder, medication effect, or other condition, so they are worth discussing with a doctor.
When is a nosebleed an emergency?
Seek emergency care if bleeding does not stop after about 20 minutes of firm pressure, is very heavy, follows a serious injury, or is accompanied by feeling faint or short of breath.
Can high blood pressure cause nosebleeds?
Very high blood pressure can make nosebleeds harder to control and may contribute to them, although it is rarely the sole cause. If you have recurrent nosebleeds, having your blood pressure checked is reasonable.
References
- Mayo Clinic. Nosebleeds — Causes and first aid.
- MedlinePlus, U.S. National Library of Medicine. Nosebleed.
- American Academy of Otolaryngology–Head and Neck Surgery. Nosebleeds.