Nosebleeds (Epistaxis)

Overview

A nosebleed, known medically as epistaxis, is bleeding from the small blood vessels that line the inside of the nose. The nose has a rich supply of fragile vessels close to the surface, which makes it prone to bleeding when the lining is irritated, dried out, or injured. Nosebleeds are very common and affect people of all ages, especially children and older adults.

Most nosebleeds come from the front part of the nose (anterior nosebleeds), are minor, and can be stopped at home within a few minutes. Less commonly, bleeding comes from deeper in the nose (posterior nosebleeds), which can be heavier and harder to control and may need medical care. While the sight of blood can be alarming, the great majority of nosebleeds are not serious.

Signs and What to Do

A nosebleed simply involves blood coming from one or both nostrils, ranging from a few drops to a steady flow. Blood may also trickle down the back of the throat. To stop a typical nosebleed:

• Sit upright and lean slightly forward (not back) to avoid swallowing blood
• Pinch the soft part of the nose just below the bony bridge
• Hold firm, continuous pressure for about 10–15 minutes without releasing to check
• Breathe through your mouth and stay calm
• Apply a cold compress to the bridge of the nose if helpful

After bleeding stops, avoid blowing the nose, bending over, or heavy activity for several hours. Seek help if bleeding continues despite proper pressure or is very heavy.

Causes

Nosebleeds happen when the delicate vessels in the nasal lining are damaged or become fragile. Common causes include:

• Dry air: Especially in winter or heated indoor environments, drying and cracking the lining.
• Nose picking or vigorous nose blowing.
• Minor injury or a blow to the nose.
• Colds, allergies, and sinus infections that inflame the nasal lining.
• Foreign objects in the nose, especially in children.
• Medications: Blood thinners, aspirin, and some nasal sprays.
• Bleeding disorders or, less commonly, high blood pressure and certain tumors.

In many cases more than one factor is involved, such as dry air plus frequent nose blowing during a cold.

Risk Factors

Nosebleeds are more likely in people who:

• Live in dry or cold climates or use heating without humidification
• Are children (who often pick their noses) or older adults (whose vessels are more fragile)
• Have allergies or frequent colds
• Take blood-thinning medications or aspirin
• Have a bleeding disorder
• Use nasal sprays regularly or use illicit drugs that are snorted
• Have had recent nasal surgery or injury

Diagnosis

Most single, minor nosebleeds need no testing. For frequent, heavy, or hard-to-control nosebleeds, a clinician will:

• Examine the inside of the nose to find the source of bleeding
• Ask about how often bleeds occur, medications, injuries, and bleeding elsewhere
• Check blood pressure
• Order blood tests to look for a bleeding disorder or anemia if bleeding is recurrent or severe
• Use additional imaging or referral to an ear, nose, and throat (ENT) specialist when a deeper or structural cause is suspected

This evaluation helps identify whether an underlying condition, such as a bleeding disorder or, rarely, a growth, is responsible for repeated bleeding.

Treatment

Most nosebleeds stop with simple first aid. When medical treatment is needed, options include:

• Cautery: Sealing a visible bleeding vessel with a chemical (silver nitrate) or heat.
• Nasal packing: Inserting special material or an inflatable device to apply pressure inside the nose for heavier or posterior bleeds.
• Treating the cause: Managing allergies, infections, or adjusting blood-thinning medication with the prescribing doctor.
• Moisturizing measures: Saline sprays or gels and humidifiers to keep the lining moist and prevent recurrence.
• Specialist procedures: For severe or recurrent bleeding, an ENT specialist may use additional techniques to control the bleeding vessel.

Recurrent nosebleeds are often well controlled once the underlying trigger is addressed and the nasal lining is kept moist.

Prevention

You can reduce nosebleeds by protecting and moisturizing the nasal lining:

• Use a humidifier, especially in winter or dry climates
• Apply saline spray or a thin layer of water-based gel inside the nostrils to prevent drying
• Avoid picking the nose and blow gently
• Treat allergies and colds promptly
• Keep children's fingernails trimmed and discourage nose picking
• Discuss bleeding risk with your provider if you take blood thinners

When to See a Doctor

Seek urgent or emergency care if a nosebleed:

• Does not stop after 15–20 minutes of firm, correct pressure
• Is very heavy or accompanied by large amounts of blood draining down the throat
• Follows a significant head or facial injury
• Causes lightheadedness, weakness, difficulty breathing, or paleness

Make a routine appointment for frequent or recurring nosebleeds, bleeding in someone on blood thinners, or nosebleeds with easy bruising or bleeding elsewhere, which may point to a bleeding disorder. A provider can find the source and recommend treatment to prevent future episodes.

Related Topics

Frequently Asked Questions

References

1. American Academy of Otolaryngology - Head and Neck Surgery.
2. Mayo Clinic. Nosebleeds.
3. MedlinePlus, U.S. National Library of Medicine.