Nosebleed: How to Stop It and When to Get Help

How to stop a nosebleed

1. Sit up and lean forward. This keeps blood from running down your throat, which can cause choking or vomiting. Do not lie down or tilt your head back.
2. Blow out any clots gently once, if possible. This lets the vessel contract.
3. Pinch the soft part of your nose (below the bony bridge) firmly with your thumb and index finger, closing both nostrils. Breathe through your mouth.
4. Hold for 10 to 15 minutes by the clock. Do not let go to check. Releasing early restarts the bleeding.
5. Optional: a decongestant spray such as oxymetazoline (2 sprays in the bleeding nostril) before pressing can help shrink vessels. Do not use it in young children or if you have very high blood pressure.
6. Cool the area: an ice pack on the bridge of the nose or sucking an ice cube may help.
7. If bleeding continues, repeat for another 10 to 15 minutes. If it is still bleeding after 20 to 30 minutes total, seek emergency care.

After it stops

For the next 24 to 48 hours:

• do not blow, pick or rub your nose
• avoid heavy lifting, straining, bending over and strenuous exercise
• avoid hot drinks, hot showers and alcohol for a day
• sneeze with your mouth open
• apply a thin layer of petroleum jelly or saline gel inside the nostril to keep it moist

Common mistakes

• Tilting the head back: blood runs into the throat and stomach.
• Pinching the bony bridge: the bleeding point is lower down.
• Stuffing tissues deep into the nose and removing them: this dislodges clots.
• Checking every minute.

Why nosebleeds happen

About 90% of nosebleeds come from Kiesselbach's plexus, a network of small vessels at the front of the septum (the wall between the nostrils) that sit close to the surface. These are anterior nosebleeds, and they are usually easy to control. A small number come from deeper vessels at the back (posterior nosebleeds). These are heavier, run down the throat, are more common in older adults, and often need hospital treatment.

Common causes

• Dry air: heated indoor air in winter and dry climates crack the lining.
• Nose picking: the most common cause in children.
• Colds, sinusitis and allergies: inflammation and frequent blowing.
• Nasal sprays: steroid sprays aimed at the septum rather than outward.
• Minor injury: a bump to the nose.

Things that make nosebleeds worse or more frequent

• Blood thinners: aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, and NSAIDs.
• Bleeding disorders: von Willebrand disease, hemophilia and low platelets (thrombocytopenia).
• High blood pressure: does not usually cause nosebleeds directly, but can make them harder to stop.
• Alcohol and some supplements (fish oil, ginkgo, vitamin E).
• Hereditary hemorrhagic telangiectasia (HHT): an inherited condition with fragile vessels and frequent nosebleeds.
• Cocaine use, which damages the septum.
• Rarely, tumors in the nose or sinuses, usually with one-sided blockage and bloody discharge.

Nosebleeds in children

Nosebleeds are very common in children aged 2 to 10, usually from picking, dry air and colds. Use the same first aid: sit the child up, lean forward and pinch for 10 minutes. Keep fingernails short and use saline gel or petroleum jelly at bedtime. See a doctor for nosebleeds in babies, frequent or heavy bleeds, or bleeding with bruising.

When a doctor treats a nosebleed

At the ER or clinic, a clinician will look inside the nose to find the bleeding point. Treatments include:

• Cautery: sealing the vessel with a silver nitrate stick after numbing the nose.
• Nasal packing: a sponge or inflatable balloon placed in the nose for 1 to 3 days.
• Treating the cause: checking blood pressure, blood counts and clotting, and reviewing blood thinners.

Heavy posterior bleeds may need hospital admission, posterior packing, or a procedure to block the bleeding artery. See nosebleeds (epistaxis) for more on types, recurrent nosebleeds and medical treatment.

Preventing nosebleeds

• Use a humidifier in the bedroom in dry seasons.
• Apply saline gel or petroleum jelly inside the nostrils once or twice daily.
• Use saline nasal sprays to keep the lining moist.
• Aim steroid nasal sprays toward the outer wall of the nostril, away from the septum.
• Blow your nose gently, one side at a time.
• Do not smoke, which dries and irritates the nose.

Frequently asked questions

What is the fastest way to stop a nosebleed?

Sit up, lean forward and pinch the soft part of your nose firmly for 10 to 15 minutes without letting go, breathing through your mouth. A cold pack on the bridge of the nose and a decongestant spray in the bleeding side can help. Tilting your head back does not.

When should I worry about a nosebleed?

Go to the ER if bleeding lasts over 20 minutes despite pressure, is heavy, makes you dizzy or faint, follows a head injury, or you take blood thinners and cannot stop it. See a doctor for frequent nosebleeds, one-sided bleeds with blockage, or bleeding with bruising.

What causes sudden nosebleeds for no reason?

Most "random" nosebleeds are from dry, cracked nasal lining, often in winter, or from minor irritation by colds, allergies or nasal sprays. Blood thinners and NSAIDs make them more likely. Frequent unexplained nosebleeds should be checked for bleeding disorders or nasal problems.

Can high blood pressure cause nosebleeds?

High blood pressure is rarely the direct cause, but it can make a nosebleed heavier and harder to stop, especially in older adults. If you have frequent nosebleeds, have your blood pressure checked. Very high readings with headache or chest pain need urgent care.

Should you tilt your head back during a nosebleed?

No. Tilting your head back sends blood down your throat, which can cause choking, coughing or vomiting, and hides how much you are bleeding. Lean forward instead and pinch the soft part of the nose.