Nosebleeds

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Introduction

What are nosebleeds?

A nosebleed occurs when the tissue lining of the nose breaks and blood is released. This tissue contains small blood vessels, called arterioles, which can rupture easily. A nosebleed is medically known as epistaxis. Nosebleeds are very common, and children between the ages of two and 10 and adults between 50 and 80 years seem to be most susceptible.

The most common nosebleeds happen in the front (anterior) of the nose. Anterior nosebleeds flow down and out of the nose. These nosebleeds generally occur in the septum, which divides the nostrils. Anterior nosebleeds are most frequently caused by some type of trauma. The blood vessels in the septum can be broken by scratching with a fingernail or during a high-impact injury to the nose. Dry air can cause the septum lining to dry out and crack, which may also cause a nosebleed in the anterior of the nose.

Anterior nosebleeds can be stopped by sitting upright to ensure that your head is higher than your heart. Breathe through your mouth instead of your nose and lean forward slightly to avoid swallowing blood. Using your thumb and index finger, gently pinch the soft fleshy part of your nose closed for 15 minutes.

Nosebleeds in the back (posterior) of the nose are less common and potentially more dangerous. Posterior nosebleeds occur higher and deeper in the nose, causing blood to flow down the throat. A posterior nosebleed can also result from a blow to the face or nose. Stopping a posterior nosebleed may require the assistance of a health care provider.

Frequent nosebleeds may be a symptom of a blood clotting disorder that is present from birth and should be discussed with your health care provider.

Seek immediate medical care (call 911) for a nosebleed that occurs after a head injury, if the nosebleed lasts longer than 30 minutes, if you are vomiting blood or having difficulty breathing, or if you experience confusion or loss of consciousness even for a brief moment.

Seek prompt medical care if you have recurring nosebleeds.

Symptoms

What are the symptoms of nosebleeds?

Nosebleed symptoms are easily recognizable: blood coming out of your nose, or from your nose down the back of your throat.

Symptoms that might indicate a serious condition

In some cases, gingivitis can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

  • Abnormal pupil size or reactivity to light

  • Abrupt confusion, fatigue, changes in thinking, or lethargy soon after a head trauma

  • Coughing up blood (hemoptysis)Deformity or fracture of bones

  • Difficulty breathing

  • Nosebleed after a head injury

  • Nosebleed along with a misshapen nose after a blow or injury to the nose

  • Nosebleed that lasts longer than 30 minutes

  • Seizures

  • Slowed or stopped breathing

  • Unconsciousness (even if brief)

Causes

What causes nosebleeds?

Nosebleeds can be caused by a variety of factors. The most common cause of a nosebleed is dry air or dryness in the nasal passages. An injurious blow to the nose may also cause a nosebleed. Chronic nosebleed can be caused by blood clotting disorders that run in families.

Everyday causes of nosebleeds

Your nosebleed may be due to common causes including:

  • Allergies

  • Change in altitude

  • Chemical irritants

  • Cold or dry air

  • Medications such as anti-inflammatory drugs, blood thinners, or aspirin

  • Nose picking

  • Vigorous nose blowing

  • Vigorous sneezing

Serious causes of nosebleeds

Serious causes of nosebleed that may require medical attention include:

  • Foreign object in the nose

  • Nose fracture

  • Respiratory infection

  • Surgery of the nose or face

  • Trauma to the nose

  • Tumor

Genetic causes of nosebleeds

Nosebleeds can also be caused by disorders that run in families including:

  • Hemophilia (rare hereditary disorder in which blood does not clot normally)

  • Hemorrhagic telangiectasia (hereditary disorder that makes blood vessels very fragile)

  • Thrombocytopenia (low blood platelet count; platelets help form clots to stop blood loss)

  • Von Willebrand’s disease (hereditary bleeding disorder)

What are the risk factors for nosebleeds?

A number of factors increase the risk of developing nosebleeds. Not all people with risk factors will get nosebleeds. Risk factors for nosebleeds include:

  • Allergies

  • Family history of bleeding disorders, such hemorrhagic telangiectasia

  • Tumors of the sinuses and nasopharynx

  • Tumors

  • Use of certain medications, such as anti-inflammatory drugs, blood thinners, or aspirin

Treatments

How are nosebleeds treated?

Stopping an anterior nosebleed is simple. You should sit upright to ensure that your head is higher than your heart and use your mouth to breathe. Lean forward slightly to avoid swallowing blood. Using your thumb and index finger, gently pinch the soft fleshy part of your nose closed for 15 minutes.

Stopping posterior nosebleeds is more difficult and may require the assistance of a health care provider. Posterior nosebleeds are less common than anterior nosebleeds and occur higher and deeper in the nose, with blood flowing down the throat.

Recurring nosebleeds should be discussed with your health care provider. Your health care provider may elect to treat a recurring nosebleed by cauterization or sealing the affected blood vessel. Another treatment option is a packing. A piece of treated gauze is packed into the vessel to stop the flow of blood.

What you can do to prevent nosebleeds

You can also prevent or limit nosebleeds by:

  • Avoid long-term use of nasal decongestant sprays

  • Keeping fingernails short to mitigate damage to the interior of the nose

  • Quitting smoking

  • Using a cool-mist humidifier to counteract the effects of dry air

  • Using a moisturizing nasal spray

What are the potential complications of nosebleeds?

In some cases, chronic nosebleeds may be the result of a hereditary blood clotting disorder. You should consult your health care provider if you are experiencing frequent nosebleeds. You may be referred to an otolarynogologist (eye, ear, nose and throat specialist) for further evaluation and treatment.

Because chronic nosebleeds can be caused by serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Adverse effects of nosebleed treatment

  • Choking

  • Fainting

  • Organ damage

  • Shock

  • Uncontrollable blood loss

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Nosebleed. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm
  2. Nosebleeds. American Academy of Otolaryngology - Head and Neck Surgery. https://www.enthealth.org/conditions/nosebleeds/
  3. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med 2009; 360:784
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