What causes nosebleeds?
While nosebleeds often look frightening, most of them are not serious and can be easily treated, for example, at home. The inside of the nose is especially prone to bleeding because of the abundance of blood vessels inside the nose that help warm and humidify the air we breathe. The blood vessels in the nasal passages are also very close to the surface and are therefore quite vulnerable to injury.
The majority of nosebleeds arise from small blood vessels located in the front of the nasal passages. Rarely, nosebleeds come from larger blood vessels in the back of the nose. Nosebleeds from larger vessels are more serious and may be due to high blood pressure, atherosclerosis, or significant injury to the nose.
Most nosebleeds are caused by dryness (for example, from heated indoor air in winter) or minor mechanical damage from picking the nose. In children, nosebleeds can occur if they insert objects into the nose. Other factors that predispose to nosebleeds include:
- upper respiratory infections,
- blood clotting disorders,
- cocaine use,
- alcohol abuse, and
- cigarette smoking.
Taking medications such as warfarin (Coumadin), or aspirin that interfere with the normal clotting of blood can also increase the risk of nosebleeds.
What should I do if I get a nosebleed?
If you get a nosebleed, sit down and bend forward. Sitting is preferable to lying down, since keeping the head above the level of the heart will help reduce the bleeding. Bending forward is also important. It lets the blood drain out through the nose rather than down the throat.
Hold the soft portion of your nose pinched together with your fingers until the bleeding stops. This might take five to ten minutes. Placing an ice pack across the bridge of your nose can also be helpful.
If a nosebleed goes on for more than 15 minutes, occurs following a serious injury, or is accompanied by severe blood loss, you should call your doctor or visit the emergency room. You should also visit your doctor for an examination if you get nosebleeds frequently, as they can in rare instances be early warning signs of serious conditions. Nosebleeds in the elderly are also more likely to be related to serious conditions than in younger persons.
How can I prevent nosebleeds?
You can help prevent nosebleeds by using humidifiers in winter and keeping the lining of the nasal passages moistened with a very thin layer of an ointment such as petroleum jelly in winter or in dry climates. A saline nasal spray can also help keep the nasal cavities moist. Frequent trimming of fingernails, especially children's, can also help reduce nosebleeds from picking the nose.
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UpToDate. Patient information: Nosebleeds (epistaxis) (Beyond the Basics).