- Things to Know
- How to Stop: 7 Tips
- How to Treat
- How to Prevent
Things to know about nosebleed (epistaxis)
- The definition of a nosebleed is simply bleeding from the blood vessels in the nose. The medical term for nosebleed is epistaxis.
- Nosebleeds are common due to the location of the nose on the face, and a large number of blood vessels in the nose.
- The most common causes of nosebleeds are drying of the nasal membranes and nose picking (digital trauma), which can be prevented with proper lubrication of the nasal passages and not picking the nose.
- Most nosebleeds can be stopped at home.
- Consult a doctor for a nosebleed if bleeding cannot be stopped, there is a large amount of blood lost, or you feel weak or faint.
- Chronic nosebleeds or persistent nosebleeds may need to be stopped with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble), or application of a topical medicine called thrombin that promotes local clotting of blood.
- A doctor may use nasal packs to stop nosebleeds when conservative measures fail.
- Do not take aspirin or other blood-thinning products when you get a nosebleed (if they are doctor-prescribed, consult your doctor before stopping any medication).
What causes nosebleeds?
The nose is a part of the body rich in blood vessels (vascular) and is located in a vulnerable position protruding on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to a bloody nose if they take medications that prevent normal blood clotting (warfarin [Coumadin, Jantoven], clopidogrel [Plavix], aspirin, or any anti-inflammatory medication). In this situation, even a minor trauma could result in significant bleeding.
The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home result in drying and changes in the nose which make it more susceptible to bleeding. Nosebleeds also occur in hot, dry climates with low humidity, or when there is a change in the seasons. The following risk factors predispose people to nosebleeds:
- Trauma, including self-induced nose picking (this is a common cause of nosebleeds in children)
- Allergic and non-allergic rhinitis
- Hypertension (high blood pressure)
- Use of blood-thinning medications
- Alcohol abuse
- Less common causes of nosebleeds include tumors and inherited bleeding problems
- Hormonal changes during pregnancy may increase the risk of nosebleeds.
What usually causes chronic nosebleeds?
If a nosebleed recurs four times or more in a week, see a healthcare professional determine why this is occurring. Frequent or chronic nosebleeds may be caused by many factors including
- Frequent picking or blowing the nose
- A low humidity environment
- Chronic allergies
- Medications include blood thinners, aspirin, anti-inflammatory drugs, antihistamines, decongestants, or nasal sprays
- Health conditions that affect normal blood clotting
- A structural problem within the nose
- Abnormal blood vessels within the nose (for example Osler-Weber-Rendu syndrome, a hereditary condition)
- A polyp or tumor in the nose or sinuses.
- The use of complementary and alternative medicines such as Ginkgo biloba and vitamin E may increase the risk of bleeding.
- Snorting drugs such as cocaine.
If the nosebleed persists or is recurrent, see your healthcare professional who may recommend stopping the nosebleed with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble), or application of a topical medicine called thrombin that promotes local clotting of blood. Blood tests may be ordered to check for bleeding disorders. If bleeding is still persistent, the doctor may place nasal packs, which compress the vessels and stop the bleeding. In rare situations, you may be admitted to the hospital or require surgical treatment or a procedure where the material is used to plug up the bleeding vessels in the nose (angiographic embolization).
- FDA Panel Backs RSV Vaccine for Infants, Some Toddlers
- Seniors: Stay Social, Active for 'Optimal Aging,' Study Shows
- Diabetes Med Metformin Might Help Prevent Long COVID
- Disability a Growing Concern for U.S. Cancer Survivors
- Smoke From Wildfires Is Especially Tough If You Have Asthma. Here’s How to Protect Yourself
- More Health News »
How to stop the common nosebleed: 7 Tips
Most people who develop nose bleeding can handle the problem without the need for treatment by a healthcare professional if they follow the step-by-step first aid recommendations below on how to stop a nosebleed:
- Lean forward slightly with the head tilted forward. Leaning back or tilting the head back allows the blood to run back into the sinuses and throat, and can cause gagging or inhaling of blood.
- Spit out any blood that may collect in your mouth and throat. It may cause nausea, vomiting, or diarrhea if swallowed.
- Gently, blow any blood clots out of your nose. The nosebleed may worsen slightly when you do this but this is expected.
- Pinch all the soft parts of the nose together between the thumb and index finger.
- Press firmly toward the face - compressing the pinched parts of the nose against the bones of the face. Breathe through your mouth as you do this.
- Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding.
- Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.
- Apply ice (wrapped in a towel) to the nose and cheeks afterward.
- Oxymetazoline (Afrin), phenylephrine hydrochloride (Neo-Synephrine, Neofrin), or phenylephrine-DM-guaifenesin (Duravent) nasal spray can be used short-term to help with congestion and minor bleeding if you do not have high blood pressure. However, these sprays should not be used for more than a few days at a time, as they can make congestion and nosebleeds worse.
Stuffing cotton or tissue into your nose is not recommended.
When should you go to an emergency room for a nosebleed?
- If bleeding cannot be stopped or keeps occurring (persistent or chronic).
- If bleeding is rapid, or if blood loss is large.
- If you feel weak or faint.
- If your nosebleed is associated with trauma to the face, loss of consciousness, or blurry vision.
- If your nosebleed is associated with a fever or headache.
- If your infant or baby has a nosebleed, contact the pediatrician.
What should I do if the doctor places nasal packs in my nostrils?
Nasal packs are used when less conservative measures fail. These packs are frequently placed on both sides of the nose. The packs are usually made of a material called "Merocel" which is a compressed sponge-like material or a gel gauze-wrapped balloon (called a "Rhino Rocket") used to help compress the area of the nose that is bleeding. The doctor usually leaves them in for several days. This requires a follow-up appointment so your doctor can remove the packs.
The patient will need someone to drive them and bring them home after the nasal packs are removed. During this time, the patient may be prescribed antibiotics and pain medication as needed.
It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. The doctor may permit the patient to clean the nostrils with hydrogen peroxide soaked Q-tips. Prevention methods described previously should be considered to help to avoid bleeding again.
Patients with nosebleeds should not take aspirin or any other blood-thinning products. If patients are already taking these medications when the nosebleed is noticed, they should notify their doctor.
What remedies or medications can you take to prevent nosebleeds?
The most common cause of nosebleeds is drying of the nasal membranes. If a person is prone to recurrent or frequent nosebleeds, it is often helpful to lubricate the nose with an ointment of some type. The ointment can be applied gently with a Q-tip or fingertip up inside the nose, especially on the middle portion (the septum).
Many people use remedies for nosebleeds such as
- A + D ointment,
- methylsalicylate/menthol (Mentholatum, BenGay, Icy Hot),
- neomycin/bacitracin/polymyxin (Neosporin ointment), or
- Saline mist nasal spray is often helpful (Ocean Spray).
Nosebleeds in children may be prevented by ensuring children do not pick their noses.
Subscribe to MedicineNet's General Health Newsletter
How do you prevent the nose from bleeding again?
- Go home and rest with your head elevated at 30 to 45 degrees.
- Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.
- Do not strain during bowel movements. Use a stool softener, for example, docusate (Colace).
- Do not strain or bend down to lift anything heavy.
- Try to keep your head higher than the level of your heart.
- Do not smoke.
- Eat a diet of soft, cool foods and beverages. No hot liquids for at least 24 hours.
- Do not take any medications that will thin the blood for example, aspirin, ibuprofen (Advil, Motrin, and others), clopidogrel bisulfate (Plavix) or warfarin (Coumadin). Do not stop taking any medications without first contacting your doctor.
- Your doctor may recommend some form of lubricating ointment for the inside of the nose.
- If re-bleeding occurs, try to clear the nose of blood clots by sniffing in forcefully. A temporary remedy such as a nasal decongestant spray, for example, Afrin or Neo-Synephrine may be helpful. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction so they are recommended for short-term use only. Do not use it if the patient has high blood pressure.)
- Repeat the steps above on how to stop the common nosebleed. If bleeding persists, call the doctor and/or go to the nearest emergency department.
Pain and Injury Resources
Health Solutions From Our Sponsors
Health Solutions From Our Sponsors
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
Shovlin, Claire. "Clinical manifestations and diagnosis of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)." UpToDate. July 2018. <http://www.uptodate.com/contents/hereditary-hemorrhagic-telangiectasia-osler-weber-rendu-syndrome>.
Suh Jeffrey D. and Rohit Garg. "Epistaxis (Nosebleeds)." Feb. 17, 2015. <http://care.american-rhinologic.org/epistaxis>.
Washington University Sinus Institute. "Prevention Tips for Nosebleeds." <http://sinus.wustl.edu/Details.aspx?ID=300>.
Top Nosebleed Related Articles
Allergy (Allergies)An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
AnemiaAnemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. There are several types of anemia such as iron deficiency anemia (the most common type), sickle cell anemia, vitamin B12 anemia, pernicious anemia, and aplastic anemia. Symptoms of anemia may include fatigue, malaise, hair loss, palpitations, menstruation, and medications. Treatment for anemia includes treating the underlying cause for the condition. Iron supplements, vitamin B12 injections, and certain medications may also be necessary.
Blood Disorders QuizExactly what is sickle cell anemia? Learn about sickle cell and other diseases by testing your IQ with the Blood and Bleeding Disorders Quiz.
Children's HealthChildren's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health, and community health.
Chronic Rhinitis and Post-Nasal DripChronic rhinitis (non allergic rhinitis) causes runny nose, sneezing, nasal itching and congestion. Post-nasal drip is drainage of mucus from the sinuses into the throat. Treatment includes over-the-counter (OTC) medications.
Dengue FeverDengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms and signs of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Drug Abuse and AddictionDrug abuse and addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
First Aid Sprains/StrainsView this First Aid slideshow on Care and Pain Relief. See how to get pain relief if you've bumped your head, sprained your ankle, or had a bruise, strain, or some other minor injury.
8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and MoreAre you always prepared for a first aid crisis? See which basic first aid items to pack to treat minor scrapes, cuts, and stings when you're on the go.
Head and Neck Cancer Symptoms and TreatmentsHead and neck cancers include cancers of the throat, lips, nose, mouth, larynx, and salivary glands. They are more likely to affect men over the age of 50. Head and neck cancer treatments include radiation, surgery, chemotherapy, targeted therapy, and hyperfractionated radiation therapy.
Hereditary Hemorrhagic TelangiectasiaHereditary Hemorrhagic Telangiectasia. Also called Osler-Rendu-Weber syndrome, hereditary hemorrhagic telangiectasia is an inherited condition that causes malformations of blood capillaries that develop on the skin and mucous membranes. They may cause nose bleeds and iron deficiency anemia resulting from bleeding in the stomach or elsewhere in the gastrointestinal tract. Treatments are blood or iron replacement.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
What Is High Blood Pressure (Hypertension)? Symptoms, TreatmentsWhat causes high blood pressure (hypertension)? What is normal blood pressure? Know the warning signs and symptoms of high blood pressure. Read about high blood pressure medications, diet, and long-term treatments.
HBP QuizTake this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and heart attacks. How are dizziness, snoring, and gout related to HBP? Find the answer and learn how medical treatments and lifestyle adjustments fight this common problem.
Things to Know About High Blood Pressure TreatmentHigh blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Nasal Airway Surgery (Septoplasty)Deviated septum surgery (septoplasty) and turbinectomy (nasal airway surgery) is performed on individuals who have a deviated or crooked septum or enlarged tissues (turbinates) within the nose. The goal of surgery is to improve breathing, control nosebleeds, relieve sinus headaches, and promote drainage of the sinus cavities. Risks and complications of surgery should be discussed with the surgeon prior to surgery.
Sinus Infection (Sinusitis)Sinus infection (sinusitis) is caused by allergies, infection, and chemicals or other irritants of sinuses. Signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Trauma/First Aid QuizWhat should be in your first-aid kit? Take this quiz to understand trauma and learn the truth about how to administer first aid.