Most nosebleeds are not usually serious and can be stopped with home treatment. Most nosebleeds occur in the front of the nose (anterior epistaxis) and involve only one nostril. Some blood may drain down the back of the nose into the throat. Many things may make a nosebleed more likely.
Changes in the environment. For example:
Cold, dry climates; low humidity
High altitude
Chemical fumes
Smoke
Injury to the nose. For example:
Hitting or bumping the nose
Blowing or picking the nose
Piercing the nose
An object in the nose. This is more common in children, who may put things up their noses, but may be found in adults, especially after an automobile accident, when a piece of glass may have entered the nose.
Medical problems. For example:
An abnormal structure inside the nose, such as nasal polyps or a deviated nasal septumClick here to see an illustration.
Colds, allergies, or sinus infections
High blood pressure
Kidney disease
Liver disease
Blood clotting disorders, such as hemophilia, leukemia, thrombocytopenia or von Willebrand's disease
Abnormal blood vessels in the nose, such as with Osler-Weber-Rendu syndrome. This syndrome is passed in families (inherited). The abnormal blood vessels make it hard to control a nosebleed.
Medicines. For example:
Those that affect blood clotting, such as warfarin (Coumadin), heparin, Lovenox, Plavix, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
Cold and allergy medicines
Oxygen
Nasal inhalers, such as Afrin
Steroid nasal sprays
Nasal abuse of illegal drugs, such as cocaine and amphetamines
A less common but more serious type of nosebleed starts in the back of the nose (posterior epistaxis) and often involves both nostrils. Large amounts of blood may run down the back of the throat. Posterior epistaxis occurs more frequently in older adults because of other health conditions they may have. Medical treatment will be needed to control the bleeding from posterior epistaxis.
Use the Check Your Symptoms section to decide if and when you should see a doctor.
Nosebleed Treatment
Nosebleed Self-Care at Home
A small amount of bleeding from a nosebleed requires little intervention. For example, if a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue, one should avoid forceful nose blowing, sneezing, and nose picking. This is usually enough to keep the bleeding from getting worse.
How to stop a nosebleed
Remain calm.
Sit up straight and lean slightly forward.
Lean your head forward. Tilting your head back will only cause you to swallow the blood.
Pinch the nostrils together and apply direct pressure with the thumb and index finger for approximately 10 minutes. Time it to make sure the nostrils are not released earlier.
Spit out any blood in the mouth. Swallowing blood may make the affected individual vomit.
This technique will stop the majority of simple nosebleeds.
What to do after the bleeding has stopped
Once the bleeding has stopped, try to prevent any further irritation to the nose, such as sneezing, nose blowing, or straining for 24 hours.
Ice packs do not help nosebleeds.
Exposure to dry air, such as in a heated home in the winter, can contribute to the problem. Adding moisture to the air with a humidifier or vaporizer will help keep the nose from drying out and triggering more bleeding. Another option is to place a pan filled with water near a heat source, such as a radiator, which allows the water to evaporate and adds moisture to the air.
Nasal saline sprays or other lubricating ointments or gels also may be useful to promote tissue healing and keeps the nasal passages moist.
Nosebleed Medical Treatment
Anterior nosebleed
A minor nosebleed that has stopped may require no treatment at all. Frequently, the body will form a clot at the site of the bleeding that stops any further bleeding.
If the source of the bleeding is from a blood vessel that is easily seen, a health care practitioner may cauterize it (seal the blood vessel) with a chemical called silver nitrate after applying a local topical anesthetic inside the nose. Chemical cauterization is most effective when the visible bleeding originates from the very front part of the nose.
In more complicated cases, a nasal packing may be required to stop the bleeding. Nasal packings apply direct pressure inside the nostril to promote clotting and stop the bleeding. Many different types of nasal packings are available, including petroleum (Vaseline) gauze, balloon nasal packs, and synthetic sponge packs that expand when moistened. The decision as to which one to use is made by the health care practitioner.
Most people who receive an anterior nasal packing go home with it in place. Because these packings block the drainage pathways of the sinuses, antibiotics may be started to prevent a sinus infection. The packing is usually left in place for 48 to 72 hours.
Posterior nosebleed
A posterior nosebleed that does not stop bleeding on its own requires admission to the hospital, as these types of nosebleeds can be very serious. In order to control the bleeding, a posterior nasal packing will be inserted by your health care practitioner. Different types of packings are available, though a balloon nasal pack is most commonly used.
Unlike anterior nasal packings, posterior nasal packings are much more uncomfortable and frequently require sedatives and pain medications. Furthermore, potential complications such as infection and blockage of the breathing passages may be encountered with posterior nasal packings. Consequently, admission to the hospital, close monitoring and consultation with an otolaryngologist are required.
Posterior packings are usually left in place for 48 to 72 hours. If this does not control the bleeding, arterial embolization or certain surgical procedures may be required.
Nosebleed Self-Care at Home
A small amount of bleeding from a nosebleed requires little intervention. For example, if a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue, one should avoid forceful nose blowing, sneezing, and nose picking. This is usually enough to keep the bleeding from getting worse.
How to stop a nosebleed
Remain calm.
Sit up straight and lean slightly forward.
Lean your head forward. Tilting your head back will only cause you to swallow the blood.
Pinch the nostrils together and apply direct pressure with the thumb and index finger for approximately 10 minutes. Time it to make sure the nostrils are not released earlier.
Spit out any blood in the mouth. Swallowing blood may make the affected individual vomit.
This technique will stop the majority of simple nosebleeds.
What to do after the bleeding has stopped
Once the bleeding has stopped, try to prevent any further irritation to the nose, such as sneezing, nose blowing, or straining for 24 hours.
Ice packs do not help nosebleeds.
Exposure to dry air, such as in a heated home in the winter, can contribute to the problem. Adding moisture to the air with a humidifier or vaporizer will help keep the nose from drying out and triggering more bleeding. Another option is to place a pan filled with water near a heat source, such as a radiator, which allows the water to evaporate and adds moisture to the air.
Nasal saline sprays or other lubricating ointments or gels also may be useful to promote tissue healing and keeps the nasal passages moist.
When to Seek Medical Care
Contact a health care practitioner if the person experiences the following:
repeated episodes of nosebleeds;
additional bleeding from places other than the nose, such as in the urine or stool;
easy bruising;
if the person has nosebleeds and is taking any blood-thinning medications (for example, aspirin or warfarin [Coumadin]);
if the person has nosebleeds and any underlying disease that may affect blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot); or
if the person has nosebleeds and recently had chemotherapy.
Go to the hospital if the person with the nosebleed:
is still bleeding after pinching the nose for 10 to 20 minutes;
is having repeated episodes of nosebleeds over a short time or if a large amount of blood is lost;
feels dizzy or light-headed, or feels that they are going to pass out;
has a rapid heartbeat or trouble breathing;
is vomiting blood;
has a rash or temperature greater than than 101.4 F (38.5 C); or
if a health care practitioner instructs you to go to a hospital's emergency department.
Nosebleed Diagnosis
The diagnosis of a nosebleed is generally self-evident and apparent upon seeing the patient, though some individuals may not have any active bleeding by the time they arrive to seek medical care. More importantly, however, your health care practitioner will need to locate the source of bleeding and determine whether the person has an anterior or posterior nosebleed. Furthermore, other less common causes of nosebleeds may need to be sought depending upon the individual's medical history and the findings on the physical exam.
To examine the nose, the health care practitioner will place medications into the nostrils (usually with a cotton ball) in order to numb the inside of the nose and constrict the blood vessels in that area. Numbing medications make the examination less painful. The medication that constricts the blood vessels shrinks the nasal tissue and may even control the bleeding to make it easier to see inside this small, dark cavity and identify the exact site of bleeding. A metallic instrument called a nasal speculum is then inserted into the nostrils to visualize the inside of the nose.
The diagnosis diagnosis of a posterior nosebleed is usually made when attempts to control the bleeding with measures used for an anterior nosebleed have failed, or when an anterior source is not identified. Seeing the source of a posterior nosebleed is nearly impossible. Other findings suggestive of a posterior nosebleed include heavy bleeding from both nostrils or visualizing blood draining down the back of the throat.
Laboratory tests are usually not needed. For severe nosebleeds, however, a blood count may be checked to assess the degree of blood loss. For individuals with blood clotting disorders or for those taking blood thinners, additional blood tests may also be ordered. If there are concerns about malignancy or other less common causes of nosebleeds, further blood tests and/or imaging studies may be considered.
Nosebleed Prognosis
With proper treatment, the vast majority of people recover from nosebleeds with no long-term effects. A minority of patients may experience severe bleeding, which can rarely be life-threatening.
Synonyms and Keywords
nosebleeds, nose bleeds, epistaxis, nasal hemorrhage, bloody nose, nose bleed, nasal bleeding, anterior nosebleed, anterior nose bleed, posterior nosebleed, posterior nose bleed, nasal packing
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