What Is It?

The inside of the nose is covered with moist, delicate skin that has a rich supply of blood vessels. When the nasal skin is injured, even from a minor nick or scratch, these blood vessels tend to bleed rather heavily. For this reason, nosebleeds are very common, especially anterior nosebleeds, which involve the lower front portion of the wall between the nostrils (nasal septum). In most cases, this type of nosebleed is not serious, and it usually can be stopped with some local pressure and a little patience.

Only rarely is a nosebleed life threatening or actually fatal. In these cases, the hemorrhage is usually from a posterior nosebleed, in which the site of bleeding is higher and deeper within the nose and the blood flows primarily down the back of the throat. Also, in most cases of life-threatening nosebleeds, some underlying health problem (hypertension, a bleeding disorder, use of anticoagulant medication) is working against the clotting process.

Although nosebleeds can affect people of all ages and backgrounds, certain people are at higher risk because of their environment, work history, underlying health problems or use of medications that increase the tendency to bleed. Common risk factors for nosebleeds include:

• A hot, dry indoor climate — This is an important trigger for nosebleeds in parts of the United States in which heat (especially forced-air heat) is used during the winter. The hot, dry indoor air causes the delicate nasal skin to crack and bleed.
  
  
• A deviated septum — A nasal septum that is shifted away from the midline (deviated) produces an uneven airflow pattern within the nostrils. The altered airflow pattern causes the skin on one side of the nasal septum to become dry and cracked, increasing the risk of bleeding.
  
  
• Colds and allergies — Both upper respiratory tract infections and allergies trigger nasal inflammation, which can increase the risk of bleeding. Strenuous nose blowing to clear the nose also can cause a nose to bleed or to start bleeding again after a nosebleed has been controlled.
  
  
• Exposure to irritating chemicals — The primary culprit is cigarette smoke, even secondhand cigarette smoke. Workers also may develop nosebleeds from on-the-job exposure to sulfuric acid, ammonia, gasoline or other chemical irritants.
  
  
• Medical conditions — Examples include chronic renal disease (kidney failure), thrombocytopenia (low levels of the blood platelets needed for clotting) and hereditary bleeding disorders, such as hemophilia.
  
  
• Heavy alcohol use — Alcohol seems to interfere with the normal activity of platelets in the blood, and this increases the time needed for blood clots to form. It also makes superficial blood vessels dilate, making them more likely to bleed.
  
  
• Medications that interfere with blood clotting — These include prescription anticoagulants (blood-thinners) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin and others).

Nosebleeds also commonly are caused by trauma, such as nose picking, forceful blowing of the nose or severe facial trauma from an automobile accident or contact sports.

Nosebleeds vary in location and severity, and they can involve one or both nostrils. In a posterior nosebleed (higher up in the nose), large amounts of blood typically flow down the back of the throat. However, the person may swallow some blood even in an anterior nosebleed (from the front of the nose), especially if he or she is not sitting up and leaning forward.

In otherwise healthy people, most mild anterior nosebleeds can be self-diagnosed and treated at home. If your nosebleed is severe and does not respond to first-aid measures, you will need to see a doctor immediately.

The doctor will review your health history and current medications. He or she also will ask you to estimate the amount of blood you’ve lost, which usually is based on how long you’ve been bleeding and the number of soaked towels or tissues you’ve used. Next, the doctor will examine your nose to determine whether the bleeding is anterior or posterior. If necessary, he or she may insert an endoscope (a lighted, tubelike instrument) into your nose to visualize the site of bleeding. Blood tests may be done to rule out any bleeding abnormalities.

When performed correctly, simple first-aid measures usually will stop an uncomplicated anterior nosebleed within minutes.

You can help prevent nosebleeds by:

• Not picking your nose
• Being gentle whenever you blow your nose
• Not smoking
• Using a humidifier if your indoor climate is dry during the winter months
• Using a nonprescription saline nasal spray to moisturize the inside of your nose
• Applying a dab of petroleum jelly to the inside of your nostrils before bedtime
• Avoiding facial trauma by wearing a seatbelt and shoulder harness in the car and by using well-fitting headgear to protect your face during contact sports, such as football or karate
• Using protective equipment to avoid breathing irritating chemicals at work

If you are bleeding from the front of your nose, begin by trying the following first-aid measures:

• Sit up so your head is above the level of your heart, lean forward slightly and breathe through your mouth.
• Pinch the entire front of your nose, just above your nostrils, and hold it for five minutes.
• Apply an ice pack or a plastic bag of crushed ice to your nose to slow the blood flow.
• After you have pinched your nose for five minutes, release it to see if bleeding continues.
• If your nose is still bleeding, pinch it for an additional 10 minutes.
• After 10 minutes, release your nose again. If you are still bleeding, seek emergency medical help.

When simple first aid does not stop a nosebleed, your doctor may treat the problem by:

• Packing your nose with gauze
• Cauterizing (sealing off) the injured blood vessel with a chemical, such as silver nitrate, or with an electric probe
• Applying medication directly to the inside of your nose to stop the bleeding
• Using other methods, such as cryotherapy (using cold temperature to freeze the site of bleeding), laser therapy (using a laser beam to seal the bleeding blood vessel) or, in rare cases, embolization (injecting a special plug into the bleeding vessel to block blood flow) or surgery

If you cannot stop a nosebleed by using the first-aid measures, call your doctor immediately or go to an emergency room.

Also, contact your doctor if you have a persistent, less dramatic oozing of blood from your nose, especially if you also have persistent nasal stuffiness or a foul-smelling nasal discharge. In older people, especially smokers, these can be symptoms of a tumor inside the nose or sinuses. In a young child, these may be signs that a foreign object is lodged in a nostril.

With a little patience and localized pressure, almost all uncomplicated anterior nosebleeds respond to simple first-aid measures. Even the rare nosebleed that requires a doctor’s care usually can be treated successfully with packing, cauterization or another option.

In general, hospital treatment for a severe nosebleed is most likely in people older than 60. Among those who use anticoagulants to treat circulatory problems, nosebleeds can be a persistent problem.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.