Nosebleeds

Nosebleeds involve bleeding from inside the nose. Many people have nosebleeds once in a while. They tend to be more common in children younger than 10 and adults older than 35. Nosebleeds also are called epistaxes (ep-ih-STAK-seez).

Nosebleeds may cause concern, but they’re generally only a minor annoyance. Typically, they aren’t dangerous. Nosebleeds are thought to be frequent if they happen more than once a week. 

The lining of the nose has many tiny blood vessels. Those blood vessels lie close to the surface and are easily irritated.

The two most common causes of nosebleeds are:

• Dry air. When nasal membranes dry out, they’re more likely to bleed.
• Nose picking.

Other causes of nosebleeds include:

• Accidents or other injury to the nose.
• Acute sinusitis
• Allergies
• Aspirin use.
• Bleeding conditions, such as hemophilia.
• Blood thinners, called anticoagulants, such as warfarin and heparin.
• Chemicals that can irritate the inside of the nose, such as ammonia.
• Chronic sinusitis
• Cocaine use.
• Common cold
• Deviated septum
• Nasal sprays, such as those used to treat allergies, if they’re used often.
• Nonallergic rhinitis
• Object in the nose.

Less common causes of nosebleeds include:

• Alcohol use.
• Hereditary hemorrhagic telangiectasia
• Immune thrombocytopenia (ITP)
• Leukemia
• Nasal and paranasal tumors
• Nasal polyps
• Nasal surgery.

In general, nosebleeds are not a symptom of or caused by high blood pressure.

Most nosebleeds aren’t serious. They typically stop on their own or with the use of self-care steps. Although nosebleeds can cause concern, the amount of blood lost typically is less than it might seem.

Seek immediate medical attention

Get help right away if nosebleeds:

• Follow an injury, such as a fall or a car accident.
• Involve a lot of blood.
• Make it hard to breathe.
• Last longer than 30 minutes.
• Happen in children younger than age 2.

Don’t drive yourself to an emergency room if you’re losing a lot of blood. Call 911 or your local emergency number. Or have someone drive you.

Schedule a doctor’s visit

Make an appointment to see your healthcare professional if you’re having nosebleeds more than once a week, even if you can stop them easily. It’s important to find the cause of nosebleeds that happen often.

Self-care

To treat nosebleeds at home, take these steps.

• Sit upright and lean forward. This position helps you avoid swallowing blood, which can cause an upset stomach.
• Gently blow your nose to clear out any clotted blood.
• Pinch your nose. Pinching your nose shut often stops the flow of blood. Follow these steps:

• Use your thumb and index finger to pinch both nostrils shut. Do this even if only one side is bleeding.
• Breathe through your mouth.
• Keep pinching your nose for about 15 to 20 minutes. Use a clock to keep track of the time.
• During this time, don’t stop pinching your nose to check if the bleeding has stopped. Keep pressure constant.

Some nosebleeds start too high up in the nose to be affected by pinching the nostrils shut. But those nosebleeds often still stop on their own.

• Use a nasal decongestant. If the bleeding hasn’t stopped after 20 minutes, spray both nostrils with 3 to 4 sprays of a nasal decongestant (Afrin, Mucinex, Nasin, others).
• Repeat pressure. If the bleeding continues, pinch your nose shut again. If a nosebleed doesn’t stop within 30 minutes, get emergency medical care.

After the bleeding has stopped, to keep it from starting again, don’t pick or blow your nose. Don’t bend down for several hours. Keep your head higher than the level of your heart.

Tips to help prevent nosebleeds

• Keep the lining of the nose moist. Especially during colder months when air is dry, put a thin coating of petroleum jelly (Vaseline) or other ointment into your nose with a cotton swab three times a day. Saline nasal spray also can help moisten the inside of the nose.
• Use a humidifier. A humidifier may help ease the effects of dry air on the nose by adding moisture to the air.
• Trim children’s fingernails. Keeping fingernails short helps discourage nose picking.