Nosebleed (Epistaxis)

What is epistaxis?

Epistaxis is the medical term for a nosebleed. A nosebleed — meaning a loss of blood from the tissue that lines the inside of your nose — can occur in one or both nostrils. Usually, it only affects one nostril.

Your nose has many tiny blood vessels in it. These vessels help warm and moisten the air you breathe. But they lie close to the inner surface of your nose. When air moves through your nose, it can dry and irritate your blood vessels. This makes them very easy to injure or break, causing a nosebleed.

About 6 in 10 people will have at least one nosebleed at some point in life. Most nosebleeds are minor and go away with at-home care. But if bleeding is severe or you have other symptoms (like vomiting or trouble breathing), you should go to the emergency room.

Types of nosebleeds

There are two main types of nosebleeds. Healthcare providers describe them by the site of the bleeding.

Anterior nosebleed

An anterior nosebleed starts in the front of your nose on the lower part of the wall that separates the two sides of your nose (septum). Capillaries and small blood vessels in this front area of your nose are fragile and can easily break and bleed. This is the most common type of epistaxis and usually isn’t serious. You can usually treat these nosebleeds at home.

Posterior nosebleed

A posterior nosebleed occurs deep inside your nose. A bleed in larger blood vessels in the back part of your nose near your throat causes this type. It can result in heavy bleeding, which may flow down the back of your throat. You may need medical attention right away for this type of nosebleed.

What are the symptoms of a nosebleed?

Usually, you won’t have any symptoms other than blood coming from your nose. If you have a posterior nosebleed, some blood may drain down the back of your throat into your stomach. This can cause a bad taste in the back of your throat and make you feel nauseated.

If you have additional symptoms, it may be a sign of a medical condition.

What causes a nosebleed in one nostril?

Most nosebleeds only affect one nostril, but they can affect both at the same time. Epistaxis has many causes. Fortunately, most aren’t serious.

The most common cause of nosebleeds is dry air. The air is typically drier in:

• Hot, low-humidity climates
• Areas at high altitudes
• Heated indoor spaces

Dry air causes your nasal membrane (the delicate tissue inside your nose) to dry out and become crusty or cracked. It’s then more likely to bleed when rubbed or picked or when blowing your nose.

You may also develop a nosebleed if you:

• Insert an object in your nose
• Injure your nose and/or face
• Have a deviated septum
• Have an upper respiratory infection or sinus infection that makes you keep sneezing, coughing and blowing your nose
• Have allergic or nonallergic rhinitis (inflammation of your nasal lining)
• Frequently use antihistamine or decongestant nasal sprays, which can dry out your nasal membranes
• Take blood-thinning medications like aspirin, NSAIDs or warfarin
• Breathe in chemicals from cleaning supplies, fumes at your workplace or other strong odors
• Use recreational drugs (like cocaine) that you inhale through your nose

Less common causes of nosebleeds include:

• Alcohol use
• Bleeding disorders, like hemophilia or von Willebrand disease
• High blood pressure
• Atherosclerosis
• Facial and nasal surgery
• Nasal tumors
• Nasal polyps
• Immune thrombocytopenia
• Leukemia
• Hereditary hemorrhagic telangiectasia
• Pregnancy

What causes nosebleeds while sleeping?

The reasons for nosebleeds during sleep are the same as the reasons why they occur during the day. Dry air, allergies and upper respiratory infections damage the delicate nasal membrane lining your nose. Sleeping with your head to the side may also put direct pressure on your nasal cavity and cause epistaxis at night.

Risk factors

Anyone can get nosebleeds. Most people will have at least one case in their lifetimes. But some people are more likely to have a nosebleed. They include:

• Children between the ages of 2 and 10. Dry air, colds, allergies and sticking fingers and objects into their noses make children more prone to nosebleeds.
• Adults between the ages of 45 and 80. Blood may take longer to clot as you approach the age of 50. Around this age, you’re also more likely to have high blood pressure, atherosclerosis (hardening of the walls of arteries) or a bleeding disorder.
• Those who are pregnant. Blood vessels in your nose expand while you’re pregnant, which puts more pressure on the delicate blood vessels in the lining of your nose.
• People taking blood-thinning medications. These drugs include aspirin and warfarin.
• People who have blood clotting disorders. These include hemophilia and von Willebrand disease.

When should I worry about a nosebleed?

Although seeing blood coming out of your nose can be alarming, most nosebleeds aren’t serious. You can usually manage them at home. But you should call a healthcare provider if:

• You get nosebleeds often
• You have symptoms of anemia (feeling weak, faint, tired, cold or short of breath or having pale skin)
• You get a nosebleed around the time you start a new medication
• You get nosebleeds and also notice unusual bruising all over your body — this combination may indicate a more serious condition such as a blood-clotting disorder (hemophilia or von Willebrand disease), leukemia or a nasal tumor

Call your pediatrician if your child is under age 2 and has a nosebleed. No matter your child’s age, it’s a good idea to mention any nosebleeds at their next well-check.

How doctors diagnose this condition

A healthcare provider asks you questions about your nosebleed, including:

• Length (in minutes) of your nosebleed
• Approximate amount of blood that came out
• How often you get them
• If the bleed involved one or both nostrils

They also ask about:

• Medications, including over-the-counter (OTC) blood-thinning medications like aspirin and drugs for colds and allergies
• Your biological family history, including any history of blood disorders
• Your use of alcohol and/or any recreational drugs in which you sniffed the drug up your nose

Next, your provider examines your nose to determine the source of the bleeding and what may have caused it. They use a small speculum to hold your nostril open and use various light sources or an endoscope (lighted scope) to see inside your nasal passages.

Your provider may use topical medications to numb (anesthetize) the lining of your nose and to narrow blood vessels. Your provider may remove clots and crusts from inside your nose. This can be unpleasant but isn’t painful.

Occasionally, they may order X-rays, a CT scan or blood tests to check for bleeding disorders, blood vessel abnormalities or nasal tumors.

What are the treatments for epistaxis?

Nosebleed treatment depends on the cause of the bleeding. Your provider will explain what’s necessary in your situation. Epistaxis treatment may include:

• Nasal packing. Your healthcare provider inserts gauze, special nasal sponges or foam, or an inflatable latex balloon into your nose to create pressure at the site of the bleed. Your provider may want to leave the material in place for 24 to 48 hours before removing it.
• Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. Your provider sprays a local anesthetic in your nostril first to numb the inside of your nose.
• Medication adjustments/new prescriptions. Reducing the amount of blood-thinning medications you take — or stopping them — can be helpful. In addition, medications for managing blood pressure may be necessary. Your provider may prescribe tranexamic (Lysteda®), a medication to help blood clot.
• Foreign body removal. If the cause of the nosebleed is a foreign object, your provider will remove it.
• Surgery. Surgery can repair a broken nose or correct a deviated septum (septoplasty).
• Ligation. In this procedure, your provider ties off the culprit blood vessel to stop the bleeding.

How can I stop a nosebleed at home?

Follow these steps to stop a nosebleed:

• Keep calm and breathe through your mouth.
• Sit up straight with your head slightly forward.
• Use your thumb and index finger to pinch the soft sides of your nose (just above your nostrils).
• Wait for the bleeding to stop. Use a tissue or damp washcloth to catch the blood.

At-home care is often enough. But some nosebleeds need medical care at a hospital. Have someone drive you to the nearest emergency room or call 911 (or your local emergency service number) if:

• You can’t stop the bleeding after more than 15 to 20 minutes of pinching your nose
• The blood loss is large (more than 1 cup)
• You’re taking blood-thinning medications (like aspirin or warfarin) or have a blood-clotting disorder and the bleeding won’t stop
• You’re having difficulty breathing
• You’ve swallowed blood and can’t stop vomiting
• Your nosebleed happened after a blow to your head or a serious injury (fall, car accident or a smash to your face or nose)

Can I drink water after a nosebleed?

Yes, you should drink plenty of fluids after a nosebleed. Good options include water, juice and other non-caffeinated liquids. After you experience epistaxis, some blood may drain down the back of your throat into your stomach. This may make you feel nauseated. But drinking water won’t affect a nosebleed.

Can you die from a nosebleed?

Nosebleeds that occur higher on your septum or deeper in your nose may be harder to control. However, nosebleeds are rarely fatal.

What can I do to prevent nosebleeds?

Here are some tips for preventing nosebleeds:

• Use a saline nasal spray or saline nose drops two to three times a day in each nostril to keep your nasal passages moist. You can purchase these products over the counter or you can make them at home.
• Add a humidifier to your furnace or run a humidifier in your bedroom at night to add moisture to the air.
• Spread a nasal gel or ointment in your nostrils with a cotton swab. Bacitracin®, Vaseline® or Ayr Gel® are examples of over-the-counter ointments you can use. Be sure not to insert the swab more than 1/4 inch into your nose. You can purchase these gels and ointments in most pharmacies.
• Avoid blowing your nose too forcefully.
• Sneeze through an open mouth. Always sneeze into a tissue or your elbow.
• Avoid putting anything solid into your nose, including your fingers.
• Limit your use of medications that can increase bleeding, like aspirin and ibuprofen. Always check with your healthcare provider before making any changes to your medications. This is especially important for prescribed medications like warfarin (Coumadin®) and nonsteroidal anti-inflammatory drugs (NSAIDs).
• See your provider if you can’t easily control your nasal allergy symptoms with over-the-counter or prescription medications. Make sure you closely follow the directions when using over-the-counter products. Overusing them can cause nosebleeds.
• Quit smoking. Smoking dries out your nose and irritates it.
• Wear protective headgear if you do activities that could result in an injury to your face and nose.

To help your child avoid nosebleeds, teach them not to put things up their nose. It’s also a good idea to keep your child’s fingernails short. Your pediatrician can offer more advice, too.

Are blood clots in a nosebleed normal?

Yes. Blood clots are clumps of blood that form in reaction to an injured blood vessel. Blood clotting prevents excessive bleeding when a blood vessel is damaged. When you pinch your nose to stop a nosebleed, the blood will begin to clot. It’ll normally remain there until you remove it or gently blow your nose.

Why do I get frequent nosebleeds?

There are many reasons you may be getting frequent nosebleeds. They can affect one or both nostrils. The most common causes are:

• You frequently use nasal sprays to treat allergy symptoms or colds/congestion
• The air is dry where you live
• You snort drugs into your nose

You may need to stop using sprays for a short period or stop them altogether. Talk with your provider if you use these products.

In rare cases, repeated epistaxis could be a sign of a bleeding disorder or other more serious conditions. If you have frequent nosebleeds, see a healthcare provider.