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Nosebleeds

DEFINITION


Nosebleeds involve bleeding from the inside of your nose. Many people have occasional nosebleeds, also known as epistaxis (ep-ih-STAK-sis). Nosebleeds may be scary, but generally are a minor annoyance. Frequent nosebleeds are those that occur more than once a week.


Seek emergency medical attention if nosebleeds are severe, last longer than 30 minutes, interfere with breathing or follow an injury.




CAUSES


The lining of your nose contains many tiny blood vessels that lie close to the surface and are easily damaged.


The two most common causes of nosebleeds are:

  1. Dry air — when your nasal membranes dry out, they’re more susceptible to bleeding and infections
  2. Nose picking


Other causes of nosebleeds include:

  1. Acute sinusitis
  2. Allergies
  3. Aspirin use
  4. Blood thinners (anticoagulants), such as warfarin and heparin
  5. Chemical irritants, such as ammonia
  6. Chronic sinusitis
  7. Cocaine use
  8. Common cold
  9. Deviated septum
  10. Foreign body in the nose
  11. Nasal sprays, such as those used to treat allergies, if used frequently
  12. Nonallergic rhinitis
  13. Trauma to the nose


Less common causes of nosebleeds include:

  1. Alcohol use
  2. Hemophilia
  3. Hereditary hemorrhagic telangiectasia
  4. Idiopathic thrombocytopenic purpura (ITP)
  5. Leukemia
  6. Nasal polyps
  7. Nasal surgery
  8. Nasal tumor
  9. Sarcoidosis


Studies haven’t confirmed an association between high blood pressure and nosebleeds. Some specialists suggest that high blood pressure may prolong bleeding if you have a nosebleed.




WHEN TO SEE A DOCTOR


Most nosebleeds aren’t serious and will stop on their own or by following self-care steps.


Seek emergency medical care if your nosebleed:

  • Involves a greater than expected amount of blood

  • Makes it difficult for you to breathe

  • Won’t stop after 30 minutes even with compression

  • Occurs after an injury, such as a car accident


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.


Talk to your doctor if you’re having frequent nosebleeds, even if you can stop them fairly easily. It’s important to determine the cause of frequent nosebleeds.


Self-care steps for occasional nosebleeds include:

  • Sit upright and lean forward. By remaining upright, you reduce blood pressure in the veins of your nose. This discourages further bleeding. Sitting forward will help you avoid swallowing blood, which can irritate your stomach.

  • Pinch your nose. Use your thumb and index finger to pinch both nostrils shut, even if only one side is bleeding. Breathe through your mouth. Continue to pinch for five to 10 minutes. This maneuver puts pressure on the bleeding point on the nasal septum and often stops the flow of blood.

  • Repeat. If the bleeding doesn’t stop, repeat these steps for up to a total of 15 minutes.


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