The medical term for a nosebleed is epistaxis. Because of the position of the nose and its high density of blood vessels, most people will experience nosebleeds in their life.

Local trauma is the most common cause of nosebleeds. This can range from blows to the face to nose picking. However, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air can also cause them.

Nosebleeds are typically not a cause for concern. In rare cases, however, they can be life threatening.

In this article, we detail what nosebleeds are, what causes them, and how a person can treat and prevent them from occurring.

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A nosebleed is blood loss from the tissue inside a person’s nose. This is a common occurrence and rarely a cause for concern. The medical term for a nosebleed is epistaxis.

The nose is full of blood vessels, which is why even minor injuries to the face can cause the nose to bleed. Nosebleeds may also occur without outside influence. These may appear spontaneously but often result from unseen factors.

For example, when the mucous membrane — which is a mucus-secreting tissue inside the nose — dries, crusts, or cracks, it will cause bleeding.

Nosebleeds are also common in people taking anticoagulants, as well as those with bleeding disorders. Anticoagulants are blood-thinning medications, such as aspirin.

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Nose bleeds are caused by rupture of blood vessels in the nasal mucosa. Credit: Wenzdai Figueroa.

Nosebleeds can be either anterior or posterior.

In anterior nosebleeds, the bleeding comes from the wall between the two nostrils. This part of the nose contains many delicate blood vessels. Anterior nosebleeds are the most common type of nosebleed.

In posterior nosebleeds, the bleeding originates farther back and higher up the nose. This area of the nasal cavity contains artery branches that supply blood to the nose. Ruptures to these arteries cause heavy bleeding that may alternate with periods of no bleeding at all.

Posterior nosebleeds are often more serious than anterior ones and may require medical attention.

Common causes of nosebleeds

Common causes of nosebleeds include:

  • Direct injury: A blow to the face may damage the lining of a person’s nose, which can cause bleeding.
  • Irritation: Frequent picking or blowing of the nose can make its lining more likely to bleed.
  • Foreign bodies: Foreign bodies in the nasal cavity can disturb local tissue and blood vessels.
  • Air travel and altitude: Changes in altitude and air pressure can cause nasal blood vessels to expand and contract. These disturbances can lead to nosebleeds.
  • Inflammation: Inflammation due to allergies or infections, such as sinusitis, can damage blood vessels in the nose.
  • Humidity: Climates with low humidity can cause cracking in nasal tissue. This in turn can lead to bleeding.
  • Liver disease: Liver disease can interfere with blood clotting and result in frequent or severe nosebleeds.
  • Medications: The use of blood thinners or nonsteroidal anti-inflammatory drugs can cause nosebleeds. Nasal steroid medications can also dry the nasal lining, increasing the risk of a nosebleed.
  • Illegal drugs: The use of cocaine or other nasally ingested drugs can disturb the nasal lining and cause bleeding.
  • Irritants: Exposure to smoke or irritant fumes can damage the nasal lining and cause nosebleeds.
  • Radiation therapy and chemotherapy: Chemotherapy can lower the number of platelets in the blood. This makes blood clotting more difficult, and bleeding more common.

Other causes of nosebleeds

In some cases, underlying health conditions and less common occurrences can result in nosebleeds. These include:

The main symptom of a nosebleed is blood coming from the nose. This bleeding can vary in severity and can come out of one or both nostrils. Posterior nosebleeds are more likely to cause bleeding in both nostrils.

If the nosebleed occurs while a person is lying down, they will typically feel liquid in the back of the throat before the blood comes from the nose.

Most nosebleeds are not a medical emergency, and people can treat them at home. The first step of home treatment is to stop the bleeding.

A person should do the following:

  1. Sit down and pinch the soft parts of the nose firmly, breathing through the mouth.
  2. Lean forward to prevent blood from draining into the sinuses and throat, which can result in inhaling the blood or gagging.
  3. Sit upright so that the head is higher than the heart. This reduces blood pressure and slows further bleeding.
  4. Continue putting pressure on the nose, leaning forward, and sitting upright for 10–15 minutes so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is necessary.

Individuals should seek medical attention immediately if:

  • they experience frequent nosebleeds
  • they have sustained an injury to the head
  • they are taking blood-thinning medications
  • the bleeding lasts more than 10–15 minutes
  • they experience heart palpitations

A doctor will attempt to stop the bleeding as the first course of action. They may also check a person’s blood pressure and pulse.

If they suspect a fracture in the nose or face, they may also order an X-ray before recommending a suitable treatment option.

The severity of a person’s nosebleed, as well as its underlying cause, will direct treatment. Common treatment options include:

  • Nasal packing: A doctor may insert ribbon gauze or special nasal sponges into the nasal cavity to put pressure on the source of the bleed.
  • Cautery: In this procedure, a medical professional cauterizes, or burns, an area of nasal lining to seal bleeding blood vessels.
  • Embolization: In embolization, a surgeon will insert materials into blood vessels or arteries to block blood flow. This will stop any bleeding from the nose. However, doctors will rarely recommend this for nosebleeds.
  • Septal surgery: If a deviated septum is causing frequent nosebleeds, a doctor may straighten it during a surgery.
  • Ligation: This surgical procedure involves tying the ends of the identified blood vessels or arteries causing the bleeding. Medical professionals typically use nasal ligation if other treatment options have not worked. Only 5–10% of posterior nosebleed cases require ligation.

There are several things a person can do to prevent the onset of nosebleeds, such as:

  • avoiding picking the nose
  • avoiding blowing the nose too hard or too frequently
  • avoiding exertion or strenuous activity after nosebleeds
  • avoiding irritants and drying nasal medications
  • having the mouth open when sneezing

Keeping the lining of the nose moist can help prevent nosebleeds. For example, using nasal saline sprays and humidifiers at high altitudes or in dry climates may be of benefit to some people.

One 2018 review found a correlation between humidity and a reduction in nosebleed incidence in children. However, other reviews in pediatric settings found only insignificant links between the two.

Nosebleeds are a common occurrence that typically do not require emergency medical attention. They are often the result of direct injury or irritation, and a person can treat them at home with rest and nasal packing.

However, in some cases, nosebleeds occur due to underlying conditions. If a person experiences severe or recurrent bleeding that does not stop, they should contact a doctor.

People taking blood thinners or living with conditions that impair blood clotting should seek immediate emergency care if they experience a nosebleed. Surgical interventions include cautery, embolization, and ligation.

Minimizing irritation to the nasal lining, avoiding activities that may result in facial injury, and keeping the inside of the nose moist can all help prevent nosebleeds.

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