Nosebleeds, also known as epistaxis, occur when blood vessels inside the nose are damaged. This damage leads to blood flowing out from inside the nose.
Depending on the area where tissue damage occurs, nosebleeds are categorized either as anterior or front or as posterior or back.
Posterior nosebleeds involve bleeding from the back of the nasal cavity. Blood flow tends to be heavier than in anterior nosebleeds.
At least 60 percent of people are estimated to be affected by at least one nosebleed in their lifetime with 6 percent requiring professional treatment.
The two main types of nosebleeds are anterior nosebleeds and posterior nosebleeds.
In an anterior nosebleed, blood comes from the wall between the two nostrils. This wall is called the septum, and it contains delicate blood vessels that can be easily damaged. Anterior nosebleed is not usually serious and can often be treated at home. Children most commonly experience anterior nosebleeds.
A posterior nosebleed occurs when the artery branches that supply blood to the nose become damaged. This arterial damage leads to heavier bleeding than anterior nosebleeds, and the blood can often flow into the throat.
If bleeding from the nose occurs for more than 20 minutes, or if it starts after an injury to the head or face, it is likely to be a posterior nosebleed.
Posterior nosebleeds can be caused by:
Trauma or irritation
Examples of trauma that can typically lead to nosebleeds include:
- blowing the nose too harshly or too frequently
- frequent picking or scratching the nose
- inhaling chemicals, such as ammonia
- frequent exposure to cigarette smoke
- prolonged exposure to dry air
- injury to the nose or skull
Posterior nosebleeds can also occur after surgery to the head or nose.
Medical conditions or medications
Relevant medical conditions include:
- high blood pressure
- carotid artery aneurysm
- calcium deficiency
- blood disorders, such as hemophilia or leukemia
- tumors around or in the nose
- inflammatory diseases and immune disorders
- atherosclerosis, causing hardening and narrowing of the arteries
- Von Willebrand disease, a genetic blood disorder
Medications that increase the risk of nosebleeds include anti-inflammatory drugs and blood thinners. Examples of these include:
Some complementary and alternative medicines, such as ginkgo biloba and vitamin E, may increase the risk of bleeding from the nose.
According to the American Rhinologic Society, the most common known causes of nosebleeds in general are trauma, foreign objects placed inside the nose, infection, and continued exposure to dry air.
However, many cases of bleeding from the nose are classed as idiopathic, meaning the cause is unknown.
The first-line treatments for nosebleeds include holding pressure on the nose and nasal decongestant sprays.
The following steps can be taken to treat a nosebleed:
- remain calm
- sit upright, to keep the head above heart level
- lean forward, to prevent blood entering the throat
- gently blow out any clotted blood
- use a nasal decongestant spray, such as oxymetazoline or neo-synephrine
- with the thumb and index finger, pinch the soft area at the front of the nose
- avoid placing tissue, gauze, or other objects in the nose
- hold this position for up to 15 minutes
- check if bleeding has stopped
- if bleeding has not stopped after 20 minutes, seek immediate medical attention
After the bleeding has stopped, it can be helpful to place a bag of ice on the nose to reduce pain and swelling. Do not pick or blow the nose for several hours following the bleed. Avoid irritants, such as cigarette smoke, until the injury has healed.
These steps work particularly well for anterior nosebleeds. For posterior nosebleeds that do not resolve spontaneously, further medical care may be needed.
The most common medical treatments for nosebleeds include:
- Packing the nose: Packing the anterior or posterior area of the nose with a cotton gauze, nasal sponge, or inflatable latex balloon places direct pressure on the source of the bleed, helping to stop blood flow. Inflatable balloon catheters work well to stop blood flow for posterior bleeding sources.
- Chemical or electric cauterization: This technique is used if pressure alone does not stop the nosebleed, in cases of anterior small vessel sources. The blood vessel is burned with silver nitrate, a laser, or an electric current.
- Surgical ligation: Also known as clipping, ligation is a surgical procedure that involves tying the ends of the vessel or artery that is causing the bleeding.
Though not always required, medical treatment may be necessary if nosebleeds persist or happen frequently.
Posterior nosebleeds can be prevented by:
- Avoiding irritations, such as picking or placing foreign objects inside the nose.
- Blowing the nose gently and only when necessary.
- Using a humidifier in dry climates.
- Avoiding situations or activities that increase the risk of trauma or a blow to the face, such as in contact sports.
- Managing conditions that increase the risk of nosebleeds.
- Discussing with a doctor the use of medications that increase the risk of nosebleeds.
- Avoiding strenuous activity for at least 7 days, following a nosebleed, to prevent a recurrence.
When to see a doctor
Seek emergency medical treatment if:
- bleeding from the nose persists for 20 minutes or longer
- blood is felt or tasted in the throat, even if the bleeding has stopped
- the nosebleed occurs after an injury
- symptoms, such as dizziness, fever, fainting, or vomiting occur
- there is more blood than is typically associated with a nosebleed
- the bleed interferes with breathing
- a nosebleed occurs in a child under 2 years of age
- the bleeding could be linked to a medical condition or medication use
It is also important to see a doctor if nosebleeds are frequent, even if they can be stopped easily.
Nosebleeds are generally not serious. Frequent or recurrent nosebleeds may suggest an underlying issue that needs to be addressed. A posterior nosebleed is more concerning than an anterior one and often requires medical treatment.
Most people will recover from posterior nosebleed without any complications or long-term problems. However, a minority may have severe bleeding. In rare cases and if left untreated, this can be life-threatening.