Health Library NosebleedsFrom Healthwise

Most nosebleeds are not serious and can be stopped with home treatment. Most nosebleeds occur in the front of the nose (anterior epistaxis) and involve only one nostril. Some blood may drain down the back of the nose into the throat. Many things may make a nosebleed more likely.

• Changes in the environment. For example:
  • Cold, dry climates; low humidity
  • High altitude
  • Chemical fumes
  • Smoke
• Injury to the nose. For example:
  • Hitting or bumping the nose
  • Blowing or picking the nose
  • Piercing the nose
  • An object in the nose. This is more common in children, who may put things up their noses, but may be found in adults, especially after an automobile accident, when a piece of glass may have entered the nose.
• Medical problems. For example:
  • An abnormal structure inside the nose, such as nasal polyps or a deviated nasal septum
  • Colds, allergies, or sinus infections
  • High blood pressure
  • Kidney disease
  • Liver disease
  • Blood clotting disorders, such as hemophilia, leukemia, thrombocytopenia or von Willebrand's disease
  • Abnormal blood vessels in the nose, such as with Osler-Weber-Rendu syndrome. This syndrome is passed in families (inherited). The abnormal blood vessels make it hard to control a nosebleed.
• Medicines. For example:
  • Those that affect blood clotting, such as warfarin (Coumadin), heparin, Lovenox, Plavix, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Cold and allergy medicines
  • Oxygen
  • Nasal inhalers, such as Afrin
  • Steroid nasal sprays
• Nasal abuse of illegal drugs, such as cocaine and amphetamines

A less common but more serious type of nosebleed starts in the back of the nose (posterior epistaxis) and often involves both nostrils. Large amounts of blood may run down the back of the throat. Posterior epistaxis occurs more frequently in older adults because of other health conditions they may have. Medical treatment will be needed to control the bleeding from posterior epistaxis.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• A severe nosebleed with signs of shock:
  • In children
  • In adults and older children
• Unconsciousness
• Moderate to severe difficulty breathing:
  • In children
  • In adults and older children
• A serious head injury

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If your nosebleed occurred after any of the following situations, evaluate those symptoms first.

• A head injury: Go to the topic Head Injuries, Age 4 and Older or Head Injuries, Age 3 and Younger. If a visit to a health professional is not needed for the head injury, return to the topic Nosebleeds for more information.
• An injury or blow to the nose: Go to the topic Nose Injuries.
• An object in the nose: Go to the topic Objects in the Nose.

	Yes	Do you have a nosebleed? See how to stop a nosebleed.
When to See a Doctor See significance of nosebleed if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you having a severe nosebleed? Yes Are you unable to stop a nosebleed after applying pressure for 10 to 20 minutes? Call your health professional today if you answer "Yes" to the following question. Yes Have you had a moderate nosebleed that stops with direct pressure but has returned several times in the past 24 hours? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had fewer than 4 mild nosebleeds in the past 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have frequent nosebleeds with other bruising or bleeding?
When to See a Doctor See significance of abnormal bruising or bleeding if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have frequent nosebleeds and other bleeding or abnormal bruising? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you taking a blood thinner, such as warfarin (Coumadin) or heparin?
When to See a Doctor See significance of blood thinners if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Have you had more than 1 nosebleed during the past 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had more than 4 nosebleeds in 1 week?
When to See a Doctor See significance of recurring nosebleeds if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had 4 or more mild to moderate nosebleeds in 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

How to stop a nosebleed

Follow these steps to stop a nosebleed:

• Sit up straight and tip your head slightly forward. See an illustration of how to stop a nosebleed.

  Note: Do not tilt your head back. This may cause blood to run down the back of your throat, and you may swallow it. Swallowed blood can irritate your stomach and cause vomiting. And vomiting may make the bleeding worse or cause it to start again. Spit out any blood that gathers in your mouth and throat rather than swallowing it.

• Blow all the clots out of your nose. This may require fairly forceful blowing, and the bleeding may increase when clots come out of the nose.
• After blowing out the clots, use your thumb and forefinger to firmly pinch the soft part of your nose shut. The nose consists of a hard, bony part and a softer part made of cartilage. Nosebleeds usually occur in the soft part of the nose. Spraying the nose with a medicated nasal spray (such as Afrin) before applying pressure may help stop a nosebleed. You will have to breathe through your mouth.
• Apply an ice pack to your nose and cheeks. Cold will constrict the blood vessels and help stop the bleeding.
• Keep pinching for a full 10 minutes. Use a clock to time the 10 minutes. It can seem like a long time. Resist the urge to peek after a few minutes to see if your nose has stopped bleeding.
• Check to see if your nose is still bleeding after 10 minutes. If it is, hold it for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of direct pressure.
• Put a light coating of a moisturizing ointment, such as Vaseline, inside your nose. Do not blow your nose or put anything else inside your nose for at least 12 hours after the bleeding has stopped.
• Rest quietly for a few hours.

Nosebleeds in children

• Crying increases the blood flow to the face and makes bleeding from the nose worse. If your child has a nosebleed and is crying, speak in a quiet, relaxed manner to help control your child's fear.
• Make sure to check for an object in the nostrils. If an object is found, go to the topic Objects in the Nose.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• A nosebleed cannot be stopped after 10 to 20 minutes of direct pressure.
• Nosebleeds recur 4 or more times in 1 week after trying prevention measures.
• Nosebleeds become more severe or more frequent.

The following tips may reduce your risk for developing nosebleeds.

• Use saltwater (saline) nose drops or a spray.
• Avoid forceful nose-blowing.
• Do not pick your nose or put your finger in your nose to remove crusts.
• Avoid lifting or straining after a nosebleed.
• Elevate your head on one or two pillows while sleeping.
• Apply a light coating of a moisturizing ointment, such as Vaseline, to the inside of your nose.
• Limit your use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, if you have frequent nosebleeds. Acetaminophen, such as Tylenol or Panadol, may be used to relieve pain.
• Do not use nonprescription antihistamines, decongestants, or medicated nasal sprays. These medicines can help control cold and allergy symptoms, but overuse may dry the inside of the nose (mucous membranes) and cause nosebleeds.
• Keep your blood pressure under control if you have a history of high blood pressure. This will help decrease the risk of nosebleeds.
• Do not smoke. Smoking slows healing. For more information, see the topic Quitting Tobacco Use.
• Do not use illegal drugs, such as cocaine or amphetamines.

Make changes in your home

• Humidify your home, especially the bedrooms. Low humidity is a common cause of nosebleeds.
• Keep the heat low [60 °F (16 °C) to 64 °F (18 °C)] in sleeping areas. Cooler air does not dry out the nasal passages.
• Breathe moist air, such as from a shower, for a while if your nose becomes very dry. Then put a little moisturizing ointment, such as Vaseline, inside your nostrils to help prevent bleeding. However, do not put anything inside your nose if your nose is bleeding. Occasional use of saline nasal sprays may also help keep nasal tissue moist.

Prevent nosebleeds in children

• Keep your child's fingernails trimmed and discourage nose-picking.
• Caution children not to put any object in their noses.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• How often do you have nosebleeds?
• When was your last nosebleed?
• How long do your nosebleeds usually last? Do you swallow blood?
• What do you think may be causing your nosebleeds?
• Have you had a nose injury?
• Have you recently been in an automobile accident?
• What home treatment measures have you tried to stop the nosebleeds? Did they help? Be sure to include any nonprescription medicines you have taken.
• What prescription and nonprescription medicines do you take? Are you taking blood thinners, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs)? Do you take herbal supplements or vitamins? Bring a list of your medicines with you to your appointment.
• Do you have a family history of bleeding problems?
• Do you have any health risks?

• Allergic Rhinitis
• Body Piercing Problems
• Facial Injuries
• Facial Problems, Noninjury
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• High Blood Pressure (Hypertension)
• Home Blood Pressure Test
• Nose Injuries
• Objects in the Nose
• Quitting Tobacco Use
• Respiratory Problems, Age 12 and Older
• Sinusitis

Author:	Jan Nissl, RN, BS	Last Updated: April 20, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Charles M. Myer, III, MD - Otolaryngology
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