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Nosebleeds
Topic Overview
Most nosebleeds are not usually 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 aspirin, other blood thinners, or 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 often in older adults because of other health conditions they may have. Medical treatment will be needed to control the bleeding from posterior epistaxis.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
Do you have a nosebleed problem?
Yes
Nosebleed problem
No
Nosebleed problem
How old are you?
Less than 4 years
Less than 4 years
4 years or older
4 years or older
Are you male or female?
Male
Male
Female
Female
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.
Have you had a head injury in the past 24 hours?
Yes
Head injury in past 24 hours
No
Head injury in past 24 hours
Have you had a nose injury in the past 2 weeks?
Yes
Nose injury in past 2 weeks
No
Nose injury in past 2 weeks
Do you have symptoms of shock?
The symptoms in an adult or older child are different than the symptoms in a young child.
Yes
Symptoms of shock
No
Symptoms of shock
Are you having trouble breathing (more than a stuffy nose)?
Yes
Difficulty breathing more than a stuffy nose
No
Difficulty breathing more than a stuffy nose
Would you describe the breathing problem as severe, moderate, or mild?
The symptoms in an adult or older child are different than the symptoms in a young child or baby.
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Would you describe the nosebleed as severe, moderate, or mild?
Severe
Severe nosebleed
Moderate
Moderate nosebleed
Mild
Mild nosebleed
Can you stop the bleeding?
Yes
Able to stop bleeding
No
Unable to stop bleeding
Have you kept the nose pinched shut for at least 20 minutes?
Yes
Has tried to stop nosebleed with direct pressure for at least 20 minutes
No
Has tried to stop nosebleed with direct pressure for at least 20 minutes
Do you feel lightheaded or dizzy, like you are going to faint?
It’s normal for some people to feel a little lightheaded when they first stand up. But anything more than that may be serious.
Yes
Feels faint
No
Feels faint
Do you take a medicine that affects the blood’s ability to clot, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix)?
These medicines can cause bleeding and can make it harder to control bleeding.
Yes
Takes medicine that affects blood’s ability to clot
No
Takes medicine that affects blood’s ability to clot
Have you had more than 1 nosebleed in the past 24 hours?
Yes
More than 1 nosebleed in past 24 hours
No
More than 1 nosebleed in past 24 hours
Are you having nosebleeds more often than is normal for you?
Some people get nosebleeds from time to time. What you are looking for is an increase in how often they occur.
Yes
Frequent nosebleeds
No
Frequent nosebleeds
Have you had more than 4 nosebleeds in 1 week?
Yes
More than 4 nosebleeds in 1 week
No
More than 4 nosebleeds in 1 week
Are you bleeding anywhere else?
Yes
Bleeding from other sites
No
Bleeding from other sites
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
To stop a nosebleed:
- Sit up straight, and tip your head slightly forward. (Do not tilt your head back. This may cause blood to run down your throat and make you vomit.)
- Pinch the soft part of your nose shut with your thumb and index finger for 10 full minutes.
- After 10 minutes, check to see if your nose is still bleeding. If it is, pinch it shut for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of pressure.
Symptoms of difficulty breathing can range from mild to severe. For example:
- You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).
Severe trouble breathing means:
- You cannot talk at all.
- You have to work very hard to breathe.
- You feel like you can’t get enough air.
- You do not feel alert or cannot think clearly.
Moderate trouble breathing means:
- It’s hard to talk in full sentences.
- It’s hard to breathe with activity.
Mild trouble breathing means:
- You feel a little out of breath but can still talk.
- It’s becoming hard to breathe with activity.
Severe trouble breathing means:
- The child cannot eat or talk because he or she is breathing so hard.
- The child’s nostrils are flaring and the belly is moving in and out with every breath.
- The child seems to be tiring out.
- The child seems very sleepy or confused.
Moderate trouble breathing means:
- The child is breathing a lot faster than usual.
- The child has to take breaks from eating or talking to breathe.
- The nostrils flare or the belly moves in and out at times when the child breathes.
Mild trouble breathing means:
- The child is breathing a little faster than usual.
- The child seems a little out of breath but can still eat or talk.
A nosebleed is severe if:
- You have moderate to large amounts of blood even after you have pinched the nose shut for 10 minutes.
- Your nose is still bleeding even after 20 full minutes of direct pressure.
A nosebleed is moderate if:
- You have some bleeding, but direct pressure stops it within 20 minutes.
- The nose bleeds small amounts of blood more than 3 times in 24 hours.
A nosebleed is mild if:
- You have a little bleeding, but direct pressure stops it within 10 minutes.
- The nose bleeds no more than 3 times in 24 hours, and each time the bleeding is mild.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.
Babies and young children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Being very sleepy or hard to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused. The child may not know where he or she is.
Abnormal bleeding means any heavy or frequent bleeding or any bleeding that is not normal for you. Examples of abnormal bleeding include:
- Nosebleeds.
- Vaginal bleeding that is different (heavier, more frequent, at a different time of month) than what you are used to.
- Rectal bleeding and bloody stools.
- Bloody or pink urine.
- Gums that bleed easily when you eat or gently brush your teeth.
When you have abnormal bleeding in one area of your body, it’s important to think about whether you have been bleeding anywhere else. This can be a symptom of a more serious health problem.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Nose Injuries
Head Injury, Age 4 and Older
Head Injury, Age 3 and Younger
Home Treatment
How to stop a nosebleed
Follow these steps to stop a nosebleed:
- Sit up straight, and tip your head slightly forward.
- 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.
- 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.
- 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 thin layer of a saline- or water-based nasal gel, such as NasoGel, or an antiseptic nasal cream 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
Call your doctor 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 you have tried prevention measures.
- Nosebleeds become more severe or more frequent.
Prevention
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 thin layer of a saline- or water-based nasal gel, such as NasoGel, to the inside of your nose.
- Limit your use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen, such as Tylenol, may be used to relieve pain. Be safe with medicines. Read and follow all instructions on the label.
- Use prescription blood-thinning medicine as instructed by your doctor.
- 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 Smoking.
- 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 thin layer of a saline- or water-based nasal gel, such as NasoGel, inside your nostrils to help prevent bleeding. But 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.
Preparing For Your Appointment
To prepare for your appointment, see the topicMaking the Most of Your Appointment.
You can help your doctor 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?
- What home treatment measures have you tried to stop the nosebleeds? Did they help?
- What nonprescription medicines have you tried? Did they help?
- What prescription and nonprescription medicines do you take? Are you taking aspirin or some other blood thinner 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?
Current as of: June 26, 2019
Author: Healthwise Staff
Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine
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