Nosebleeds: Causes, How to Stop One and When to See a Doctor

01Why

Why does the nose bleed?

The front part of the nasal septum has a rich network of tiny blood vessels (Kiesselbach’s plexus) lying just under a thin lining. Dry air, irritation or a small injury can break them. Nine in ten nosebleeds come from this area (anterior nosebleeds) and are easy to control. Posterior nosebleeds come from deeper in the nose, are less common, heavier and usually affect older people or those with high blood pressure; they need medical care.

02Causes

Common causes

• Dry air: winter heating, air conditioning, low humidity.
• Nose picking and rubbing.
• Colds, sinusitis and allergies, especially with frequent blowing and sneezing.
• Nasal sprays (steroid and decongestant) if aimed at the septum or overused.
• Injury: a blow to the nose, or a foreign object in a child.
• Medicines: aspirin, warfarin and other anticoagulants, clopidogrel, some herbal supplements.
• High blood pressure: rarely the cause, but may make bleeding harder to stop.
• Bleeding disorders (such as von Willebrand disease), liver disease, alcohol.
• Deviated septum, polyps and, rarely, tumours; hereditary haemorrhagic telangiectasia (HHT) is a rare cause of recurrent bleeds.
• Cocaine and other nasal drug use.

03First aid

How to stop a nosebleed

• Sit upright and lean slightly forward, so blood does not run down your throat.
• Pinch the soft part of the nose (below the bony bridge) firmly with thumb and index finger and hold for 10–15 minutes without checking.
• Breathe through your mouth.
• Spit out any blood in your mouth; swallowing it can upset the stomach.
• A cold compress on the bridge of the nose may help.
• After it stops, do not blow your nose, pick it, strain, lift heavy items or drink hot drinks for 24 hours.
• If it restarts, pinch for another 10–15 minutes.
• Do not tilt your head back, lie flat or pack the nose with tissue.

04Prevention

Preventing nosebleeds

• Keep the inside of the nose moist with saline spray or gel, or a thin layer of petroleum jelly.
• Humidify dry rooms.
• Keep fingernails short and avoid picking; discourage children.
• Aim steroid sprays slightly away from the septum.
• Treat allergies and avoid forceful nose blowing.
• Wear protective gear in contact sports.
• Do not stop prescribed anticoagulants on your own; talk to your doctor.

05Children

Nosebleeds in children

Children get frequent nosebleeds, mostly from dry air, picking and colds. They are rarely serious. Teach the lean-forward-and-pinch technique, keep nails short, use saline gel or ointment and humidify the bedroom. See a doctor if bleeds are very frequent (several a week), heavy, one-sided with a blocked nose, or if the child has easy bruising, gum bleeding, or a family history of bleeding disorders.

07Treatment

What a doctor can do

The doctor will examine the nose, check blood pressure and ask about medicines. For recurrent anterior bleeding, treatment may include cautery of the bleeding vessel (silver nitrate or electrocautery), nasal packing, absorbable haemostatic materials or tranexamic acid. Posterior bleeds may require a balloon or packing in hospital, and, rarely, procedures to tie off or embolise a vessel. Blood tests are done when a bleeding disorder is suspected. The AAO-HNSF guideline includes these options for nosebleed management.

08Cases

Three common situations

Winter nosebleed in a child at night: lean forward, pinch for 10–15 minutes, then use saline gel and a humidifier.

Older adult on warfarin with a nosebleed that will not stop: apply pressure and seek urgent care; do not change your anticoagulant without medical advice.

Frequent bleeds from one nostril in an adult: arrange an ENT exam to look for a vessel, polyp or other lesion.

09Older adults

Nosebleeds in older adults

Older adults are more likely to have nosebleeds because the lining of the nose becomes thinner and drier, blood pressure is more often raised and many take blood-thinning or antiplatelet drugs. They are also more likely to have posterior bleeds, which can be heavy. Anyone over 60 with a nosebleed that does not stop in 20 minutes should go to an emergency department. Do not stop anticoagulants on your own: discuss with the prescribing doctor.

10Summary

Key points to remember

Most nosebleeds are minor: lean forward and pinch for 10–15 minutes. Moisturise the nose, avoid picking and treat allergies. Seek care if bleeding is heavy, prolonged, recurrent or you take anticoagulants.

This guide is for general information and does not replace an assessment by your own doctor or ENT specialist.