Nosebleeds
Topic OverviewMost 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 SymptomsDo you have a nosebleed problem? How old are you? Less than 4 years Less than 4 years 4 years or older 4 years or older 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? 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? Severe Severe difficulty breathing Moderate Moderate difficulty breathing Mild Mild difficulty breathing Can you stop the 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. 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. 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 TreatmentYou 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. Symptoms of shock (most of which will be present) 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. Symptoms of shock in a child may 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 NowBased 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 TodayBased 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 NowBased 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 TreatmentHow to stop a nosebleedFollow 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 treatmentCall 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.
PreventionThe 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 thinners, such as warfarin (such as Coumadin), enoxaparin (Lovenox), and clopidogrel (Plavix) 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 AppointmentTo prepare for your appointment, see the topic Making 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, warfarin (such as Coumadin), enoxaparin (Lovenox), clopidogrel (Plavix), 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?
CreditsByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Current as ofApril 3, 2017 Current as of:
April 3, 2017 Last modified on: 8 September 2017
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