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Nosebleeds: What to Do and When to Seek Treatment

A nosebleed can seem scary, but the good news is that most are harmless. They are common, too—a recent article in the New England Journal of Medicine estimates that 60% of people will get a nosebleed during their lifetime. But only 6% require medical treatment.

Because the nose is lined with many small blood vessels that are near the surface of the lining of your nose, they can easily become irritated or injured. The most common causes of nosebleeds, also known as epistaxis, are a dry climate, using cold or allergy medication that dry out the nose, nose picking, or facial trauma.

“Having a runny, drippy nose, or what we call rhinitis, can also cause bleeding when drainage from the nose dries out the nasal mucosa,” says Jessica Bailey, PA-C, who specializes in otolaryngology (ear, nose, and throat) issues in adults and children. Rhinitis occurs sometimes with allergies due to inflammation. Similar inflammation with sinusitis can also cause nose bleeds.

Those Most Susceptible to Nosebleeds

Nosebleeds are more common among children than adults. For one, they may be prone to nasal drainage and picking their nose. It is also quite common for children to get nose injuries when they are out playing. To help avoid nosebleeds, it can be helpful to swab a small amount of Vaseline using a cotton swab inside the child’s nose, or use a saline spray to moisturize the inside of the nose. A humidifier can help as well.

Others that are susceptible include:

  • Athletes and adults ages 45-80
  • Adults with medical conditions, such as hypertension, atherosclerosis, or a bleeding disorder
  • Those taking nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), blood thinners or aspirin
  • Pregnant people due to blood vessels in the nose that might expand during pregnancy

First Aid for Nosebleeds

Bailey suggests these steps to patients who suffer from nosebleeds:

  1. Blow the nose gently to remove any clots. The clots form as a reaction to the injury or bleeding, but Bailey says, “The clots continue to sequester blood or make it ooze a little bit, so getting the clots out is helpful.”
  2. Use an oxymetazoline nasal spray like Afrin® or Vicks Sinex®, spraying 2-3 times on the side of the nose that is bleeding to help close off the blood vessels.
  3. Pinch the end of the nose somewhat hard and maintain the pressure for 15 minutes to help stop the bleeding.

In some instances, a cold compress can help stop the bleeding as well. Patients are also advised to stay sitting upright instead of lying back, which can cause blood to drain down the throat.

What to do and not to do when you get a nosebleed

When to Visit a Health Care Provider

See a health care provider or seek emergency care if you:

  • Continue to bleed for 20 minutes or more
  • Begin feeling lightheaded
  • Can’t breathe through your nose
  • The nosebleed was caused by a head injury
  • Have frequent nosebleeds (two to three times a month)

“If we see a prominent blood vessel in the front part of the nose, we will use a cautery stick made of silver nitrate,” Bailey says. “That’s a chemical we put on the vessel to close it off, and that can really help with the bleeding.”

Most nosebleeds are anterior nosebleeds because they happen in the front of the nose. More serious and rare are the posterior nosebleeds which occur in the far back part of the nose.  “It's not an area patients can put pressure on at home to get the bleeding to stop,” Bailey explains. “So, a lot of times, the patients have to go into the ER, and we'll have to pack fully pack the nose to get that bleeding to stop. Sometimes we have to surgically intervene with those nosebleeds.”

Bailey says the surgical intervention may include a chemical cauterization, a heavier type of packing in the nose, or interventional radiology. These posterior nosebleeds usually occur after facial trauma or in individuals with high blood pressure.