If you frequently experience nosebleeds, you might come to regard them as nothing more than a messy inconvenience.
Yet, even though most nosebleeds are mild and benign, they should not happen “if everything inside the nose is healthy”, says Dr Patricia Loftus, an otolaryngologist at the University of California, San Francisco.
Here’s what experts say about nosebleeds.
What is a nosebleed?
A nosebleed, known medically as epistaxis, comes in two forms: anterior and posterior.
About 90% of nosebleeds are anterior, and start in the area between your two nostrils, called Kiesselbach’s plexus, says Loftus. This area contains a lot of blood vessels – little capillaries that keep the nostrils well supplied with blood, to warm the air you inhale. These can break open, creating a bleed that mostly pours from the nostril, though some blood may trickle into the mouth or throat, especially if you lean your head back.
Posterior nosebleeds are rarer and bigger. These are triggered when larger blood vessels deeper in the nasal passage burst. If there is significantly more blood flowing down the back of your throat, potentially causing you to choke, that’s a posterior nosebleed, explains Dr Amin Javer, an ear, nose and throat (ENT) surgeon and research director at the University of British Columbia.
Posterior nosebleeds are more serious than anterior ones, and require prompt medical attention. They are most often seen in older adults, especially those taking anticoagulants, which increase the risk of hemorrhage.
What should you do when your nose is bleeding?
When a nosebleed starts, many people instinctively tip their head back.
“That’s the worst thing you could do,” says Javer. “You’re going to just start drinking the blood.” Blood in the stomach causes nausea, so it’s best to avoid this.
Instead, you should put your head forward and very gently pinch your nose, he says. A cold compress on the neck or nose can help constrict blood vessels and slow the bleed, as can a spritz of a nasal decongestant such as oxymetazoline.
If you see thick clots come out of your nose, it can be unsettling. But it’s not necessarily a bad sign, nor is it uncommon. “It’s actually just showing that your blood is clotting effectively,” says Dr Peter Manes, an ENT surgeon and residency director at Yale School of Medicine.
If your nosebleeds are occurring multiple times a week, interfering with your daily life or lasting longer than 30 minutes, they warrant seeing a doctor for a clinical evaluation.
What causes nosebleeds?
“One of the most common reasons for [anterior] nosebleeds is when the area dries out,” says Loftus.
Dry air is especially to blame in winter. “It doesn’t matter how much rain there is outside – our heaters turn on, the humidity in our bedrooms goes down,” says Javer. He recommends cracking a window while you sleep or getting a humidifier to keep humidity levels between 40% and 50%. You can also moisturize your nasal lining with saline spray or a very thin layer of Vaseline just inside the nostrils.
Another common reason for nosebleeds is “digital manipulation, which is a nice way of saying nose picking or scratching your nose”, says Loftus. The nose is delicate, and even a light bump or scratch can pop a capillary and cause bleeding.
Inflammation from allergies or viral infections can make the lining more fragile and prone to cracking. Physical exertion sometimes plays a role too. Exercises, especially those that combine effort with positions where your head dips below your heart, like downward dog pose, can increase pressure in the face and prompt a bleed.
Medications and supplements add another layer of risk. Prescription blood thinners and aspirin make bleeding more likely, and some herbal supplements have similar effects. “Ginseng, garlic, ginkgo – some of those herbal medications can thin your blood,” says Manes.
Why am I having frequent nosebleeds?
“If you’re having a nosebleed every day and you don’t know what’s causing it, you need evaluation,” says Loftus. “Even if it’s not bothering you that much, that’s alarming enough to come see a doctor.”
Manes agrees that nosebleeds can become “normalized”, and easy to dismiss as minor, but they do occasionally signal more serious issues.
Abundant nosebleeds can indicate that your blood is not clotting correctly, Loftus says. Poor clotting may be related to autoimmune issues such as immune thrombocytopenia, an illness that causes low platelet counts. A doctor may ask about alcohol use or other factors to discern if a liver issue is involved.
Hormonal changes in pregnancy can play a role. Loftus says pregnancy-induced surges in hormones such as estrogen and progesterone are linked to a higher likelihood of lobular capillary hemangioma, a “usually pretty small lesion in the nose” that can cause nosebleeds. These growths are not inherently dangerous, but should be evaluated by a doctor.
If you’re in your 20s and suddenly having frequent, heavy nosebleeds, you could be among the roughly one in 5,000 people with hereditary hemorrhagic telangiectasia (HHT), a genetic vascular abnormality that often presents in young adulthood and requires treatment. Without medical attention, patients with HHT may “succumb to death from nosebleed”, says Javer.
Frequent unilateral nosebleeds – bleeding from only one nostril – are a significant red flag for doctors. That pattern can signal a tumor or polyp, especially if accompanied by symptoms on the same side of the face, like not being able to breathe through the nose; facial pain or pressure; or unilateral ear pain, numbness or vision changes, says Loftus. “That should get checked out,” she says.
How do doctors treat a nosebleed?
Many nosebleeds can be taken care of at home. But if you have persistent, frequent or high-volume nosebleeds that disrupt your daily life, or if you think you are having a posterior bleed, seek medical attention.
If you arrive in the emergency room or a doctor’s office with an active nosebleed, there are a few things you can expect.
First is “a thorough examination of your nasal cavity, trying to identify a source of the bleed”, says Manes. Most bleeds can be controlled with packing – the insertion of a nasal tampon (which is different to the menstrual product).
A doctor may cauterize the area that is bleeding, says Manes. The procedure stings, but a numbing cream can ease the pain.
You may have your vitals checked and blood drawn to look for issues such as anemia or clotting abnormalities. If symptoms suggest a mass in the sinuses, a CT scan or MRI may be recommended. And if you have lost a significant amount of blood, you could require a transfusion.
