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by Scholten A

Nosebleed

(Epistaxis; Bloody Nose)

Definition

A nosebleed is blood flowing from inside the nose.
There are two types:
  • Bleeding from the front of the nose
  • Bleeding deep within the nose
The Nasal Passage
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Copyright © Nucleus Medical Media, Inc.

Causes

Nosebleeds may be caused by:
  • An irritated nose lining
  • Injury to the nose from:
    • Picking
    • A bump or hit
    • Blowing or rubbing too hard
    • An object in the nose
    • Barotrauma
  • Dry nasal tissue
  • A loose clot from a past bleed
  • A nose or sinus tumor

Risk Factors

Nosebleeds can happen at any age. They are more common in children less than age 11. They are also more common in adults over age 50. Things that raise the risk are:
  • Sinusitis, colds, and allergies
  • A defect in the nose
  • Bleeding or clotting problems
  • Blood vessel problems in the nose
  • Dry air
  • Drugs, such as—blood-thinners, aspirin, and nasal sprays
  • Cocaine use

Symptoms

Symptoms are:
  • Front nosebleed:
    • Blood flows from one nostril—when sitting or standing
    • Blood may pass down the throat—if coughing or tipping the head back
  • Back nosebleed:
    • Blood passes down the back of the mouth and throat
    • Blood may flow from the nostril—if leaning forward

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.
If bleeding is severe, tests may be done. They may be:
  • Blood tests—to check for anemia or clotting problems
  • Sinus x-rays—to check for defects or masses
  • Endoscopy—to look at nasal tissues

Treatment

Treatment depends on how bad the nosebleed is. Most nosebleeds stop within 15 minutes. Some nosebleeds are more serious. They need medical care. Options are:
  • Pinching the nostrils for 15 minutes—until bleeding stops
  • Nasal spray or packing
  • Sealing off the blood vessel—if bleeding does not stop
  • A nasal balloon—uses pressure to stop bleeding
  • Surgery—if other methods do not work

Prevention

Some nosebleeds may be prevented by:
  • Keeping the inner nose moist with:
    • Creams or saline nasal sprays
    • A humidifier
  • Not picking the nose
  • Keeping children's fingernails short

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
Family Doctor—American Academy of Family Physicians
https://familydoctor.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca
Canadian Society of Otolaryngology
http://www.entcanada.org

References

Epistaxis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/epistaxis. Accessed January 29, 2021.
Nosebleeds. American Academy of Otolaryngology website. Available at: http://www.entnet.org/content/nosebleeds. Accessed January 29, 2021.
Nosebleeds. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/nosebleeds. Accessed January 29, 2021.
Womack JP, Kropa J, et al. Epistaxis: outpatient management. Am Fam Physician. 2018;98(4):240-245.

Revision Information

  • Reviewer: EBSCO Medical Review Board Shawna Grubb, RN
  • Review Date: 09/2020
  • Update Date: 03/02/2021