Bleeding from the nose; Epistaxis
A nosebleed is loss of blood from the tissue lining the nose. Bleeding most often occurs in 1 nostril only.
Nosebleeds are very common. Most nosebleeds occur because of minor irritations or colds.
The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose. Crusts can form that bleed when irritated. Nosebleeds occur more often in the winter, when cold viruses are common and indoor air tends to be drier.
Most nosebleeds occur on the front of the nasal septum. This is the piece of the tissue that separates the 2 sides of the nose. This type of nosebleed can be easy for a trained professional to stop. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose. Such nosebleeds may be harder to control. However, nosebleeds are rarely life threatening.
Nosebleed can be caused by:
Repeated nosebleeds may be a symptom of another disease such as high blood pressure, a bleeding disorder, or a tumor of the nose or sinuses. Blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, may cause or worsen nosebleeds.
To stop a nosebleed:
It may help to apply cold compresses or ice across the bridge of the nose. Do not pack the inside of the nose with gauze.
Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed. If bleeding persists, a nasal spray decongestant (Afrin, Neo-Synephrine) can sometimes be used to close off small vessels and control bleeding.
Things you can do to prevent frequent nosebleeds include:
Get emergency care if:
Call your health care provider if:
The provider will perform a physical exam. In some cases, you may be watched for signs and symptoms of low blood pressure from losing blood, also called hypovolemic shock.
You may have the following tests:
The type of treatment used will be based on the cause of the nosebleed. Treatment may include:
You may need to see an ear, nose, and throat (ENT) specialist for further tests and treatment.
It's a nosebleed. Do you tilt your head back? Do you apply ice to the nose? Learn how to treat a nosebleed and when to call the doctor.
Pfaff JA, Moore GP. Otolaryngology. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 72.
Simmen D, Jones NS. Epistaxis. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 42.
Last reviewed on: 8/5/2015
Reviewed by: Sumana Jothi MD, specialist in laryngology, Clinical Instructor UCSF Otolaryngology, NCHCS VA, SFVA, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.