Nosebleeds: When to Seek Medical Help

February 24, 2023

Nosebleeds are a very common medical condition. Also known as epistaxis, they’re usually a minor inconvenience that can be managed at home. Nosebleeds can occur at any age, but they’re most common in children and adults over 65.

The most common cause of nosebleeds in children is injury or trauma from sports injuries or excessive nose-picking – a habit that can damage the delicate tissues inside the nose and make them susceptible to bleeding.

In older adults, nosebleeds are often due to age-related thinning and drying out of the nasal tissues – changes that can make bleeding with nose blowing or sneezing more likely. Uncontrolled high blood pressure can also increase the risk of nosebleeds. Although rare, blood clotting disorders, certain genetic diseases or nasal tumors may also be contributing factors.

At Home Remedies

For occasional nosebleeds in otherwise healthy people, the bleeding can usually be stopped by doing the following:

Keep your head in a neutral position. Do not tilt the head back - this can actually be dangerous because it increases the risk of choking and swallowing the blood. In some cases, heavy blood flow could actually block the airway.
Use 3 sprays of Afrin in the nostril that is bleeding. Afrin is a decongestant that works by constricting blood vessels. Some people may need to gently blow their nose prior to using Afrin to remove any small clots that may have formed, blocking the medication from getting to where it needs to be.
Apply pressure to the nose. Pinch the lowest, soft part of the nose and hold firmly for ten minutes.

“You may repeat this process up to three times, totaling 30 minutes,” says Courtney McAvinew, CNP, nasal and sinus specialist at University Hospitals Ear, Nose & Throat Institute. “If you’re still actively bleeding after 30 minutes, I advise patients to head for the ER, particularly if you’re experiencing other symptoms such as lightheadedness or dizziness.”

How to Prevent Nosebleeds

To reduce the frequency of nosebleeds that are not caused by a medical problem or condition, follow a good nasal hydration regimen that includes:

Use nasal saline spray every two hours while awake.
Run a cool mist humidifier in the bedroom when sleeping.
Use a water-based saline gel, sprayed into the nose before bed.
Avoid nose-picking and try to sneeze through your mouth to minimize pressure on nasal blood vessels.

If you have high blood pressure, talk to your provider about medications and other strategies to keep it under control.

In addition, talk to your provider about any prescription or non-prescription medications and supplements you take. In people with chronic nosebleeds, some medication dosages may need to be adjusted or some supplements discontinued. Examples include:

Blood thinning medications such as aspirin, NSAIDs, Plavix, warfarin/coumadin, Eliquis and Xarelto
Inhaled nasal steroids like Flonase, Nasacort and Nasonex
Herbal supplements like ginkgo biloba, garlic, ginsing and fish oil, all of which can have mild blood-thinning effects

Get Medical Help if Bleeding Persists

If the home remedies and prevention recommendations discussed above do not work and a nosebleed continues or worsens, you should seek medical attention.

“The first step in managing a nosebleed is to determine where the blood is coming from,” says McAvinew. “First we will examine the front (anterior) portion of the nose with a nasal speculum to look for scabs, crusting or exposed blood vessels that may be the source of the bleeding. Anterior bleeds are the most common, accounting for up to 90 percent of nosebleeds.”

“Even if the blood source is confirmed to be in the front of the nose, I almost always perform nasal endoscopy to verify that there are no sources of bleeding in the back (posterior) portion of the nose. Posterior bleeds are harder to stop, are usually high volume and can be more dangerous.”

In addition, the provider may order imaging exams and blood tests to rule out certain rare causes for recurrent nosebleeds.

Medical Treatments for Acute Nosebleeds

Nosebleeds are most often treated with nasal packing. A tampon-like device, which may be infused with clotting medication, is inserted into the nose and the patient is usually sent home with the packing in place. Depending on the type of packing used, they will be advised when to see their provider for removal.

People with nasal packing are usually put on antibiotics to prevent toxic shock syndrome, a rare complication of a bacterial infection commonly associated with the use of vaginal tampons.

If the bleeding is coming from the back of the nose, people are less likely to be sent home with nasal packing. Because posterior bleeds often involve major arteries, they can be more serious and harder to manage. Patients may be hospitalized and closely monitored until the bleeding can be controlled.