Whether you’re seeing a new blockbuster at the movie theater, enjoying a first date at a restaurant or giving a presentation at work, the last thing you need is a nosebleed. Nosebleeds – also called epistaxis – are common and, thankfully, severe ones are rare. However, their normalcy doesn’t stop them from interrupting your daily life.

Read on to learn what causes nosebleeds, how you can stop them and steps you can take to prevent them from happening.

Why do we get nosebleeds?

First, let’s talk about the anatomy of our noses and why nosebleeds happen. The nose does more than just smell. It acts like a filter, removing toxins and bacteria from the air we breathe to keep us from getting sick, while also warming and humidifying the air to prevent lung irritation.

In order to condition the air, our nasal passages are lined with blood vessels. These delicate blood vessels lie close to the surface of the nasal passage and transfer heat from our blood to the air as we inhale.

Blood vessels in the nose typically break when they are disturbed in some way – either by environmental conditions or by something solid inserted into your nose – resulting in a nosebleed.

Nosebleed causes

The two most common culprits of nosebleeds are dry air and nose picking. Dry air causes the normally moist membranes in our nasal passages to dry out. When these membranes crack and crust over, they expose and break the blood vessels underneath. The reason nosebleeds happen so often in the winter is because heated indoor air has almost no moisture.

Nose picking causes trauma to the delicate membranes inside your nose, especially if your or your child’s fingernails are long – this is why nosebleeds are so common among children between 2-10 years old. The force of an inserted finger is enough to damage the blood vessels.

Nosebleeds can also be caused by:

  • Sinusitis
  • The common cold
  • Allergies
  • A deviated septum
  • Blood thinners
  • Blood clotting disorders
  • Impact to your nose
  • Insertion of a foreign body into your nose
  • Inhaling irritants

How to stop a nosebleed

A nosebleed can be a startling event, but it’s important to stay calm because stress can make the bleeding worse. Take the following steps to stop nosebleeds fast:

Lean forward, not back

Sit upright and lean your body forward, making sure your head stays above your heart. While it used to be common practice to tilt the head up and back to treat a nosebleed, this is no longer recommended as it can cause blood to flow into the throat and stomach, putting you at risk of choking or vomiting. With your head positioned forward and slightly down, blood can drain out of your nose.

Pinch your nostrils shut

Find the spot on your nose where the bony ridge – the bridge – tapers down to soft cartilage. Place your thumb and forefinger on either side of this area, just above your nostrils, and pinch with firm pressure. However, you should still be able to scrunch your nose underneath your fingers. With your nostrils shut, breathe through your mouth while squeezing.

Apply consistent pressure

Pinch your nose for at least 10 minutes before checking to see if your nosebleed has stopped. If you release the pressure from your nose before the burst blood vessel has been able to form a clot, you risk restarting the bleeding. After 10 minutes, check the flow. If you’re still bleeding, resume pinching and maintain pressure for another five minutes.

Apply ice

If your nose is still bleeding after 15 minutes, apply an ice pack to the bridge. This will help constrict the blood vessels and stop the bleeding. Make sure to continue pinching your nose with your fingers while using the ice pack.

Types of nosebleeds

There are two different types of nosebleeds, based on the location of the broken blood vessel inside your nasal passages.

Anterior nosebleed

Anterior nosebleeds occur at the front of the nose, where the blood vessels are relatively small. Blood will flow out of one or both nostrils. Anterior nosebleeds are more common and less serious than the posterior type. They can almost always be resolved at home.

Posterior nosebleed

Posterior nosebleeds occur at the back of the nose, where the blood vessels are larger. The blood flow is heavier, and you may feel blood dripping down the back of your throat in addition to coming out of your nose. A posterior nosebleed may indicate a larger health issue and usually requires medical treatment.

How to prevent nosebleeds

Nosebleeds happen. In fact, about 60% of people will experience at least one nosebleed during their lifetime. However, that doesn’t mean you have to suffer through them. There are several things you can do to prevent nosebleeds:

  • Use a humidifier in the winter, or year-round if you live in a dry climate
  • Don’t smoke, as cigarette smoke can irritate your nose and sinuses
  • Don’t put anything solid up your nose, including your finger
  • Use saline nasal sprays or nose drops to keep your nasal passages moist
  • Apply moisturizing gels or ointments, like petroleum jelly, to dry nasal passages
  • Avoid aspirin and ibuprofen, both of which act similarly to blood thinners. If pain relief is needed in the days following a nosebleed, use acetaminophen (Tylenol) instead

When to worry about a nosebleed

Most nosebleeds are not serious and will usually resolve on their own. However, if you or your child’s nosebleeds are frequent – they occur more than once a week for several weeks – you should talk to your primary care doctor or your child’s pediatrician. Other factors that may warrant a conversation with your doctor about your nosebleeds include:

  • You’re currently taking blood thinners (anticoagulants)
  • You’re showing signs of anemia, such as weakness, pale skin and tremors
  • You have a blood clotting disorder
  • You take medication through your nose

When to seek emergency care

A nosebleed is rarely a medical emergency, but you should be aware of several symptoms that make it into something more serious. Go to urgent care or the emergency room if you experience any of the following with your nosebleed:

  • You can’t get the bleeding to stop even after 20 minutes of applied pressure
  • You’re bleeding so heavily that it’s hard to breathe
  • The amount of blood is a cup or more
  • You feel dizzy and weak

Treatment for chronic nosebleeds

Your primary care doctor may refer you to an ear, nose and throat (ENT) specialist if your nosebleeds are frequent enough to interrupt your daily life. The ENT doctor will ask questions about the frequency and duration of your nosebleeds, as well as your medical history and current medications.
They may perform a nasal endoscopy, a procedure in which a thin wire with a camera and light on the end is inserted into your nose. This allows the ENT doctor to view the inside of your nasal passages and sinuses.

Based on their findings, they may recommend the following treatments:

  • Nose cauterization: During this procedure, your doctor will use a chemical or electrical device to cauterize, or seal, any abnormal blood vessels inside your nose.
  • Nasal packing: Your doctor will insert gauze coated with an antibiotic ointment into one or both of your nasal passages to put direct pressure on the blood vessels. The depth to which it’s inserted depends on whether you’re having anterior or posterior nosebleeds. The gauze will remain in your nose for a few days. Depending on the type of packing, your clinician will have you return for the removal, or the gauze will dissolve on its own.
  • Surgery: If a deviated septum is the cause of your nosebleeds, your doctor may suggest a procedure called a septoplasty. A septoplasty straightens your septum, allowing for better airflow in your nose.

If nosebleeds have become a regular and disruptive part of your life or the life of your child, our ENT specialists are here to help.