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Nosebleeds - What to do when your nose bleeds

Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What causes nosebleeds?

The most common causes are dryness (often caused by indoor heat in the winter) and nose picking. These two things work together - nose picking occurs more often when mucus in the nose is dry and crusty.

Other, less common causes include injuries, inflammation from colds, allergies or drug use such as cocaine and alcohol. Kids may stick small objects up the nose. Older people may have other health problems such as kidney disease, high blood pressure and blood clotting disorders, or they may be taking drugs like aspirin, NSAID's or warfarin that interfere with blood clotting. The cause of nosebleeds often can't be determined.

Why is the nose prone to bleeding?

Blame it on anatomy. The nose has many blood vessels in it to help warm and humidify the air you breathe. These vessels lie close to the surface, making them easy to injure.

Are nosebleeds serious?

Most aren't. Most nosebleeds occur in the front part of the nose and stop in a few minutes. A few nosebleeds stem from large vessels in the back of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, kidney disease, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed.

You'll need to get medical attention if a nosebleed goes on for more than 15 minutes or if it occurs after an injury, such as a punch in the face, especially if you think you may have a broken nose. A nosebleed after a fall or a car wreck could be a sign of internal bleeding. Frequent nosebleeds may mean you have a more serious problem. For example, nosebleeds and bruising can be early signs of leukemia. Nosebleeds can also be a sign of blood clotting disorders and nasal tumors (cancerous and non-cancerous).

What should I do when I get a nosebleed?

A nosebleed can be scary to get -or see- but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home with simple first aid measures.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will make your nose bleed less. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can cause nausea, vomiting and diarrhea.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. You'll need to get medical attention if a nosebleed goes on for more than 15 minutes.

You can also place a cold compress or an ice pack across the bridge of your nose. Another option is to plug the affected nostril with gauze or cotton wool soaked in a topical decongestant such as Otrivin.

Once the bleeding stops, don't do anything that may make it start again, such as bending over, picking or blowing your nose.

See your doctor if

The bleeding goes on for more than 15 minutes despite the measures above.
The bleeding was caused by a serious injury.
You get nosebleeds often.

Tips on preventing nosebleeds

To keep the lining of your nose moist, gently apply a light coating of petroleum jelly (an example is Vaseline) inside your nose with a cotton swab twice a day. You can use nasal lubricants such as orgels, secaris or rhinaris.
Keep children's fingernails short to discourage nose picking.
Counteract the drying effects of indoor heated air by using a humidifier at night in your bedroom.
Quit smoking. Smoking dries out your nose and also irritates it. Exposure to second hand smoke can be a risk for others.
Open your mouth when you sneeze.
Blow gently - one side at a time.

What will my doctor do for a nosebleed?

Your doctor will try to find out where the bleeding is coming from in your nose and what the cause might be. He or she will probably ask you some questions and examine your nose. If the bleeding doesn't stop on its own or with pressure applied, your doctor may cauterize the bleeding vessel, pack your nose, or use an antiseptic cream to stop the bleeding. A special balloon may be used if the bleeding is from large vessels in the back of the nose.

Cauterization involves using special solutions or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.

Packing the nose involves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding.

Antiseptic Cream is particularly useful in children although it may smell and taste unpleasant.

A special balloon is passed to the back of the nose and inflated to stop the bleeding if indicated. As mentioned, this is rarely required.

Revised 2007
The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor.

This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada:

The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages.

This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.