What causes nosebleeds?
A nosebleed, medically called epistaxis, happens when one of the many small, fragile blood vessels lining the inside of the nose breaks and bleeds. The front part of the nose is especially rich in these delicate vessels, close to the surface, which is why most nosebleeds come from there and are usually easy to stop. Nosebleeds are very common, particularly in children and older adults, and are usually harmless.
Many everyday things can trigger a nosebleed. Dry air — from cold weather or heated indoor environments — dries out the lining of the nose and makes it crack and bleed. Nose-picking, blowing the nose hard, a knock to the nose, and colds or allergies that inflame the nasal lining are all common causes. Less commonly, nosebleeds relate to blood-thinning medication, high blood pressure, or bleeding disorders, which is part of why frequent or heavy nosebleeds are worth discussing with a doctor.
How to stop a nosebleed correctly
Stopping a nosebleed is usually simple, but it is important to do it the right way — and to avoid the common mistake of tipping the head back. To stop a nosebleed: sit down and lean forward slightly, so that blood drains out of the nose rather than down the throat. Pinch the soft part of the nose, just below the bony bridge, firmly between your thumb and finger. Hold it continuously for 10 to 15 minutes without releasing to check, breathing through your mouth.
Leaning forward matters because tilting the head back sends blood down the throat, which can be swallowed (causing nausea) or, rarely, breathed in. After 10 to 15 minutes of continuous pressure, release and check — most nosebleeds will have stopped. Applying a covered ice pack to the bridge of the nose can help. Once it stops, avoid blowing your nose, bending down, or strenuous activity for several hours, as these can restart the bleeding.
What not to do during a nosebleed
Some traditional responses to a nosebleed are unhelpful or counterproductive, and knowing what to avoid is as useful as knowing what to do. Do not tilt your head back or lie down — this is the most common mistake and sends blood down the throat instead of stopping the bleeding. Do not lean so far back that blood trickles backwards; forward is the correct direction. Swallowed blood can cause nausea or vomiting.
Also avoid the temptation to keep releasing the pinch every minute or two to check whether it has stopped — this interrupts the clot forming and can prolong the bleed. Hold continuously for the full 10 to 15 minutes. Do not pack the nose tightly with tissue or cotton wool, which can disturb the clot when removed; gentle pinching is more effective. And once the bleed stops, resist blowing or picking the nose, which can dislodge the fragile new clot.
Preventing nosebleeds
If you or your child get frequent nosebleeds, a few simple measures can reduce them, most of which centre on keeping the lining of the nose moist and undisturbed. In dry conditions, a little petroleum jelly or a saline nasal spray applied inside the nostrils helps keep the lining from drying and cracking. Using a humidifier to add moisture to dry indoor air, especially in heated rooms or during cold weather, can make a real difference.
Discouraging nose-picking, particularly in children, and blowing the nose gently rather than forcefully, both help protect the delicate vessels. Keeping fingernails short in children who pick reduces damage. If nosebleeds are linked to allergies, managing the allergy reduces the inflammation that makes the nose bleed. If you take blood-thinning medication and get frequent nosebleeds, mention it to your doctor rather than stopping the medication yourself.
Frequent or recurrent nosebleeds
Occasional nosebleeds are normal and rarely a cause for concern, but nosebleeds that happen often, are heavy, or are hard to stop are worth having assessed by a doctor. Sometimes a single fragile blood vessel is responsible for repeated bleeds and can be sealed by a doctor with a simple procedure called cautery, which is quick and effective. Identifying and treating such a vessel can stop a frustrating pattern of recurrent nosebleeds.
A doctor will also consider whether an underlying factor is contributing, such as blood-thinning medication, a bleeding tendency, or, less commonly, other conditions. This does not mean recurrent nosebleeds are usually serious — most are not — but assessment allows any treatable cause to be addressed and provides reassurance. For most people, recurrent nosebleeds turn out to have a simple, manageable explanation such as dryness or a prominent vessel.
When a nosebleed needs medical help
Most nosebleeds stop with correct first aid, but some need medical attention. You should seek help if a nosebleed does not stop after 20 to 30 minutes of continuous, correct pressure, if the bleeding is very heavy, or if you feel weak, dizzy or short of breath. A nosebleed following a significant injury to the head or face, or one where the bleeding seems to be coming from deep in the nose or running down the throat despite leaning forward, also warrants prompt assessment.
Other reasons to see a doctor include frequent recurrent nosebleeds, nosebleeds in someone taking blood-thinning medication that are hard to control, or nosebleeds accompanied by easy bruising or bleeding elsewhere, which can occasionally point to a bleeding problem. For a child, a nosebleed that is very heavy or will not stop should be assessed. In the great majority of cases, though, a nosebleed is a minor, self-limiting event handled easily at home.