Almost everyone has had a nosebleed at some point in their lives…and most of the time they are transient or harmless. But not always. Bottom Line Personal asked Peter Filip, MD, associate professor and board-certified ENT at Rush Medical Center, to explain what causes nosebleeds, how to stop them…and when they are cause for concern.
What Causes Nosebleeds
Nosebleeds occur when the delicate blood vessels of the nasal mucosa—the soft lining of the nose—become disrupted or damaged. The most common place for a nosebleed is the Kiesselbach’s plexus at the front of the septum (the septum is the anatomical structure that separates the two nasal passages). Bleeding at the back of the septum in the network of veins called the Woodruff’s plexus is less common but can result in more severe bleeding that’s more difficult to stop. Other areas within the nose can bleed, but this is rare.
In adults, common catalysts for a nosebleed are nasal dryness or external irritation such as allergies. For kids, it’s often from picking the nose. Other common causes include dry air, forceful nose blowing, nasal infections and overuse of nasal sprays.
What else can nosebleeds be a sign of? More concerning causes of bleeding stem from very high blood pressure, blood-thinning medications, blood-clotting disorders, intranasal drugs (such as cocaine) and nasal tumors, but these are uncommon.
How to Stop a Nosebleed
For the most common type of nosebleed from the front of the nose, sitting and leaning forward while pinching the nose stops most bleeding. Apply firm pressure to the cartilaginous portion of the nose (the soft part of your nose—just above the nostrils) for 10 to 15 minutes without stopping. Pinching the upper portion of the nose (the hard bony portion) does not work and is a common misconception.
If possible, use a decongestant spray, such as phenylephrine or oxymetazoline, before applying pressure. This can be a very effective strategy. You also might hold a cold compress on the bridge of the nose at the same time to help constrict blood vessels.
Caution: Do not hold your head up and lean back! Leaning backward, especially with a severe bleed, can cause blood and blood clots to go down the throat.
When to Worry About a Nosebleed
While relatively rare, there are some situations that should prompt a call to 911 and a trip to the nearest emergency department…
- Nosebleed lasts longer than 15 to 20 minutes despite direct pressure, is severe or keeps coming back.
- Nosebleed with a lot of bright red blood, meaning cups of blood or soaking several tissues as opposed to mild spotting into a tissue. This could indicate a severe artery bleed that needs medical attention. Other signs of significant blood loss include tachycardia or a heart racing of over 100 beats per minute at rest…low blood pressure, meaning under 90/60 mmHg…feeling lightheaded or passing out. You may need fluids or even a transfusion.
- Nosebleed that results from a facial trauma or fracture. You should always be evaluated right away after such a trauma.
- You’re choking on your own blood, which typically is from a bleed at the very back of the nose. You may need packing—material or a device placed inside the nose to apply pressure and stop the bleeding.
- You’re having a severe nosebleed and are taking blood thinners or are experiencing very high blood pressure. You could be at risk of a catastrophic bleeding event.
