Symptoms · nose & sinuses
Nosebleed (epistaxis) — causes and first aid
A nosebleed is a common problem that is usually not serious and can be stopped with proper first-aid measures. However, there are cases when bleeding signals a more serious condition — high blood pressure, a clotting disorder, or, rarely, a tumor.
Types of bleeding
- Anterior bleeding — 90% of cases. Blood exits from the front of the nose (Kiesselbach’s plexus). Easier to control, less profuse.
- Posterior bleeding — 10% of cases. Blood may run down into the throat; often heavier and more dangerous. Requires ENT intervention.
Most common causes
Local causes
- Dry air — especially during heating season; the mucosa cracks
- Nose picking — the most common “hidden” cause, especially in children
- Trauma — blow to the nose, surgery
- Foreign bodies (in children)
- Deviated nasal septum with exposed mucosa
- Chronic rhinosinusitis, allergic rhinitis
- Tumors (rare, but important — especially in unilateral, recurrent bleeding in adults)
Systemic causes
- High blood pressure — especially in older patients, with recurrent bleeding
- Anticoagulants and antiplatelets — warfarin, dabigatran, clopidogrel, aspirin
- Coagulation disorders (hemophilia, von Willebrand)
- Thrombocytopenia
- Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu)
⚠️ When bleeding is urgent and needs medical attention
- Bleeding lasting more than 20 minutes despite compression
- Blood loss is heavy or “gushing”
- Blood runs into the throat (posterior bleeding)
- The patient is on anticoagulants and is bleeding heavily
- Bleeding accompanied by pallor, dizziness, or collapse (significant blood loss)
- In small children — any bleed warrants an exam
- Recurrent unilateral bleeding in an adult (may be a tumor)
First aid — proper technique to stop bleeding
- Sit upright, tilt the head slightly forward (not back — blood enters the throat and can cause choking or vomiting)
- Pinch the soft part of the nose (below the bone, where the nose becomes soft) with your fingers — thumb and index finger
- Maintain compression continuously for 10–15 minutes without interruption to check
- Breathe through your mouth during compression
- If needed, a cold compress on the nose and forehead (reduces blood flow)
- Don’t pick, don’t blow your nose hard, don’t sniff for 24 hours after a nosebleed
Diagnostics
After a bleeding episode, especially when recurrent, we perform:
- Endoscopic nasal exam — identifies the bleeding source, any anomalies, polyps, tumors
- Blood pressure measurement
- Laboratory tests (CBC, coagulation) if we suspect a systemic cause
- Mucosal exam for signs of chronic dryness, atrophic rhinitis
Treatment
Acute bleeding control
- Compression + ice pack
- Vasoconstrictor drops (oxymetazoline) or adrenaline-soaked packing
- Cauterization of the bleeding vessel — electrical (electrocautery) or chemical (silver nitrate). A painless procedure under local anesthesia.
- Anterior or posterior packing — for heavier bleeding
- Vessel ligation (for refractory cases)
Prevention
- Humidified air in the home (humidifier during heating season)
- Petroleum jelly or nasal ointments on the inside of the nostrils nightly
- Regular saline rinses
- Blood pressure correction in hypertensive patients
- Stop nose picking in children (short nails)
💡 Home prevention of recurrent bleeds
- Petroleum jelly inside the nostrils 2× daily during winter
- Humidifier in the bedroom
- Avoid aspirin and ibuprofen unless necessary
- For hypertension — regular BP monitoring
- For recurrent bleeds in a child — exam, rule out a foreign body or anomaly
Related topics
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Recurrent nosebleeds?
An endoscopic nasal exam identifies the cause and allows targeted treatment. Cauterizing the bleeding vessel often resolves the problem.