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Epistaxis (Nosebleed)

Nosebleeds (epistaxis) are a common condition that can affect anyone, but are most common in young children and in adults between the ages of 50 and 80. Roughly 60% of people in the United States will experience at least one nosebleed in their Trusetd Source Checkbox Trusted Source Nosebleeds American Academy of Otolaryngology-Head and Neck Surgery Go to Source lifetime. In most cases, epistaxis is not considered to be a medical emergency. However, frequent, severe, or persistent nosebleeds may be more serious and should be addressed by an experienced doctor.

Board-Certified Otolaryngologist (ENT) and fellowship-trained rhinologist Dr. Shawn Allen specializes in treating conditions of the nose and sinuses, and treats complex and severe epistaxis for residents of Houston and The Woodlands, Texas.

Woman stopping her nosebleed with a tissue

Types of Epistaxis

Anterior Epistaxis

Anterior epistaxis starts at the front of the nose (generally from the nasal septum) and is the more common type of nosebleed. The front of the nose is lined with very small blood vessels and capillaries that can rupture easily. Most anterior nosebleeds respond to treatment quickly and are not serious.

Posterior Epistaxis

Posterior epistaxis originates further back in the nose and may be the result of rupture in a larger blood vessel. Unlike anterior epistaxis, posterior nosebleeds may cause heavy bleeding that can be life-threatening if not managed appropriately.

young boy with a nosebleed

What Causes Nosebleeds?

Epistaxis results when blood vessels within the nasal mucosa are ruptured. Dry air is the most common cause of epistaxis, but there are many additional factors that may cause a bloody nose:

  • Deviated septum
  • Sinus infections
  • Non-allergic rhinitis
  • Nasal polyps
  • Sinus tumors
  • Common colds
  • Digital manipulation (nose picking)
  • Injury or trauma
  • High blood pressure
  • Liver insufficiency
  • Alcohol abuse
  • Vascular malformations
  • A clotting or bleeding disorder (vonWillebrand’s disease, hemophilia)
  • Hereditary hemorrhagic telangiectasia
  • Leukemia
  • Allergies
  • Exposure to chemical irritants
  • Non-steroidal anti-inflammatory drugs (such as ibuprofen and acetaminophen)
  • Blood thinners/anticoagulants (warfarin)
  • Topical nasal sprays
  • Certain vitamins and supplements
  • Trusetd Source Checkbox Trusted Source Epistaxis Tabassom A, Cho JJ Go to Source Drug use

Nosebleed Treatment at Home

Simple or anterior nosebleeds can usually be treated at home through the following measures:

  • Remain calm
  • Sit upright and lean your head slightly forward to prevent blood from running down the throat
  • Focus on mouth breathing
  • Pinch the soft part of the nose against the bony bridge of the nose to apply gentle pressure for at least 5 minutes to stop blood flow
  • If bleeding continues, apply gentle pressure for another 10 minutes
  • You may also apply an ice pack to the bridge of the nose or back of the neck, and use an over-the-counter decongestant spray (Afrin) to help stop bleeding
  • Once bleeding has stopped, refrain from nose blowing, straining, bending forward, or heavy lifting for Trusetd Source Checkbox Trusted Source Nosebleed (epistaxis) Cleveland Clinic Go to Source
    24 hours
    (or for longer if the bleeding recurs easily)

Medical Treatment for Epistaxis

If simple home treatments do not stop a nosebleed, emergency medical attention is necessary. Emergency treatment for epistaxis involves packing the nose with nasal sponges or foam, gauze, or a small latex balloon. Nasal packing should remain in place for 24 to 48 hours. Antibiotics are often provided to prevent infection while nasal packing is in place.

Once a nosebleed has stopped, it is important to seek follow-up care with Dr. Allen in clinic to treat the cause of epistaxis, especially if nosebleeds are frequent or are interfering with your life. Dr. Allen may perform a nasal endoscopy to view the inner structures of your nose so that he can determine the source of epistaxis.

Treatments Dr. Allen may perform for chronic or severe epistaxis include:

  • Cauterization (sealing) of ruptured blood vessels with heat or silver nitrate
  • Ligation (tying off) or electrocautery of ruptured blood vessels under anesthesia
  • Removal of any foreign bodies that may cause epistaxis
  • Septoplasty (deviated septum repair)
  • Endoscopic sinus surgery to remove nasal polyps or sinus tumors

Frequently Asked Questions About Epistaxis

When should I see a doctor for a nosebleed?

Most often, a nosebleed can be treated at home. If a nosebleed continues for more than 20 minutes despite home treatment, if your nosebleed is a result of a nose or head trauma, or if you feel lightheaded or weak, you should seek emergency medical care. You should also consult with an experienced ENT like Dr. Allen if nosebleeds occur frequently.

Can nosebleeds be prevented?

While not every nosebleed can be prevented, there are some steps you can take to reduce the likelihood of epistaxis:

  • Discourage children from picking their noses
  • Keep the lining of the nose moist:
    • Use a humidifier
    • Coat the inside of the nose with saline gel, petroleum jelly (Vaseline), or antibiotic ointment
    • Use a saline nasal spray
    • Control allergies and sinus problems that contribute to inflammation of the nose
    • Avoid overuse of decongestant nasal sprays such as Afrin
    • Avoid medications and supplements that worsen bleeding (such as Aspirin, fish oil, and some herbal supplements) unless prescribed for specific medical indications
Dr. Shawn Allen

Contact Dr. Shawn Allen

If you experience frequent or chronic nosebleeds, it is important that you seek treatment from an experienced ear, nose, and throat doctor. As a Board-Certified Otolaryngologist (ENT) and fellowship-trained rhinologist, Dr. Allen specializes in treating nose and sinus conditions for residents of Houston, The Woodlands, and nearby communities in Texas. To schedule your consultation with Dr. Allen, please contact us today.

1 American Academy of Otolaryngology-Head and Neck Surgery. Nosebleeds. Available: https://www.enthealth.org/conditions/nosebleeds/. Accessed February 21, 2023.
2 Tabassom A, Cho JJ. Epistaxis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435997/. Accessed February 21, 2023.

3 Cleveland Clinic. Nosebleed (epistaxis). Available: https://my.clevelandclinic.org/health/diseases/13464-nosebleed-epistaxis. Accessed February 21, 2023.

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Dr. Shawn Allen has either authored or reviewed and approved this content.

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