Nosebleeds can be caused by a wide variety of reasons, the two most common being nose picking and dry air.

Also known as epistaxis, nosebleeds are very common and usually harmless. They occur more frequently in children between 2 to 8 years old, and in those over the age of 65. Around 60% of people have had at least one nosebleed in their lifetime. Although only 10% of cases are concerning enough to require medical attention, nosebleeds are the most common ENT (ear, nose, throat) condition to present to emergency at the hospital.


What Causes Nosebleeds?

The nose may be particularly susceptible to bleeding due to the anatomy of its blood supply. The part of the nose with the most active circulation is the nasal septum (the wall separating the nostrils) at the opening of the nasal cavity. This means it’s exposed to heat, cold, changes in environmental moisture, and is more easily subject to trauma. The mucous membranes in this part of the nose are also particularly thin, further increasing the likelihood of a bleed from this area.

Nosebleeds can be caused by a wide variety of reasons, the two most common being nose picking and dry air. Other causes of epistaxis include:

  • Deviated septum
  • Trauma, including excessive nose blowing
  • Chronic nasal cannula use
  • Alcoholism
  • Blood vessel abnormalities
  • Diseases affecting blood clotting
  • Allergies, including hay fever
  • Low environmental humidity
  • Medications, including non-steroidal anti-inflammatories, anticoagulants, nasal steroid sprays, and complementary medications
  • Recreational drugs, such as cocaine

Certain medical conditions can involve frequent nosebleeds, including hypertension (high blood pressure), leukemia, nasal polyps, and sinusitis. Pregnant women may also be more prone to nosebleeds.

First Aid for Nosebleeds

It is rare for a nosebleed to require emergency medical attention. However, if a nosebleed is associated with other concerning symptoms, such as pain or neurological symptoms, don’t hesitate in visiting your family doctor.

To manage a nosebleed, sit upright and lean your head slightly forward. The advice to tilt your head back is outdated and can result in blood flowing down the throat, which can irritate the stomach. Gently but firmly pinch both nostrils where you can feel the cartilage begin near the tip of your nose. Hold this pressure for 10-15 minutes, breathing through your mouth.

You can consider applying an ice pack on your forehead or the back or your neck. This may help constrict the blood vessels and reduce the bleeding.

Once the bleeding has stopped, avoid rubbing, picking, or blowing your nose, as this could restart the bleed.

You should seek emergency medical care if the nosebleed:

  • Is as a result of a significant injury, such as a car accident
  • Involves more blood loss than expected
  • Makes breathing difficult
  • Continues for longer than half an hour despite appropriate first aid treatment
  • Happens in a child under the age of 2

Medical Care for Severe Nosebleeds

If your nosebleed is severe enough to require a medical professional, they may manage the bleed with various techniques. One method is to apply a vasoconstrictor foam or gel to your nostrils to shrink the blood vessels and reduce blood flow. If this is unsuccessful, they may recommend cauterization, which uses silver nitrate to seal the broken blood vessel.

If cauterization is not successful either, you may have your nostrils packed with medical-grade absorbent material, a specially designed balloon tool, or nasal tampons.

On rare occasions, a nosebleed originates further back in the nose (posteriorly), rather than close to the opening of the nostrils (anteriorly). In these cases, conventional first aid or even the methods mentioned above are unlikely to be successful. Posterior nosebleeds are more common in people taking anticoagulant medications (aspirin or warfarin), those suffering hypertension, or with an underlying blood disorder or blood vessel abnormality. The techniques used to manage a posterior nosebleed are more invasive and come with a higher risk of complications.

In the vast majority of cases, nosebleeds are benign and not a symptom of a serious underlying medical condition. They can be alarming and cause some distress especially for young children, but can usually be comfortably managed at home with the proper first aid techniques.