Epistaxis (Nosebleed): Symptoms, Causes & Treatment

Epistaxis is bleeding from the nose due to the rupture of small blood vessels in its lining. It is among the most common conditions and affects most people at least once in their lives, and most of it is minor and not dangerous and stops quickly with correct first aid. It is divided into two types: anterior epistaxis, the most common, arising from the blood vessels in the front part of the nasal septum and usually easy to control; and posterior epistaxis, less common and heavier, arising from deeper and needing medical care.

Epistaxis has many causes: the most common is dryness of the nasal lining due to dry air or heating, picking or blowing the nose forcefully, nasal infections and allergy, and a deviated nasal septum. It may also occur with high blood pressure, taking blood-thinning medications, clotting disorders, or after an injury or nasal surgery. Epistaxis is common in children (often from picking and dryness and usually benign), in the elderly, and in users of blood thinners.

Correct first aid for epistaxis is simple but often applied wrongly: sit and lean your head slightly forward (not backward, because leaning it back makes blood go down to the throat and stomach causing nausea), then pinch with your fingers the soft part of the nose (below the bone) with continuous pressure for ten to fifteen minutes without releasing the pressure to check, while breathing through the mouth. A cold compress can be placed on the bridge of the nose. Most cases of anterior epistaxis stop this way. But if the bleeding does not stop after twenty minutes of correct pressure, or is very heavy, or resulted from a severe injury, or is accompanied by dizziness or pallor, or recurs frequently, or occurs in someone taking blood thinners, medical care should be sought. Prevention includes moisturizing the nasal lining and avoiding picking.

• Blood coming from a nostril (or both).
• In posterior epistaxis blood may go down to the throat.
• Sometimes dizziness or pallor with heavy or recurrent bleeding.

• Dryness of the nasal lining (dry air, heating) — the most common.
• Picking or forcefully blowing the nose, and nasal infections and allergy.
• A deviated nasal septum, and injuries.
• Blood thinners, clotting disorders, and sometimes high blood pressure.

• Often no tests are needed in simple anterior epistaxis.
• Nasal examination to locate the bleeding source with recurrence or heaviness.
• Clotting tests or other investigations when an underlying cause is suspected.

Correct home first aid

• Sit and lean the head slightly forward (not backward).
• Pinch the soft part of the nose with continuous pressure for 10–15 minutes while breathing through the mouth.
• A cold compress on the bridge of the nose, and avoiding blowing the nose afterward.

Medical care

• Cautery of the bleeding vessel or nasal packing when it does not stop or in posterior epistaxis.
• Treating the underlying cause (allergy, deviated septum, adjusting blood thinners under the doctor's supervision).

This content is educational and does not replace medical advice.

• Anemia with heavy or recurrent bleeding.
• Blood going down to the throat and nausea when the head is wrongly tilted back.
• Posterior epistaxis may be heavy and hard to control at home.

• Moisturizing the nasal lining with an ointment or saline and humidifying room air.
• Avoiding picking or forcefully blowing the nose.
• Treating allergy and infections, and monitoring those taking blood thinners.