Follow these steps to stop a nosebleed:
- Sit upright and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhea. (Do NOT lay flat or put your head between your legs.)
- Breathe through your mouth.
- Use a tissue or damp washcloth to catch the blood.
- Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop the bleeding.
- Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
- If you’d like, apply an ice pack to the bridge of your nose to further help constrict blood vessels (which will slow the bleeding) and provide comfort. This is not a necessary step, but you can try this if you want.
- You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then apply pressure to the nose as described above. WARNING: These topical decongestant sprays should not be used over a long period of time. Doing so can actually cause an increase in the chance of a nosebleed.
- After the bleeding stops, DO NOT bend over, strain and/or lift anything heavy. DO NOT blow or rub your nose for several days.
When should I go to the emergency room if I have a nosebleed?
Call your doctor immediately or have someone drive you to the nearest emergency room or call 911 if:
You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure on your nose as described in the steps above.
The bleeding is rapid or the blood loss is large (more than a cup).
You are having difficulty breathing.
You have vomited because you’ve swallowed a large amount of blood.
Your nosebleed has followed a blow to your head or serious injury (fall, car accident, smash to your face or nose).
Call your doctor soon if:
You get nosebleeds often.
You have symptoms of anemia (feeling weak or faint, tired, cold, short of breath, pale skin).
You have a child under two years of age who has had a nosebleed.
You are taking blood thinning drugs (such as aspirin or warfarin) or have a blood clotting disorder and the bleeding won’t stop.
You get a nosebleed that seems to have occurred with the start of a new medication.
You get nosebleeds as well as notice unusual bruising all over your body. This combination may indicate a more serious condition such as a blood clotting disorder (hemophilia or von Willebrand disease), leukemia or nasal tumor and will need to be checked by your doctor.)
What should I expect when I go to my doctor with a nosebleed?
The doctor will ask you questions about your nosebleed including:
Length (in minutes) of your nosebleed.
Approximate amount of blood that was lost.
How often you get nosebleeds.
Did the nosebleed involve one or both nostrils.
Your doctor will also ask about medications you are taking – including over-the-counter blood thinning drugs, such as aspirin, and drugs for colds and allergies. They will also ask if there is a family history of blood disorders and ask about your use of alcohol or any illegal drug use in which the drug was sniffed up your nose.
Next, your doctor will examine your nose to determine the source of the bleed and what may have caused it. They will use a small speculum to hold the nostril open and use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but is not painful. Your blood pressure and pulse will likely be taken. Occasionally, x-rays or CT scan or blood tests may be ordered to check for bleeding disorders, blood vessel abnormalities or nasal tumors.
What are the treatments for nosebleeds?
Treatments depend on the cause and could include:
- Nasal packing. Gauze, special nasal sponges or foam or an inflatable latex balloon is inserted into your nose to create pressure at the site of the bleed. The material is often left in place for 24 to 48 hours before being removed by a healthcare professional.
- Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. A local anesthetic is sprayed in the nostril first to numb the inside of your nose.
- Medication adjustments/new prescriptions. Reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary. Tranexamic (Lystedaâ), a medication to help blood clot, may be prescribed.
- Foreign body removal if this is the cause of the nose bleed.
- Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the nosebleed.
- Ligation. In this procedure, the culprit blood vessel is tied off to stop the bleeding.
What can I do to prevent nosebleeds?
- Use a saline nasal spray or saline nose drops two to three times a day in each nostril to keep your nasal passages moist. These products can be purchased over-the-counter or made at home. (To make the saline solution at home: mix 1 teaspoon of salt into 1 quart of tap water. Boil water for 20 minutes, cool until lukewarm.)
- Add a humidifier to your furnace or run a humidifier in your bedroom at night to add moisture to the air.
- Spread water-soluble nasal gels or ointments in your nostrils with a cotton swab. Bacitracin®, Vaseline®, or Ayr Gel® are examples of over-the-counter ointments you can use. Be sure not to insert the swab more than ¼ inch into your nose. These gels and ointments can be purchased in most pharmacies.
- Avoid blowing your nose too forcefully.
- Sneeze through an open mouth. Always sneeze into tissue or into the bend of your arm.
- Avoid putting anything solid into your nose, including fingers.
- Limit your use of medications that can increase bleeding, such as aspirin and ibuprofen. Please remember that any adjustment to medication, especially prescribed medication such as warfarin (Coumadin®), and non-steroidal anti-inflammatory drugs (NSAIDs), should only be done under your doctor’s supervision.
- See your doctor if your nasal allergy symptoms are not easily controlled with over-the-counter or prescription medications. Make sure you closely follow the directions when using over-the-counter products. Overusing them can cause nosebleeds.
- Quit smoking. Smoking dries out your nose and irritates it.
- Wear protective head gear if involved in activities that could result in an injury to your face and nose.
- Keep your child’s fingernails short.
- If you have any questions or concerns, do not hesitate to call your physician.
OUTLOOK / PROGNOSIS
When is a nosebleed a serious event?
Seeing blood coming out of your nose is a scary sight for many people. The good news is that most nosebleeds are not serious and can be managed at home. However, see your doctor or get emergency medical attention if you are losing a heavy amount of blood, if you cannot stop your nosebleed after 20 minutes of trying or have had an immediate injury to your head, face or nose. Make an appointment to see your doctor if you have frequent nosebleeds.
I get frequent nosebleeds. What’s the cause? Should I be concerned?
There are many non-serious reasons why you may be getting frequent nosebleeds. The most common are:
- Frequent use of nasal sprays for treatment of allerg symptoms or colds/congestion. You may need to stop using these drugs for a short period of time or may need to stop them altogether. Talk with your doctor if you use these products.
- Living in dry air conditions.
- Snorting drugs into your nose.
In rare cases, repeated nosebleeds could be a sign of a bleeding disorder or other more serious conditions. If you have frequent nosebleeds, please see your doctor.
What causes nosebleeds while sleeping?
The reasons for nosebleeds during sleep are the same as the reasons why they occur during the daytime – dried nasal membrane caused by dry air, allergies and colds and other upper respiratory infections that damage the delicate nasal membrane lining your nose. Sleeping with your head to the side also may put direct pressure on the nasal cavity and may be another reason for nosebleeds at night.
Why do I see blood every time I blow my nose?
If you blow your nose frequently or blow with force, you can damage the delicate blood vessels in your nose, causing them to bleed