What Causes Nosebleeds?

Known in medical terms as epistaxes, nosebleeds involve bleeding from the inside of the nose. Plenty of people have infrequent nosebleeds, especially younger children and older adults.

Nosebleeds can be frightening at times, especially for kids, but in most cases they’re not dangerous and are mostly just an annoyance. In rarer cases, they may be frequent (more than one per week) or may cause serious medical issues. Here’s everything you need to know about nosebleeds, including their common causes and how to treat and prevent them.

Types of Nosebleeds

The nose contains numerous blood vessels, located close to the surface in the front and back of the nose. These vessels are fragile, and can bleed easily. There are two kinds of nosebleeds:

Anterior nosebleed: When blood vessels in the front of the nose break and bleed.
Posterior nosebleed: Occurring in the back or the deepest part of the nose, this is a nosebleed where blood flows down the back of the throat. These nosebleeds can be dangerous.

Nosebleed Causes

There are numerous causes of nosebleeds, with dry air and nose-picking functioning as the two most common. Dry air can lead to nasal membranes (tissues inside the nose) drying out, which causes crusting inside the nose. Crusting then becomes irritated or itchy, and scratching or picking can cause bleeding. Medications for allergies, colds and sinus issues may also cause dry nasal membranes.

Other causes of nosebleeds may include:

Acute sinusitis
Allergies
Aspirin use
Hemophilia and other bleeding disorders
Blood thinners
Chemical irritants
Chronic sinusitis
Cocaine use
The common cold
Deviated septum
Foreign body in the nose
Nasal sprays, including those used to treat allergies
Nonallergic rhinitis
Trauma to the nose

Less common causes may include:

Alcohol use
Hereditary hemorrhagic telangiectasia
Idiopathic thrombocytopenic purpura
Leukemia
Nasal polyps
Nasal surgery
Nasal tumor
Second trimester pregnancy

How Causes Are Diagnosed

If you seek medical attention for a nosebleed, you’ll undergo a physical examination so your doctor can determine the cause. There is no single determining method here, but they might use one of a few different tests:

Complete blood count: A blood test to check for blood disorders
Nasal endoscopy: An examination of the nose using a special instrument
Partial thromboplastin time: A blood test that checks how long it takes for blood to clot
CT scan: Imaging test that takes cross-sectional pictures of the nose
X-ray of the face and nose: Uses radiation to produce pictures of bone structure

Treating and Preventing Nosebleeds

For occasional nosebleeds, a few self-care treatment steps include:

Sit upright and lean forward, to reduce blood pressure in the veins of the nose and discourage further bleeding. This also helps you avoid swallowing blood.
Gently blow the nose to clear out any clotted blood and spray a nasal decongestant.
Pinch the nose using the thumb and index finger on both nostrils—even if only one side is bleeding. Continue this for 5 to 10 minutes while breathing through the mouth.
Repeat all these steps for up to a total of 15 minutes if bleeding doesn’t stop.
Once bleeding stops, don’t pick or blow your nose or bend down for several hours, to keep it from starting again.

A few tips to help prevent nosebleeds include:

Keep the nose lining moist, particularly during cold months while the air is dry. Apply a light coating of petroleum jelly or antibiotic ointment with cotton swabs three times a day. Saline nasal spray can help for some people.
Trim fingernails: Shorter fingernails helps discourage nose picking, especially in children.
Use a humidifier: This will counter the effects of dry air by adding moisture to it.

If these home methods are unable to stop a nosebleed for you or your child, or if you have frequent nosebleeds, seek medical attention. Your doctor can offer treatment recommendations for chronic nosebleeds or nosebleeds that won’t stop.