A nosebleed, also called epistaxis, is a loss of blood from any blood
vessel in the nose. It usually appears in only one nostril.
Although unexpected or persistent bleeding from anywhere is a warning sign
and should be investigated, nosebleeds are rarely a sign of serious
illness. They are usually the result of minor injury or irritation.
Nosebleeds most often come from the front of the septum, the cartilage
that separates the nose into two nostrils. These anterior nosebleeds
comprise 80 percent of all nosebleeds. A mass of blood vessels, called
Kiesselbach's plexus, lie on either side of the septum. These blood
vessels are easy to injure and bleeding can occur.
Posterior nosebleeds, which come from the back of the nose, are less
common and much harder to manage. Bleeding usually begins in the upper
part of the nose and flows toward the throat and mouth where it is
swallowed. It is difficult to determine how much blood is lost in these
Though it is a common misconception that children are more susceptible to
nosebleeds than adults, research has found that nosebleeds are more
prevalent in older adults and more often are a sign of other health
problems. Nosebleeds do, however, occur frequently in childhood. About 30
percent of children up to five years of age have had spontaneous
nosebleeds that appeared without apparent injury to the nose. Of children
six to ten years of age, 56 percent have had them and 64 percent of
preadolescents and adolescents from 11 to 15 have as well. Moreover, over
half of adults with recurring nosebleeds had them as children. Only about
10 percent of children with frequent nosebleeds have been found to have a
previously undiagnosed bleeding disorder.
Rarely, menstruating women, even adolescents, who have endometriosis, a
condition in which tissues resembling the lining of the uterus occur
abnormally in other parts of the pelvic cavity and sometimes in other
parts of the body, can have cyclical nosebleeds with their menstrual
Causes and symptoms
The most common cause of nosebleeds is injury from picking or blowing the
nose. People with respiratory
, hay fever, and sinus infections have swollen nasal membranes that are
fragile and more likely to bleed. Physical injury to the nose from falls,
, or fighting can also cause nosebleeds. Chemical irritants such as
cleaning products, aerosols, and paint can irritate the nose, sometimes
resulting in nosebleeds. In addition, some drugs, such as cocaine, inflame
the nose, causing it to bleed. Children with deviated septums or crooked
noses are also prone to nosebleeds.
Nosebleeds occur more frequently in the winter when the air is cold
outside and homes are filled with dry air from furnaces and other heating
sources. Changes from cold to warm air or dry to humid air stress the
delicate membranes of the nose and make it vulnerable to
injury and bleeding. Also, flu, colds, and other respiratory illnesses
seem to occur more often in the winter. These also stress the nasal
passages and make injury more likely. Bleeding from the nose, therefore,
usually follows these seasonal stresses.
A nosebleed can also be an indication of illness. Certain blood disorders,
, can cause the nose to bleed. In this case, medical help should be sought
immediately. Some head injuries produce nosebleeds. Uncontrolled high
blood pressure, liver disease, leukemia, and tumors of the nasal passages
and the brain can also cause the nose to bleed.
Even some medications can cause nosebleeds. Anticoagulants, medications
used to thin the blood, including aspirin, can cause spontaneous bleeding
from the nose. Overuse of nasal sprays can also produce nosebleeds. In
addition, nosebleeds can be a side effect of alcohol abuse.
Nosebleeds in children can sometimes be caused by children putting objects
into their noses. The object can tear the delicate membranes of the nose.
Objects inserted into the nose can also cause obstruction of airflow and
may need to be removed by a doctor.
Bleeding from one or both nostrils may be a trickle or a flood. Sometimes,
it accompanies direct injury to the nose as in a sports injury or in
picking the nose or too vigorous nose blowing. Children may experience
frequent swallowing or a sensation of fluid in the back of the nose and
If the bleeding does not stop after 20 minutes, it is necessary to seek
medical help. Also, if there is a known or suspected
accompanying the nosebleed, there may be a skull fracture or brain
disorder. In this case, the child should be taken to the emergency room
immediately. In addition, if the nose is misshapen, especially after an
accident, fall, or injury, it may be broken and will need to be evaluated
by a doctor. Frequent nosebleeds, especially if they are occurring more
often and are not due to colds, allergies, or trauma, will need to be seen
by a doctor as well.
It may be a medical emergency if the bleeding is rapid or if there is a
lot of blood. If the child feels faint or weak during a nosebleed, it may
be do to blood loss and the child should see the doctor immediately.
Bleeding from the nose is the obvious determinant of a nosebleed. The
severity of it, however, may require blood work to look for bleeding
disorders, diseases of the blood, or infections. X rays may be taken to
determine if there has been a head injury or abnormalities within the
structure of the nose. To further examine the nose, the doctor may perform
a nasal endoscopy, a procedure that involves inserting a tiny camera into
the nose to look at blood vessels and nasal structures.
The first line of treatment is to gently pinch the nostrils together with
the thumb and forefinger, while sitting upright and breathing through the
mouth, for five to ten minutes. Leaning forward will prevent the child
from swallowing blood. After at least five minutes, the parent or child
can check to see if the bleeding has stopped. If it has not, then the
pinching of the nose should be resumed and the child or parent should wait
another five minutes. Most nosebleeds will stop within this time period,
especially if the child is encouraged to remain calm.
or panic will cause blood to flow more rapidly and can hinder this
self-healing process. It is very important for the child not to lie down
while having a nosebleed.
Sometimes, a cold compress or crushed ice in a washcloth or plastic bag
can be placed across the bridge of the nose and cheeks to encourage
clotting. It is important not to pack the inside of the nose with gauze
since this might further injure the nose.
In 2004, a new over-the-counter product was introduced for a quick home
treatment for simple nosebleed. Called Nosebleed QR (Quick Relief), the
product is composed of a hydrophilic polymer, a synthetic powder that
absorbs blood, and potassium salt that aids in scab formation. The parent
or child sprinkles the product onto a swab and coats the nostril then
pinches the nose for 15 to 20 seconds. The product stops bleeding within
one minute. However, it does sting and may not be a comfortable product to
use with children.
Estrogen cream, the same preparation used to revitalize vaginal tissue,
can toughen fragile blood vessels in the anterior septum and forestall the
need for cauterization. Botanical medicines known as stiptics, which slow
down and can stop bleeding, may be taken internally or applied topically.
Some of the plants used are achillea (yarrow), trillium, geranium, and
shepherd's purse (
Anatomical sideview of a nosebleed.
(Illustration by GGS Information Services)
Homeopathic remedies can be one of the quickest and most effective
treatments for nosebleeds. One well known remedy is phosphorus.
Another natural treatment includes swabbing the nose with vitamin E oil
for three days. If nosebleeds recur within that time, it is recommended to
take 500 mg of bioflavonoids twice a day. Bioflavonoids are antioxidants
found in citrus fruits that help strengthen blood vessels.
Most common nosebleeds are easily managed and can be prevented. Children
usually recover quickly. Serious nosebleeds need further investigation but
are usually controlled by treating the underlying cause.
—A shift in the position of the nasal septum, the partition that
divides the two nasal cavities.
—A condition in which the tissue that normally lines the uterus
(endometrium) grows in other areas of the body, causing pain, irregular
bleeding, and frequently, infertility.
—Any of several hereditary blood coagulation disorders occurring
almost exclusively in males. Because blood does not clot properly, even
minor injuries can cause significant blood loss that may require a blood
transfusion, with its associated minor risk of infection.
—The mass of blood vessels on either side of the septum.
—A procedure that involves inserting a tiny camera into the nose
in order to look at blood vessels and nasal structures.
—An ear, nose, and throat specialist.
—A wall or partition. Often refers to the muscular wall dividing
the left and right heart chambers or the partition in the nose that
separates the two nostrils. Also refers to an abnormal fold of tissue
down that center of the uterus that can cause infertility.
Gently blowing the nose and not picking it will also prevent nosebleeds.
This is especially important for several hours after nasal bleeding has
stopped. In some cases,
strong sniffing is also discouraged to reduce further stress on the
delicate tissues of the nose. Keeping the mouth open when sneezing can
also reduce stress on the nose.
Treatment of hay fever and other respiratory allergies decreases sneezing
and nasal inflammation. If a child is prone to sinus infections, some
doctors may also use prophylactic or preventative treatment similar to
Nosebleeds can be frightening for children. Seeing any amount of blood may
cause some children to panic or even faint. It is important to treat the
nosebleed matter-of-factly as any parent would handle any other childhood
scrape or wound. The parent's calm helps the child remain calm
while waiting for the natural blood clotting mechanisms of the body to
work. Parents should also be aware of any abnormal amount of blood during
a nosebleed and make note of any recent falls or head injuries. These
observations will inform parents about when to seek medical or emergency
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