First Aid & Emergencies

Nosebleeds

Nosebleeds can be dramatic and frightening. Luckily, most nosebleeds are not serious and can be handled fairly easily. They are divided into two types, depending on whether the bleeding is coming from the anterior (front of the nose) or posterior (back of the nose).

• Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor.

• Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).

Nosebleeds tend to occur during winter months and in dry, cold climates. They can occur at any age but are most common in children aged 2 to 10 years and adults aged 50 to 80 years.

Nosebleed Causes

Most commonly, trauma to the nose triggers a nosebleed. Trauma to the outside of the nose, such as a blow to the face, or trauma inside the nose, such as nose picking or repeated irritation from a cold, can cause a nosebleed.

Less commonly, an underlying disease process, such as an inability of the blood to clot, may contribute to the bleeding. Inability of the blood to clot is most often due to blood-thinning drugs such as warfarin (Coumadin) or aspirin. Liver disease can also interfere with blood clotting. Abnormal blood vessels or cancers in the nose are rare causes of nosebleeds. High blood pressure may contribute to bleeding but is almost never the only reason for a nosebleed.

Nosebleed Symptoms

Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx (the area inside the nose where the two nostrils merge), spilling into the other nostril to cause bleeding from both sides. Blood can also drip back into the throat or down into the stomach, causing a person to spit or even vomit blood.

• Signs of excessive blood loss include dizziness, light-headedness, confusion, and fainting. Excessive blood loss from nosebleeds is rare.
• Additional bleeding from other parts of the body, such as bleeding gums when brushing teeth, blood in urine or bowel movements, or easy bruising may indicate an inability of the blood to clot. Additional bleeding or easy bruising can be a sign of a more significant medical problem.