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Nosebleeds are a common problem in which there is blood loss from the thin tissue lining the inside of your nose. In majority of the cases, bleeding occurs in one of the nostrils. Even though that can be scary, they are rarely a sign of a serious medical issue. Most often, they are caused due to environmental factors such as cold and dry weather. The tissues that line the inside of your nose are very thin and contain numerous small blood vessels. These vessels can bleed if the tissue lining is irritated due to any reason. Persistent or severe cases of nosebleeds need immediate medical attention. 



Nosebleeds can be caused due to multiple reasons. If you have a constant habit of picking or rubbing your nose, you may damage the nasal membrane, which can cause a nosebleed. A dry environment is one of the major causative factors. In cold and dry weather, the use of heating devices inside the house can make the air less humid. This can also contribute to nosebleeds by drying out the nostrils. Dryness caused by dehydration has a similar effect.

Upper respiratory tract infections that present with nasal congestion, runny nose, frequent sneezing, etc., can also irritate your nasal membrane. The incidence is higher in the case of chronic respiratory infections. Nosebleeds can be aggravated by frequently cleaning, rubbing, or blowing your nose. Use of medications such as antihistamines or nasal decongestants to treat these conditions can also dry out your inner nostrils. Other causes of nosebleeds include chemical irritants, foreign objects, traumatic injury, deviated nasal septum, allergies, and nose surgery. Serious causes of nosebleeds include high blood pressure, bleeding or clotting disorders, and cancer. 


Risk Factors And Epidemiology

The risk of nosebleeds is higher for people living in a cold, dry environment. Overuse of heating devices inside the house can dry out the air, increasing the risk of nosebleeds. Children may be at risk if they have a persistent habit of picking their noses. People with allergies or chronic respiratory tract diseases such as asthma, chronic sinusitis, etc., are at risk. Long-term use of antihistamines or nasal decongestants may also put you at risk of nosebleeds.

Infrequent nosebleeds are common and can occur at any age due to environmental factors, traumatic injury, or medical reasons. According to research, around 60% of the total population have experienced a nosebleed at least once in their lives. Young children and older adults are more commonly affected. They are not a medical emergency and can be managed at home. 


Signs And Symptoms

Nosebleeds can occur from the anterior or posterior wall of your nose. Anterior nosebleeds are more common, and they happen when the vessels in the anterior wall of your nose are damaged or irritated. Anterior nosebleeds stop within a few minutes unless you have a bleeding or clotting disorder. Posterior nosebleeds are more dangerous because, in this case, the blood flows down from your nose to the back of your throat. It can have serious consequences and may obstruct your respiratory passage. If a nosebleed lasts longer than 20 minutes, it may signify a posterior nosebleed. Emergency medical attention is required in such cases. 



Diagnostic approach is used to determine the root cause of nosebleeds. Your doctor will perform a clinical examination to assess the inside of your nose. This is done to look for the site of bleeding, presence of any foreign object, or signs of nasal irritation. Before this examination, your doctor may apply an anesthetizing gel to numb the area and restrict bleeding. History of medications, diseases, and surgery is obtained. If the cause cannot be identified by history and examination, additional tests will be done. These tests include complete blood count (CBC), partial prothrombin time (PTT), or nasal endoscopy. In some cases, x-rays or CT scans are also advised. 


Differential Diagnosis

Simple nosebleeds caused due to environmental factors should be differentiated from more serious causes such as bleeding disorders, clotting disorders, cocaine toxicity, barotrauma, disseminated intravascular coagulation, etc. Differentiation can be made on the basis of history, clinical presentation, and diagnostic tests.



The initial treatment for a nosebleed can be done at home to control bleeding. Sit in a straight position and lean down your head slightly. Hold a tissue or towel to absorb the blood coming from your nose. Avoid lying down as it can increase the risk of blood flowing down your throat. Pinch the soft part of your nose to apply pressure. This helps in stopping bleeding. You can also use an icepack to slow down the bleeding. If bleeding does not stop for over 20 minutes despite following all these techniques, you’ll need to be dealt with in a medical emergency. Your doctor will use different procedures such as nasal packing, cauterization, or foreign body removal, depending on the cause and severity of the nosebleed.

Nasal decongestants can be used for cases of infrequent nosebleeds. Remember that long-term use of nasal decongestants can increase the risk of nosebleeds. If you have a bleeding or clotting disorder, your doctor will prescribe medications that promote normal clotting. 



Nosebleeds are easy to manage if they occur once in a while due to dry weather or respiratory infections. Severe cases of nosebleeds can only be treated by a doctor. Lifting heavyweight, high physical activity, or working in a dry environment is prohibited for a few days. 



Saline nasal drops can be used to keep the inner lining of your nose moist in cold and dry weather. It is also recommended to use a humidifier inside your home to prevent the air from drying out. Petroleum jelly or water-soluble nasal gels can also be used to protect the inner lining of your nose. They can be applied once or twice a day with a cotton swab.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 25, 2023.



Nosebleeds - Better Health Channel


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