Nose bleeding- an overview into its causes and management

Nosebleeds: Causes and First Aid Tips for Immediate Relief

Learn the common causes of nosebleeds, how to manage them effectively at home, and when to seek medical help. Discover simple first aid tips to stop nosebleeds fast.

Introduction

Nosebleeds, also known as epistaxis in medical term, are a common occurrence and usually not serious. Epistaxis is a form of bleeding occurring from tissues lining the nasal mucosa. However, they can be alarming, especially when frequent or heavy. Most nosebleeds are minor and can be managed at home with simple first aid steps.

This guide explains what causes nosebleeds, how to treat them, and when they may signal a more serious condition.

Types of Nosebleeds

There are two main types based on origin of bleed:

Causes of Nosebleeds

The causes of epistaxis can be divided into:

1. Local causes, in the nose or nasopharynx.
2. General causes
3. Idiopathic causes

1. Local causes

Nose:

• Trauma- Trauma occurring due to finger nail as in nose pricking, nose hair plucking, or due to surgical procedures of nose, any accidents leading to fractures of facial bones, hard blowing of nose or violent sneezing.
• Infections: Any form of bacterial infections leading to nasal vestibulitis, or viral infections, acute sinusitis etc.
• Foreign bodies: Living foreign bodies like maggots or leeches can cause nasal bleed. Similarly entry of any sharp or pointed objects injuring nasal mucosa can also cause bleeding.
• Tumors/masses: Benign neoplasms like haemangioma (blood vessel tumor) or malignant ones like carcinoma of nose can cause recurrent nasal bleeds.
• Atmospheric changes: High altitudes, sudden decompression as in scuba diving, dry air, etc all these can contribute to epistaxis.
• Deviated Nasal Septum (DNS): Deviation of nasal septum to one side can cause turbinate hypertrophy (mostly inferior one) on other side and can form crusting over mucosa which can bleed once the crust is removed.

Nasopharynx:

• The adenoids are a lump of lymphoid tissue present in the nasopharynx. Infection or any inflammation of these can cause posterior epistaxis.
• A highly vascular mass called Juvenile Angiofibroma (JNA) arising in nasopharyngeal region, seen mostly in juvenile age group, has high tendency to bleed.
• Any malignant tumors of nasopharynx.

2. General causes

• Cardiovascular system: Hypertension, atherosclerosis, mitral valve stenosis
• Vascular disorders: Anaemia, leukaemia, thrombocytopenia, Vitamin K deficiency.
• Liver disease: seen mostly in alcoholics where there is cirrhosis of liver leading to deficiency of clotting factors like factor 2, 7, 9 and 10.
• Kidney disease: Chronic disease of nephrons.
• Drugs: Analgesics, anticoagulant therapy for heart disease.

3. Idiopathic causes

Many times, the exact cause of epistaxis can’t be found out,  so called idiopathic.

Risk Factors for Frequent Nosebleeds

• Living in dry or high-altitude climates
• Smoking or exposure to smoke
• Using nasal oxygen without humidification
• Chronic allergies or sinus problems
• Older age (fragile nasal blood vessels)
• Associated comorbidities like hypertension or increased cholesterol

First Aid Tips: How to Stop a Nosebleed

If you or someone else experiences a nosebleed, follow these steps:

✅ Step 1: Stay Calm and Upright

• Sit up straight; don’t lie down.
• Keep your head tilted slightly forward (not backward) to avoid swallowing blood.

✅ Step 2: Pinch Your Nose

• Pinch the soft part of the nose (just below the bony bridge) using thumb and index finger.
• Hold firmly for 10–15 minutes without releasing pressure.
• Breathe through your mouth.

✅ Step 3: Apply Cold Compress

• Place an ice pack or cold towel on the bridge of the nose to constrict blood vessels and reduce bleeding.

✅ Step 4: Avoid Irritation

After the bleeding stops:

• Don’t blow your nose for a few hours.
• Avoid bending down or heavy lifting.
• Use a saline nasal spray to keep the nose moist.

When to Seek Medical Help

Call your doctor or visit an ENT specialist if:

• Bleeding lasts longer than 20 minutes
• Nosebleed is heavy or recurrent
• You feel dizzy or faint
• Blood is flowing from both nostrils or down the throat
• You have a history of high blood pressure, bleeding disorders, or blood thinner use
• The nosebleed follows a head injury

If bleeding is not controlled after appropriate local drugs like xylometazoline nasal drops or haemocogulase solutions, then your attending Doctor can go for procedures that includes:

• Packing of nasal cavity with gauze ribbon. The packing may be anterior nasal packing or posterior nasal packing or both depending on your condition.
• Cauterization i.e burning of the local blood vessel under local anaesthesia if the offending vessel is identified.
• Ligation of the bleeding vessel after identification.
• Embolization of the specific blood vessel responsible for epistaxis.

Preventing Nosebleeds

🌿 Home Tips:

• Use a humidifier in dry seasons.
• Apply petroleum jelly or nasal gels inside nostrils to prevent dryness.
• Avoid picking or blowing the nose forcefully.
• Keep fingernails short in children.
• Stay hydrated to maintain mucosal health.
• Keep you comorbidities under control.

🚫 Avoid:

• Overuse of decongestant nasal sprays
• Smoking or exposure to dry smoke-filled air
• Aspirin or NSAIDs without medical advice if prone to nosebleeds
• Excessive alcohol

Conclusion

Nosebleeds are usually harmless, but frequent or prolonged episodes shouldn’t be ignored. Simple first aid measures can stop most bleeds, while preventive care reduces recurrence. If nosebleeds persist or are accompanied by other symptoms, consult an ENT specialist for a thorough evaluation.

Remember: A little awareness goes a long way in managing and preventing nosebleeds effectively.