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Why nosebleeds happen—and how to stop them

Andrew Sheppert, MD

Nosebleeds are a common problem for people of all ages. Though “epistaxis” is not usually dangerous, it is bothersome and should be treated to make sure it’s under control. Here’s how to quickly and properly stop a nosebleed—and when to get help.

Sniffing out the cause

Nosebleeds frequently occur at the front of the nose where there are a large number of blood vessels. They are usually the result of dried mucous membranes, which sometimes lose moisture during normal, everyday breathing. Nosebleeds occur more often during the cold winter months, when the air is dry and warm from household heaters. Nose picking or rubbing are also common causes.

Allergies, hypertension, alcohol abuse, and infections may also lead to nosebleeds. Some persistent nosebleeds may be made worse by blood-thinning products like aspirin, anti-inflammatories, clopidogrel, and warfarin.

Stopping the flow

If you get a nosebleed, sit down and bend slightly forward to let the blood drain out through the nose rather than down the back of the throat. Pinch the soft part of the nose together between your thumb and index finger and press firmly toward your face until the bleeding stops. This usually takes 5 to 10 minutes, but it can take longer. It may help to apply a towel-wrapped ice pack to the nose and cheeks.

Once the bleeding is controlled, keep your head elevated and avoid blowing your nose. Avoid hot food and hot liquids for 24 hours, as these may dilate veins and increase blood flow. Also avoid straining or lifting anything heavy. Using a nasal lubricant (Ayr Saline Nasal Gel or Vaseline) or antibiotic ointment (Neosporin) can prevent the nosebleed from starting up again.

Afrin (oxymetazoline) or phenylephrine (Neosynephrine) sprays can help stop persistent nosebleeds—those lasting more than 20 minutes. If Afrin doesn’t slow the bleeding within 10 minutes, it’s time to get help.

Getting medical help

Although most nosebleeds can be stopped at home, chronic or persistent nosebleeds may need urgent medical attention. A nosebleed that cannot be stopped should be seen urgently. Likewise, if you experience lightheadedness or fainting symptoms, or lose a large amount of blood, you should get treatment immediately. Vancouver Clinic’s Urgent Care Department and any emergency room are equipped to help. You may also call 911.

You can also call Vancouver Clinic’s Ear, Nose & Throat (ENT) Department via 360-882-2778 and confirm that someone is available to help. In the ENT office we place cotton balls soaked in Afrin and other packing materials in the nose to control the bleeding. We often will anesthetize bleeding areas with topical lidocaine and cauterize the bleeding vessels with silver nitrate or electrocautery once the precise source of bleeding is located.

Dr. Andrew Sheppert is an otolaryngologist in Vancouver Clinic’s Ear, Nose & Throat Department. He has a particular interest in pediatric otolaryngology.