Nosebleeds 101

What causes a nose bleed?

The inside of our noses has delicate tissue that is lined with blood vessels. If the tissue is exposed to dry air or damaged or scratched, the tissue may sometimes bleed a little, sometimes a lot. Most nosebleeds occur in the front of the nose on the septum. Oftentimes, nosebleeds are not serious and can be treated at home with patience, pressure.

Nosebleeds are rarely fatal. In severe, more life-threatening cases, individuals have suffered from comorbid conditions such as a bleeding disorder or have required blood-thinning medications. Posterior bleeds can also be more dangerous.

Who is more at risk?

  • Most nosebleeds are treatable at home and are not a sign of anything serious. You may be more at risk for nosebleeds if you:
  • Suffer from frequent colds and flu viruses. Nosebleeds often occur naturally with upper respiratory infections. This is because our blood vessels are widening to allow white blood cells to fight infections. Make sure to practice gentle nose-blowing to reduce nosebleed risk. 
  • Live in a dry environment. Both cold and hot dry air irritates the nasal mucosa, especially during seasonal changes. Humidifiers help keep our nose moist, along with petroleum jelly and saline gels. 
  • Take homeopathic medications or consume a special diet.  Some homeopathic remedies contain natural blood thinners that can increase nosebleed severity. These include Danshen, dong Quai, feverfew, garlic, ginger, Ginko Biloba, ginseng, and vitamin E. 
  • Drink alcohol in excess. Drinking alcohol increases blood vessel size (dilation), making you more vulnerable to injury and bleeding. Alcohol also thins your blood and interferes with platelets’ normal activity in the bloodstream which decreases your ability to form blood clots if an injury does occur. 
  • Are exposed to environmental chemicals or if you smoke. If you work in an environment with heavy ammonia, dust, or fumes, wear a mask that covers your nose and mouth. If you smoke, quit! Cigarette smoke and secondhand smoke put you and others at a greater risk for nosebleeds. 
  • Take medications that interfere with blood clotting.  In patients taking medications such as warfarin (anticoagulants) and (NSAIDs), such as aspirin and ibuprofen (Aleve, Motrin, and others), nosebleeds can be a sign that your blood is too thin.
  • Have a medical condition that interferes with blood clotting.  Individuals with blood pressure, kidney failure, low platelets, and other health conditions are at risk for nosebleeds. 

What to do if you get a nose bleed:

  • 1. Sit in an upright position with your chin tucked and your head tilted down- (it’s best to sit in a chair and lean in a 45-degree angle from the floor facing down and breathe through your mouth)
  • 2. Grip the soft part of both nostrils at the bottom of the nose (see picture).
  • 3. Do not grip the bridge of your nose, as that will not help the bleeding, and do not apply pressure to just one side, even if the bleeding is only on one side.
  • 4. Hold steady pressure for at least 10 minutes.

If this does not stop bleeding, you may consider these additional steps:

  • Place a cotton ball or nasal tampons/nasal plugs in the nostril that is bleeding.
  • Spray Afrin* (oxymetazoline), a topical nasal decongestant spray, is in the nose or a cotton ball. Place the soaked cotton ball in the nose. This helps to slow nasal bleeding. This is available over the counter at any pharmacy. 
  • Apply a cold compress or ice pack to the bridge of your nose. This can help the blood vessels constrict and slow the bleeding.
  • Continue to apply pressure in the upright, seated position!
*WARNING: These topical decongestant sprays should be used sparingly. If used in excess, these medications damage the mucosa and increase bleeding risk. 

Call your doctor if:

  • You get nosebleeds often.
  • You have symptoms of anemia (feeling weak or faint, tired, cold, short of breath, pale skin).
  • You recently had surgery.
  • You are taking blood-thinning drugs (such as aspirin or warfarin) or have a blood clotting disorder, and the bleeding won’t stop.
  • Your nosebleed timing occurred with the start of a new medication that seems to have occurred with a new medication.
  • You get nosebleeds as well as notice unusual bruising all over your body. This combination may indicate a more serious condition such as a blood clotting disorder (hemophilia or von Willebrand disease), leukemia, or nasal tumor. It will need to be checked by your doctor.)

Seek emergency care if:

  • Bleeding will not stop after 30 minutes, even after using the above steps.
  • Blood loss is excessive (>1 cup of blood).
  • It becomes hard to breathe because of blood running down your throat.
  • You begin to feel lightheaded, disoriented, or fatigued.
  • Bleeding occurs after an acute injury, and you are concerned you may have broken your nose.


You can help to prevent nosebleeds by:

  • Blowing your nose gently.
  • Not smoking
  • Using a humidifier
  • Staying hydrated!
  • Wearing a mask if you around harmful irritants such as dust or fumes
  • Apply saline nasal gel to each nostril with a Q-tip or your finger
  • Don’t pick your nose!

Examples of Nasal Saline Gels

Nasal Saline Gels