Nosebleed: causes, first aid and when to seek care

A nosebleed is blood coming from one or both nostrils. It may begin after rubbing, blowing or sneezing, and blood can run forwards or trickle into the throat. A metallic taste, swallowing blood, mild light-headedness or anxiety can accompany the episode. A nosebleed often settles with steady pressure, but repeated, heavy or injury-related bleeding needs medical assessment.

Seek urgent medical help if bleeding follows a significant blow to the head or face, is accompanied by trouble breathing, fainting, marked weakness, confusion, or blood that will not slow despite firm pressure. Arrange prompt assessment for frequent recurrences, bleeding while taking medicines that affect clotting, or bleeding with easy bruising elsewhere. Do not tilt your head back, because blood can be swallowed.

The lining inside the nose has delicate blood vessels that can break when it is dry, irritated or inflamed. Conditions that may be associated with nosebleeds include allergic rhinitis, a common cold, hypertension and sinusitis. Nasal sprays, picking, forceful blowing, an object in the nose, injury, alcohol and medicines that affect bleeding can also be relevant. This list is not a ranking of explanations for an individual episode.

A clinician will ask which nostril bled, how long it lasted, what happened beforehand, and whether there are other bleeding symptoms. They may inspect the front of the nose with a light, check pulse and blood pressure, and review medicines or supplements. Blood tests or a specialist nasal examination may be considered when bleeding is recurrent, hard to control, or suggests a broader health issue.

Sit upright, lean slightly forward, and pinch the soft part of the nose continuously. Spit out blood rather than swallowing it. Once bleeding has stopped, avoid blowing, picking and strenuous activity for a short period. Treatment may address dryness or inflammation, review a medicine, or manage a local vessel. When a visible bleeding point keeps recurring, a clinician may discuss nasal cautery.

Keeping the nasal lining comfortable can help when dryness or irritation is a trigger. Use saline spray or gel if suitable for you, keep fingernails short, and blow the nose gently. A humidified bedroom may be useful in dry air. Follow directions for medicated nasal sprays and ask a clinician or pharmacist before changing prescribed medicines that affect bleeding.

Tell a clinician about blocked nose, facial pressure, sneezing, nasal discharge, reduced sense of smell, headaches, frequent bruising, gum bleeding or fatigue. These details help distinguish local nasal irritation from inflammation, injury, medicine effects or a condition requiring further checks.

A single settled episode may need no further treatment. Recurrent bleeding can lead to a review of nasal care, underlying inflammation and medicines. An ear, nose and throat clinician may examine deeper inside the nose when the source is unclear or episodes persist.