Nosebleed
(Epistaxis)

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Medical Author:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Nosebleed Overview
• Nosebleed Causes
• Nosebleeds in Children
• Nosebleed Symptoms
• When to Seek Medical Care
• Nosebleed Diagnosis
• Nosebleeds Treatment
• Nosebleed Self-Care at Home
• Nosebleed Medical Treatment
• Nosebleed Follow-up
• Nosebleed Prevention
• Nosebleed Prognosis
• Synonyms and Keywords
• Authors and Editors
• Read more on Nosebleeds from Healthwise
• Viewer Comments: Nosebleed - Causes
• Viewer Comments: Nosebleed - Length Symptoms Lasted

Nosebleed Overview

Nosebleeds (epistaxis, nose bleed) can be dramatic and frightening. Fortunately, most nosebleeds are not serious and usually can be managed at home, although sometimes medical intervention may be necessary. Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose).

• Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum, where a network of vessels converge (Kiesselbach plexus). Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a health care practitioner.

• Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).

One out of every seven people will develop a nosebleed at some time in their lives. Nosebleeds tend to occur more often during winter months and in dry, cold climates. They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.

Nosebleed Causes

Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:

• exposure to warm, dry air for prolonged periods of time,
  
  
• nasal and sinus infections,
  
  
• allergic rhinitis,
  
  
• nasal foreign body (object stuck in the nose),
  
  
• vigorous nose blowing,
  
  
• nasal surgery,
  
  
• deviated or perforated nasal septum, and
  
  
• cocaine use.

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

• Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.
  
  
• Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.
  
  
• Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.
  
  
• Vascular malformations in the nose and nasal tumors are rare causes of nosebleeds.
  
  
• High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure.