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Bloody Nose

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Last updated March 15, 2021

Bloody nose quiz

Take a quiz to find out what's causing your bloody nose.

Most of the time, a bloody nose (epistaxis) is not serious and will stop quickly. However, frequent nosebleeds for no apparent reason should be treated.

8 most common causes

Swollen Nose
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Nosebleed
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Sinusitis
Hypertensive Crisis
Illustration of various health care options.
Seasonal Allergies
Illustration of various health care options.
Broken nose
Illustration of a person thinking with cross bandaids.
Immune thrombocytopenia
Illustration of a health care worker swabbing an individual.
Osler-weber-rendu syndrome (hereditary hemorrhagic telangiectasia)

Bloody nose quiz

Take a quiz to find out what's causing your bloody nose.

Take bloody nose quiz

Bloody nose symptoms

Even though a bloody nose can be unnerving, this condition is not severe most of the time. The cause of a bloody nose will usually be evident because bleeding will follow an injury, nasal surgery, or a lengthy cold. The nose has an extensive supply of thin, delicate blood vessels needed for your sense of smell. The nose is already somewhat vulnerable to injury, illness, and medication use (or misuse). A nosebleed is also called epistaxis.

Common characteristics of a bloody nose

If you're experiencing a bloody nose, it can likely present as:

  • Lighter bleeding: A trickle of red blood may appear from one or both nostrils following a mild injury, or after blowing your nose due to a cold.
  • Heavier bleeding: A heavier gush of red blood may appear from one or both nostrils following a more severe injury, after nasal surgery, or with blood clotting problems (bleeding disorders).

Is a bloody nose serious?

The severity of a bloody nose depends on the cause.

  • Not serious: Most of the time, a bloody nose is not severe and will stop.
  • Moderately serious: See a physician for a persistent bloody nose .
  • Serious: See a physician for more frequent nose bleeds that keep coming back for no reason.

Bloody nose causes

Traumatic causes

Physical damage to the nasal passages will result in bleeding.

  • Dry air: This dries the passages and makes them thinner and more prone to bleeding.
  • Picking and blowing the nose: This causes irritation that can be severe.
  • Irritating fumes from chemicals
  • Overuse of nasal sprays: These can be very drying.
  • Cocaine use: This is extremely damaging to the lining of the nasal passages.

Medical causes

These things also cause frequent nose blowing, which causes further irritation.

  • Allergies: Most often to dust, pollen, and other inhaled irritants.
  • The common cold
  • Sinusitis: Either viral or bacterial
  • Chronic rhinitis: This is ongoing congestion and other cold-like symptoms not due to allergies.

Direct trauma or injury

Trauma to the nose in itself can result in bleeding.

  • Injury from an accident, fall, or sport
  • Foreign body: Young children may push small objects up their noses, which become lodged and cause chronic pain and bleeding.
  • Deviated septum: This means that the "wall" of cartilage dividing the left nostril from the right is crooked and possibly misshapen. The abnormal airflow is very drying and leads to bleeding of the nasal tissue.
  • Nasal surgery: This may have created spots of incomplete healing that continue to bleed.

Bleeding disorders

Bleeding disorders can manifest as a bloody nose.

  • Taking blood thinners: "Thin" blood that does not clot right away due to prescribed blood thinners, such as Coumadin, or, sometimes, aspirin.
  • Low levels of platelets in the blood: This may follow a viral infection.
  • Hereditary malformations of the blood vessels

Abnormal growths within the nose

Such growths may include nasal polyps, tumors, or even cancer of the blood-forming tissues anywhere in the body, which may have nosebleeds as a symptom.

Pregnancy

The body increases in vascularity, the number of blood vessels it carries, during pregnancy. These vessels are sometimes more vulnerable to minor bleeding.

Drinking alcohol

Regular consumption of alcohol can have a blood-thinning effect, especially if you are already taking a prescribed blood thinner or taking aspirin.

Bloody nose quiz

Take a quiz to find out what's causing your bloody nose.

Take bloody nose quiz

6 bloody nose conditions

The list below shows results from the use of our quiz by Buoy users who experienced bloody nose. This list does not constitute medical advice and may not accurately represent what you have.

Nosebleed requiring treatment

Nosebleeds are a common disorder that many (60%) will experience. It can be caused by a number of things that rupture the blood vessels in the nose such as: dry air, picking your nose, getting hit in the nose, or even just getting older

Rarity: Common

Top Symptoms: severe nosebleed

Symptoms that always occur with nosebleed requiring treatment:severe nosebleed

Urgency: In-person visit

Iatrogenic nose condition

Surgery of the nose or nose piercing can result in side effects ranging from infection, pain and swelling to numbness and decreased sense of smell.

Rarity: Uncommon

Top Symptoms: nose pain, bloody nose, bump in or on the nose, nose redness, swollen nose

Urgency: Phone call or in-person visit

Viral sinus infection (sinusitis)

Acute viral sinusitis, also called viral rhinosinusitis or "sinus infection," occurs when viruses take hold and multiply in the sinus cavities of the face.

It is most often caused by the same viruses that cause the common cold and spreads the same way, through an infected person's coughing or sneezing.

Because children have small, underdeveloped sinuses, this illness is far more common in adults.

Symptoms include clear nasal discharge (not greenish or yellowish,) fever, and pain if facial sinuses are pressed.

If there is rash, severe fatigue, or neurologic symptoms (seizures, loss of sensation, weakness, or partial paralysis,) see a medical provider to rule out more serious conditions.

Diagnosis can usually be made through history and examination alone.

Antibiotics only work against bacteria and cannot help against a viral illness.

Therefore, treatment consists of rest, fluids, and fever/pain reducers such as ibuprofen. (Do not give aspirin to children.) Symptoms of viral sinusitis last for about seven to ten days.

As with the common cold, the best prevention is frequent and thorough handwashing.

Osler-weber-rendu syndrome (hereditary hemorrhagic telangiectasia)

Hereditary Hemorrhagic Telangiectasia is a genetic disorder that leads to abnormal blood vessel formations all over your body, causing bleeding.

You should go see your primary care doctor, who will diagnose based on a physical exam, imaging, and family history questions. Treatment is to control the bleeding when it happens.

Normal nosebleed (epistaxis)

A bloody nose can be caused by a host of things, but is often idiopathic (without cause).

Your nosebleed is normal and unlikely to be caused by a serious illness. Perform moderate pressure with your fingers, just below the bony part of the nose. Try to keep your head straight to prevent blood from dripping in your throat.

Rarity: Common

Top Symptoms: bloody nose, vomiting with streaks of blood

Symptoms that always occur with normal nosebleed (epistaxis):bloody nose

Symptoms that never occur with normal nosebleed (epistaxis):severe nosebleed, nausea or vomiting

Urgency: Self-treatment

Immune thrombocytopenia

Platelets are tiny cells in the blood that help form blood clots and seal minor cuts and wounds. Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), is a condition where there are not enough platelets in the blood, causing easy bruising and tiny reddish purple dots on the skin from bleeding under the surface.

You should visit your primary care physician to determine the severity of your ITP, and plan a course of treatment if needed. Treatment is focused on raising the platelet count to prevent excessive bleeding.

Rarity: Rare

Top Symptoms: being severely ill, rectal bleeding, red stool, unexplained/excessive bleeding from cuts or wounds, unexplained bruising

Symptoms that always occur with immune thrombocytopenia: being severely ill

Urgency: Primary care doctor

Iatrogenic nose condition

Surgery of the nose or nose piercing can result in side effects ranging from infection, pain and swelling to numbness and decreased sense of smell.

You should contact a healthcare provider to decide whether your symptoms need further examination and treatment. If you have signs of an infection, it is likely a course of antibiotics will be prescribed.

Hypertensive crisis

Hypertensive crisis, also called malignant hypertension, means there has been a sudden increase in blood pressure to dangerously high levels. Any reading higher than 180/120 is enough to cause serious health problems.

High blood pressure, or hypertension, can be due to stress, poor diet, lack of exercise, obesity, sleep apnea, or use of illegal drugs. Untreated hypertension can lead to a hypertensive crisis.

Symptoms of dangerously high blood pressure can include chest pain, severe headache, blurred vision, nausea and vomiting, shortness of breath, and blacking out.

Blood pressure at these high readings, with these symptoms, can damage blood vessels and cause a stroke. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination and blood pressure measurement.

Treatment involves oral medication to reduce the blood pressure. Hospitalization is usually not required unless the medication is not effective, in which case intravenous medicine will be used.

The best prevention involves proper use of blood pressure medication along with lifestyle changes to reduce stress and improve physical fitness.

Bloody nose quiz

Take a quiz to find out what's causing your bloody nose.

Take bloody nose quiz

Chronic allergies

New-onset seasonal allergies, also called adult-onset seasonal allergies, are sensitivities to pollen, mold, and other irritants that cause nasal congestion, runny nose, sneezing, itchy eyes, and sore throat.

Seasonal allergies commonly begin in childhood but can start at any age, especially among those with a family history. Moving to a different geographic location may trigger the allergy in someone with a genetic predisposition. Anyone with asthma is more likely to experience adult-onset seasonal allergies.

Sometimes the symptoms are actually from "pregnancy rhinitis" – nasal congestion and sneezing due to the effects of pregnancy hormones on the nasal tissue.

A new-onset allergy is often thought to be a cold, but a cold will clear up without treatment. Allergies persist, never getting better or worse, and can interfere with quality of life.

Diagnosis is made by an allergist, who will use skin tests and blood tests.

There is no cure for seasonal allergies but the symptoms can be managed for greater comfort and relief. Antihistamines, corticosteroid nasal sprays, and immunotherapy or "allergy shots" can be very effective.

Rarity: Common

Top Symptoms: fatigue, irritability, trouble sleeping, runny nose, congestion

Symptoms that never occur with chronic allergies: fever, yellow-green runny nose, chills, muscle aches

Urgency: Self-treatment

Broken nose

Nasal fractures are common occurrences. The force needed to break the nasal bones is less than any of the other bones of the face because of their thinness and position. For kids, treatment and diagnosis is different because of the bones may not be fully formed.

You should go to urgent care or the emergency room immediately by car, where diagnosis can be confirmed by taking pictures. Treatment involves stabilizing the nose and referring to an Ear/Nose/Throat surgeon or a plastic surgeon for further management.

Rarity: Uncommon

Top Symptoms: mouth breathing, constant nose pain, swollen nose, nose pain caused by trauma, nose bruise

Symptoms that always occur with broken nose: nose pain caused by trauma, swollen nose, constant nose pain

Urgency: Hospital emergency room

Bloody nose treatments and relief

When it is an emergency

Seek immediate treatment in the emergency room or call 911 if your bleeding is heavy and will not stop, whether or not there is also an injury.

When to see a doctor

You should schedule an appointment for:

  • Frequent nosebleeds that occur for no apparent reason
  • Small, bright red spots that appear within the skin of the face, lips, or hands

At-home treatments

For mild congestion, try using a salt water spray instead of a nasal decongestant spray.

Questions your doctor may ask about bloody nose

  • Did your nose start bleeding after being hit in the nose?
  • Have you experienced any nausea?
  • Do you have any issues with bruising?
  • Do you have an object stuck in your nose?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Share your story
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Nosebleeds. FamillyDoctor.org. Updated October 1, 2018. FamillyDoctor.org Link
  2. Other nose disorders. Head & Neck Surgical Associates. Head & Neck Surgical Associates Link
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  4. Nosebleed. Seattle Childrens Hospital. Updated November 3, 2018. Seattle Childrens Hospital Link
  5. Chronic nosebleeds: What to do. American Academy of Pediatrics: HealthyChildren.org. Updated June 1, 2009. HealthyChildren.org Link
  6. Nosebleed. Health Navigator. Health Navigator Link
  7. Nosebleed (epistaxis) in children. Johns Hopkins Medicine. Johns Hopkins Medicine Link
  8. Blaivas AJ, Brown K, Kirsi JS, eds. Allergic rhinitis in children. University of Rochester Medical Center. URMC Link
  9. Quillen DM, Feller DB. Diagnosing rhinitis: Allergic vs. nonallergic. American Family Physician. 2006;73(9):1583-1590. AAFP Link
  10. Idiopathic thrombocytopenic purpura (ITP). FamillyDoctor.org. Updated January 18, 2018. FamillyDoctor.org Link
  11. Nosebleeds during pregnancy. NCT. NCT Link