All about Bloody Noses – Epistaxis

shutterstock_80516140A patient came into the urgent care today with a bloody nose after being hit with a baseball in the nose while playing catch.  The bleeding was so intense that blood was actually coming up through the tear ducts of his eyes.  His nose had been bleeding for about an hour prior to me seeing him and by that he came to the exam room the bleeding had almost stopped.

Nosebleeds can be dramatic and frightening but usually they stop on their own without need for intervention by a doctor.  I do however have some recommendations about what to do if you get a bloody nose (also called epistaxis) that will not stop.

1)   If your nose has been bleeding for awhile and is not stopping, blow all that goo that’s in the affected nostril out. This might cause the bleeding to increase temporarily and that’s ok.

2)   Get into a comfortable position and relax.  Don’t lay on your back, just sit up straight.

3)   If you have some Afrin (Oxymetazoline)

spray into the affected nostril.  It’s a nasal decongestant and causes the blood vessels to shrink down and this slows the bleeding down

4)   Grip the soft part of your nose  – both notrils (do not grip the bony part of the nose as that will not stop the bleeding).  Hold pressure over the nose for 15 minutes.  This is easier said than done.  You need to have a watch with you and actually keep holding pressure without letting go for the entire 15 minutes.  I’ve asked patients to hold pressure for this period of time and watched them let the pressure off after 2 minutes, thinking that they’d held for long enough, so make sure you have a watch and time this procedure.  If you take the pressure off too early, the bleeding will restart

5)   If, after performing all the above treatments your nose is still bleeding then you need to come in for evaluation.

There are two main types of nosebleeds.  The most common type is the anterior nosebleed that starts towards the front of the nose and causes blood to flow out through one of the nostrils.  The other type originates in the back of the nose near the throat.  Posterior nosebleeds are much less common and can be serious because stopping the bleeding can be more difficult.

When to seek medical care:

1)   The bleeding makes it difficult to breathe

2)   You become disoriented or light-headed

3)   The bleeding doesn’t stopped after you’ve tried the steps above

4)   You’ve recently had nasal surgery

5)   You’re having other symptoms such as chest pain

6)   You’ve had facial trauma and may have broken your nose

7)   You’re bleeding won’t stop and you’re taking a blood thinner such as Coumadin or Plavix

Prevention:  Some people seem to have issues with frequent nosebleeds.  Part of the reason is that sometimes the mucus membrane inside the nose become dry.  When that occurs the skin can rip or tear more easily and cause bleeding.  Also if the inside of the nose becomes itchy, often a patient might scratch the nose in the middle of the night and not realize it, causing trauma to the skin, bleeding and scab formation. The first line of prevention involves keeping fingers out of the nose.  I also recommend using a small amount of petrolium jelly (Vasoline) applied to the skin inside the nose to moisturize the skin and prevent bleeding for those people with recurrent nosebleeds.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO



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