Nosebleeds: When to Get Medical Attention

At some point in their lives, most adults have experienced a nosebleed, which is usually an isolated incident that stops on its own.

But for some—about 15% of people—nosebleeds are a regular occurrence.

“Frequent nosebleeds are a common reason to see a primary care doctor or an ear, nose, and throat (ENT) specialist,” says David A. Gudis, MD, chief of the Division of Rhinology and Anterior Skull Base Surgery in the Department of Otolaryngology – Head and Neck Surgery at Columbia. “When nosebleeds are frequent, they can get in the way of daily activities and be a significant hindrance to a normal and healthy quality of life.”

Recurrent nosebleeds can often be managed by simply holding pressure on the nose. But in some cases, medical or surgical intervention is necessary. In rare cases, Dr. Gudis says, frequent nosebleeds may be a sign of a more significant health issue, so it’s important to see a specialist to determine the underlying cause.

Dr. Gudis explains where nosebleeds come from, whether home remedies help, and when to call a doctor.

What can cause nosebleeds in adults?

Nosebleeds usually come from the front of the nasal septum, known as the Kiesselbach’s plexus, where several branching arteries converge. The vessels supply the area with blood, keeping the sinuses healthy, but they can also result in frequent nosebleeds.

In adults, inhaling can create a turbulent airflow through the inner nose that may irritate the lining of the nose and eventually lead to a nosebleed, especially in the case of a deviated nasal septum. “Even though it's essentially unnoticeable to the average person, over time it can cause trauma to the mucous membrane that covers Kiesselbach’s plexus and cause recurrent nosebleeds,” Dr. Gudis says. Cold, dry air can also be a trigger.

Individuals who take blood thinners or chemotherapy are also more likely to have recurrent nosebleeds.

“I often see patients who are taking some kind of antiplatelet or anticoagulant medication,” Dr. Gudis says. “It's easier for us to manage nosebleeds than to manage a stroke or a heart attack, so I would rather treat their nosebleeds aggressively so that patients can stay on their necessary anticoagulant or antiplatelet medications.”

What can cause nosebleeds in kids?

Kiesselbach’s plexus is easily accessible by small fingers. “We refer to that medically as ‘digital trauma,’" Dr. Gudis says. "Basically, you’ve poked your nose with your finger too much, and that’s a common way to traumatize the vascular region.”

When should someone see an ear, nose, and throat specialist for nosebleeds?

Frequent nosebleeds could be a reason to call a health care provider. “If nosebleeds are troublesome for the patient, upsetting, or interfering with daily activities, it's worth seeing a specialist,” Dr. Gudis says. A specialist can rule out a few diagnoses by doing an exam or taking a history.

One condition, called hereditary hemorrhagic telangiectasia, or HHT, is a genetic condition that causes abnormal blood vessel formation.

“These aren't the kind of nosebleeds that most people have experienced,” Dr. Gudis says. “These patients can lose a pint of blood every time they take a hot shower or bend over to tie their shoes.” The most frequent symptom of HHT is severe nosebleeds, but the condition also causes abnormal blood vessels in other parts of the body. “Even without a family history, spontaneous genetic mutations can cause this condition, so it’s a diagnosis that needs to be considered in patients who have frequent or recurrent epistaxis.”

Other possible causes to consider are tumors, both benign and malignant, that can form in the nose or the sinuses.

When does a nosebleed need immediate medical attention?

If a nosebleed just gets a few tissues or paper towels wet and eventually stops, “that might feel like a lot of blood,” Dr. Gudis says, “but in terms of the body's volume of blood, it’s not a severe nosebleed.”

But some nosebleeds involve such significant blood loss that they can result in an airway obstruction or an emergency.

Dr. Gudis tells patients that a nosebleed that could fill a cup with blood is severe enough to need attention. “If it's like a leaky faucet dripping from the nose, and nothing is stopping it, urgent medical attention is required. That might mean a trip to the emergency room or a primary care doctor's office. Occasionally, these can turn into life-threatening emergencies.”

Do home remedies for nosebleeds work?

It depends. If a patient has frequent nosebleeds, without any other concerning symptoms, topical moisturizers for the nose—like nasal saline gel or saline gel spray—can protect the lining and minimize nosebleeds.

Humidifiers in the bedroom or office can be very helpful for preventing cold, dry air from irritating the lining of the nose.

One common home remedy—putting a copper penny on the forehead or nose—is probably not effective. “I'm not aware of any evidence that it helps,” Dr. Gudis says. “But sometimes cold things on the nose can constrict the blood vessels, so there may be a bit of truth to the concept.”

What is silver nitrate cauterization?

For more troublesome cases, a quick application of silver nitrate in the doctor’s office can put a stop to the nosebleed.

“Silver nitrate is a chemical that's been used in medicine for hundreds of years for many different purposes. One thing it does very well is cause sclerosis of blood vessels,” Dr. Gudis says. “Essentially, the silver ions in the silver nitrate are released around the blood vessels and cause an inflammatory reaction that creates scarring in the little arteries and veins in the mucus membrane of the nose. This ‘sclerosis’ prevents blood flow through the vessels, reducing the likelihood of bleeding.”

The procedure is simple, quick, and very effective.

“I tell patients it's going to sting. Usually it's five or 10 minutes of discomfort, and by the time they’re out the door, it doesn't hurt anymore. A handful of my patients have had pain for a couple of days afterwards, but that's extremely rare and usually can be managed with over-the-counter pain relievers.”

David A. Gudis, MD, is the chief of the Division of Rhinology and Anterior Skull Base Surgery in the Department of Otolaryngology – Head and Neck Surgery and the Department of Neurologic Surgery at Columbia.