What Causes Nosebleeds, and How Do You Prevent Them?

Most people have experienced the inconvenience of a nosebleed (epistaxis) at some point in their life. And while they can seem scary, they’re fairly common and can occur easily. Sometimes, all it takes is dry air and a little nasal congestion. 

But there are many different reasons that nosebleeds can start. And there are a few types of nosebleeds that can be more serious because they’re harder to stop. So, we’ll review the different causes of nosebleeds, how to prevent them, and what to do if they happen to you.

The most common causes of nosebleeds

Seeing bright red blood from your nose can be distressing. Most of the time, it’s a nuisance rather than a sign of something serious. Here are some of the common reasons why   nosebleeds happen.

1. Dry air

You may notice that nosebleeds occur more often in the winter or hot summer days. This is mainly a result of having dry nasal passages. In the winter, air tends to be drier because of lower humidity levels and indoor heating. Similarly, on hot summer days, especially in drier climates, the inside of your nose can become dry. When this happens, the blood vessels that line the inside of your nose are more likely to start bleeding.

2. Nasal congestion

Any time your nose is congested, whether from allergies or colds, the lining of your nose can become irritated. This irritation can make the blood vessels in your nose more likely to bleed. 

Research has even suggested that nosebleeds are particularly linked to infection with the bacteria Staphylococcus aureus in children. 

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A runny nose can also lead to dry or crusty boogers. And when they get dislodged, it can accidentally cause some bleeding. 

3. Trauma

Nosebleeds can happen with any sort of trauma to the face — from a simple fall to an object hitting someone in the face. Often, this happens when someone breaks their nose. But it can happen even in the absence of broken bones or injured nasal cartilage.

Children in particular can be prone to nosebleeds from trauma. Not only do they have a tendency to fall on their face, but even minor trauma (like picking their nose) can lead to bleeding. Children also have a tendency to stick objects up their nose. And foreign objects can cause injury when they go in, while they’re stuck up the nose, or when they come out.

4. Blood thinners

Blood thinners (anticoagulants) are medications that make it harder for your blood to clot. So it probably is no surprise that they can increase your risk of a nosebleed. Even when there’s no obvious trigger or cause.

Common blood thinners include: 

• Warfarin (Coumadin)

• Rivaroxaban (Xarelto)

• Apixaban (Eliquis)

• Heparin (Panheprin)

• Aspirin

• Clopidogrel (Plavix)

5. Nasal medications and drugs

Several medications can put someone at increased risk for nosebleeds. The most common examples include:

• Nasal steroids: People with allergies often use nasal steroid sprays. These can thin the skin and blood vessels that line the inside of the nose, making them more likely to bleed.

• Nasal decongestants: Sprays, like oxymetazoline (Afrin), can significantly dry out the inside of the nose. This can make the blood vessels more prone to bleeding.

And it’s also important to mention that any recreational drugs, when snorted, can irritate the inside of the nose and cause nosebleeds. This is particularly true of cocaine.

6. Pregnancy

Nosebleeds are more likely during pregnancy. That’s because hormonal changes can lead to more engorged blood vessels, which can increase the risk of bleeding, particularly in more delicate vessels. Hormones also stretch out blood vessels, making it easier for them to break and bleed. 

7. High blood pressure

Many people blame nosebleeds on high blood pressure (hypertension). But actually, there’s no solid evidence to suggest this is true. Some studies have indeed shown that people tend to have higher blood pressure when they seek medical care for bloody noses. But other studies suggest this is just related to the stress of the event. 

8. Underlying bleeding disorder

Certain conditions can make bleeding more likely. This is usually due to abnormal blood cells that interfere with normal blood clotting. Some examples include: 

• Inherited blood conditions, such as hemophilia and von Willebrand disease

• Some cancers of the blood, such as leukemia, lymphoma, and multiple myeloma 

• Liver disease, which can interfere with the production of certain proteins that help with blood clotting

Can stress cause nosebleeds?

There are a lot of anecdotal reports that stress can cause nosebleeds. But there’s no solid evidence to suggest that this is true. 

Many people think that because stress can increase your blood pressure, it can also raise your risk of nosebleeds. But as we explained above, there’s no research to suggest increased blood pressure leads to nosebleeds. 

But it may be true the other way around. In other words, there’s evidence that increased frequency of nosebleeds leads to increased stress. This may be one of the reasons that people associate nosebleeds with stress.

What to do if you get a nosebleed at home

If you have a bloody nose, there are several things you can do at home to stop the bleeding:

• Get in a good position. Sit down and lean forward. Many people have the natural instinct to tilt their head up and back. But this will cause the blood to run down the throat rather than out the nose. So it’s better to tilt the head down and forward. 

• Pinch your nose. Be sure to pinch the softer part of the nose, near the tip. This way you can actually apply pressure to the blood vessels. Many people pinch the top hard part of the nose, near the cartilage. But this doesn’t do any good. 

• Hold constant pressure for 5 to 10 minutes. It takes time for a clot to form. While 10 minutes may feel like a long time when you’re bleeding, it will help that clot form more solidly if you give it more time.

• Don’t use ice. A study looking specifically at the use of ice in nosebleeds showed that it didn’t help in slowing bleeding.

Are there ways to prevent nosebleeds from happening?

Nosebleeds aren’t always preventable. But there are still a few things you can do that may help keep them from happening:

• In dry weather, use a humidifier to add moisture to your indoor environment. 

• Use an ointment like petroleum jelly inside your nostrils to keep them moist. 

• Avoid picking your nose. And parents can help remind their kids to keep their fingers away from their nose.

• If you or your child is congested, saline sprays and rinses can more gently remove any unwanted crustiness from inside the nose.

When should I contact my healthcare provider for a nosebleed?

Any type of bleeding can seem scary. And in those moments, it can be hard to know if your nosebleed will need medical attention. In most cases, the bleeding will stop eventually and not lead to any problems. 

But there are instances when you should consider heading to the nearest emergency room for treatment. Emergency healthcare providers have a number of tools and medicines that can effectively stop the bleeding.

You should get urgent medical attention if you are:

• Still bleeding despite holding pressure for more than 10 minutes 

• Feeling lightheaded or like you’re going to faint — particularly if the feeling started after losing a significant amount of blood 

• Swallowing a lot of blood, or throwing up blood. Often, this means that you have bleeding in the back part of your nose. These nosebleeds are harder to reach by applying pressure at home. They also tend to bleed more heavily.

• Bleeding or bruising in other parts of your body. This could mean you’re not clotting properly, and it could be a sign of a blood condition.  

• Bleeding from trauma to your face. Or you (or you child) may have a foreign body in the nose — especially if it’s a watch battery or a button battery. This can cause further damage to the inside of the nose.

• Taking any anticoagulants. These nosebleeds tend to be harder to stop. It may also be a good idea to have blood tests to make sure your blood isn’t too thin.

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Written by:

Jill L. Jaimes, MD

Jill L. Jaimes, MD, is a board-certified pediatric emergency medicine physician with over 20 years of clinical experience. She received her medical degree from Baylor College of Medicine and completed her residency and fellowship training at Texas Children’s Hospital.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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