Nose Bleeds & Nasal Fractures

A nosebleed is loss of blood from the tissue lining the nose. Bleeding most commonly occurs in one nostril only.

Nosebleeds are very common. Most nosebleeds occur because of minor irritations or colds. They can be frightening for some patients, but are rarely life threatening.

The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose, forming crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose.

The lining of the nose is more likely to become dry and irritated from low humidity, allergies, colds, or sinusitis. Thus, nosebleeds occur more frequently in the winter when viruses are common and heated indoor air dries out the nostrils. A deviated septum, foreign object in the nose, or other nasal blockage can also cause a nosebleed.

Most nosebleeds occur on the front of the nasal septum, the tissue that separates the two sides of the nose. The septum contains many fragile, easily damaged blood vessels. This type of nosebleed can be easy for a trained professional to stop. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose. Such nosebleeds may be harder to control.

Occasionally, nosebleeds may indicate other disorders such as bleeding disorders or high blood pressure.

Frequent nosebleeds may also be a sign of hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome).

Blood thinners such as Coumadin or aspirin may cause or worsen nosebleeds.

Causes

Allergic rhinitis
An object stuck in the nose
Barotrauma
Blowing the nose very hard
Chemical irritants
Direct injury to nose, including a broken nose
Nose picking
Overuse of decongestant nasal sprays
Repeated sneezing
Surgery on the face or nose
Taking large doses of aspirin or blood-thinning medicine
Upper respiratory infection
Very cold or very dry air

Repeated nosebleeds may be a symptom of another disease such as high blood pressure, allergies, a bleeding disorder, or a tumor of the nose or sinuses.

Home Care

Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for a full10 minutes. Lean forward to avoid swallowing the blood and breathe through your mouth. Wait at least 10 minutes before checking if the bleeding has stopped. Many nosebleeds can be controlled in this way if enough time is allowed for the bleeding to stop.

It may help to apply cold compresses or ice across the bridge of the nose. DO NOT pack the inside of the nose with gauze.

Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed.

When to Contact a Medical Professional

Get emergency care if:

Bleeding does not stop after 20 minutes
Nose bleeding occurs after an injury to the head -- this may suggest a skull fracture and x-rays should be taken
Your nose may be broken (for example, it is misshapen after a blow or injury)

Call your doctor if you or your child has repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.

What to Expect at Your Office Visit

The doctor will perform a physical examination. In some cases, you may be watched for signs and symptoms of hypovolemic shock. The doctor will ask you questions about your nosebleeds, including:

Is there a lot of bleeding?
Do the nosebleeds stop quickly when you press on the nostrils?
Did they begin recently?
Do they occur frequently or repeatedly?
Does the bleeding always occur on one or both sides?
What other symptoms do you have?
Is there blood in the stools?
Are you vomiting blood?
Do you bruise or bleed easily?
Are there tiny red or purple spots on the skin ( petechiae)?
Are you taking blood thinners (Coumadin) or aspirin?

Diagnostic tests that may be done include:

Complete blood count
Nasal endoscopy (examination of the nose using a camera)
Partial thromboplastin time measurements
Prothrombin (PT)
X-rays of the skull

Treatment is usually focused on the cause of the nose bleeds, and may include:

Controlling blood pressure
Closing the blood vessel using heat, electric current, or silver nitrate sticks
Nasal packing
Reducing a broken nose or removing a foreign body
Reducing the amount of blood thinners or stopping aspirin

You may be referred to an ear, nose, and throat (ENT) specialist to diagnose and treat the condition.

Prevention

A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray and water soluble jelly (such as Ayr gel) can help prevent nosebleeds, especially during the winter months.

Nasal Fractures

A nose fracture is a break in the bone or cartilage over the bridge, in the sidewall, or septum (line dividing the nostrils) of the nose.

A fractured nose is the most common fracture of the face. It usually occurs after an injury and often occurs with other facial fractures.

Sometimes, as a result of a blunt injury, the wall dividing the nostrils (septum) can separate.

Nose injuries and neck injuries are often seen together because a blow that is forceful enough to injure the nose may be hard enough to injure the neck.

Serious nose injuries cause problems that require a doctor's attention right away. However, for minor nose injuries, the doctor may prefer to see the patient within the first week after the injury if the nose may have become deformed.

Occasionally, surgery may be needed to correct a deformity of the nose or septum caused by a trauma.

Symptoms

Blood coming from the nose
Bruising around the eyes
Difficulty breathing through the nose
Misshapen appearance (may not be obvious until swelling goes down)
Pain
Swelling

The bruised appearance usually disappears after 2 weeks.

The symptoms may be the same as those of a fractured nose.

First Aid

Reassure the patient and try to keep the patient calm.
Have the patient breathe through the mouth and lean forward in a sitting position in order to keep blood from going down the back of the throat.
Apply cold compresses to the nose to reduce swelling. If possible, the patient should hold the compress so that there isn't too much pressure on the nose.
To help relieve pain, acetaminophen (Tylenol) is recommended.

DO NOT

Do NOT try to straighten a broken nose.
Do NOT move the person if there is reason to suspect a head or neck injury.

When to Contact a Medical Professional

Get medical help right away if:

Bleeding will not stop
Clear fluid keeps draining from the nose
You suspect a blood clot in the septum
You suspect a neck or head injury
The nose looks deformed
The person is having difficulty breathing

Prevention

Wear protective headgear while playing contact sports, riding bicycles, skateboards, roller skates, or rollerblades.

Use seat belts and appropriate car seats when driving.

>> Back to Sinus & Nose Conditions

Home Page

ENT Specialty Services

Meet Our Physicians & Staff