When to Worry About a Nosebleed

Usually, you do not need to worry about a nosebleed (epistaxis). Most nosebleeds stop after a few minutes and are nothing serious. However, you should get medical attention if you:

• Can't stop the bleeding
• Have lost a lot of blood
• Have trouble breathing
• Are vomiting from swallowing blood
• Have had a serious injury
• Have nosebleeds frequently

Getting care when you need it can prevent the consequences of blood loss, as well as help you get a diagnosis or treatment for a potential underlying health condition.

This article discusses the cases in which you should make an appointment with a healthcare provider or go to the hospital for a nosebleed.

Your Nose Bleeds Nonstop for 30 Minutes

Most healthy people should be able to stop a bloody nose at home in 30 minutes or less. Try leaning slightly forward and gently pinching your nostrils together. This helps the blood clot. It may take longer if you have a bleeding disorder.

If you have a condition like hemophilia, which causes problems with blood clotting, talk to your healthcare provider. If you are on blood-thinning medications, you should also seek medical help.

You Are Losing Too Much Blood

Excessive blood loss can make a bloody nose an emergency. Sometimes, though, it can be hard to judge how much blood you've lost. A few tablespoons can look like a lot. If you are gushing blood, call 911.

If pinching does not stop the dripping, use a container to catch the blood. A measuring cup is ideal because it will help you and a medical professional know how much blood you've lost. If you lose about a cup of blood, you need to get immediate medical attention.

Blood loss is most concerning if you have a history of blood diseases such as hemophilia or anemia. When you are anemic, you don't have enough red blood cells.

Prolonged nosebleeds are also a concern if you are taking medications that thin the blood, such as:

• Aspirin
• Coumadin (warfarin)
• Lovenox (enoxaparin)

Your Bloody Nose Was Caused by Severe Trauma

Trauma, especially a blow to the head, can make a bloody nose an emergency.

Minor bumps or falls that cause a bloody nose are probably not serious. Major incidents like falling down stairs, sports accidents, and fights can cause a bloody nose that becomes a medical emergency.

A severe injury to the nose may swell and make breathing difficult. You may have a broken nose, a concussion (brain injury), or a spinal cord injury. It is always best to seek emergency medical care after a major accident.

You Have High Blood Pressure

A bloody nose that is caused by high blood pressure is an emergency. These nosebleeds happen without any particular trigger.

If you get a nosebleed and you have a history of high blood pressure, contact your healthcare provider.

This is especially important if you also have a headache, chest pain, or faintness. These are symptoms of a hypertensive crisis, which can lead to loss of consciousness, stroke, or heart attack unless promptly addressed.

You Can Taste Blood

Bloody noses towards the front of the nose are usually less severe. These bleeds can usually be stopped with pressure.

If you can taste blood, you may have a posterior bleed—that is, one that comes from the back of the nose.

Posterior nosebleeds are often more severe. They cannot be stopped by pinching your nostrils. They also tend to be from major blood vessels. Seek emergency care at once if you have this type of nosebleed.

You Have More Than One Nosebleed a Week

If your nosebleeds happen more than once a week, see a healthcare provider. Recurring nosebleeds can be a sign of something more serious, such as:

• High blood pressure
• A clotting disorder
• Nasal polyps
• Immune thrombocytopenia, an autoimmune condition characterized by reduced platelets
• Hereditary hemorrhagic telangiectasia, a rare genetic condition  
• Certain cancers such as leukemia, lymphoma, or nasal and sinus cancer
  

How to Manage a Severe Nosebleed

Severe nosebleeds are managed with what's known as "nasal packing," in which a special pack, similar to a tampon, is inserted into the nose to control bleeding. Nasal packing should always be done by a trained healthcare provider.

If nasal packing does not stop the bleeding, a healthcare provider may perform an embolization. The procedure involves blocking off the blood vessel supplying the inner lining of the nose. Embolization for nosebleeds is a surgical intervention that takes one to two hours to complete.

What Not to Do for a Nosebleed

When you have a nosebleed, you should not:

• Pack your nose with tissues, tampons, or other household items.
• Pick or blow your nose.
• Tilt your head back or lie flat on your back, which can cause you to choke on blood.
• Lift anything heavy or do vigorous physical activities, which can increase your blood pressure.
• Use aspirin, ibuprofen, or naproxen for 36 to 48 hours after the nosebleed, unless your doctor tells you to. For pain relief, acetaminophen is okay.
• Use nasal sprays, as they can make your nose dry.

Summary

Bloody noses are usually not serious. Most can be stopped if you lean forward and gently pinch your nostrils.

In some cases, a bloody nose can be an emergency. If your nose bleeds for longer than 30 minutes or you lose a cup of blood or more, get emergency help. You should also seek emergency care if you were in a serious accident, have high blood pressure, or can taste blood.