Nosebleeds can be dramatic and frightening. Luckily, most nosebleeds are not serious and can be handled fairly easily. They are divided into two types, depending on whether the bleeding is coming from the anterior (front of the nose) or posterior (back of the nose).
Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor.
Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).
Nosebleeds tend to occur during winter months and in dry, cold climates. They can occur at any age but are most common in children aged 2 to 10 years and adults aged 50 to 80 years.
Spitting up, also known as reflux or gastroesophageal reflux disease (GERD), is messy. But unlike vomiting, it usually isn't painful, and babies often don't notice they're spitting up. Most babies outgrow this by 9 or 10 months of age.
Most commonly, trauma to the nose triggers a nosebleed. Trauma to the outside of the nose, such as a blow to the face, or trauma inside the nose, such as nose picking or repeated irritation from a cold, can cause a nosebleed.
Less commonly, an underlying disease process, such as an inability of the blood to clot, may contribute to the bleeding. Inability of the blood to clot is most often due to blood-thinning drugs such as warfarin (Coumadin) or aspirin. Liver disease can also interfere with blood clotting. Abnormal blood vessels or cancers in the nose are rare causes of nosebleeds. High blood pressure may contribute to bleeding but is almost never the only reason for a nosebleed.
Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx (the area inside the nose where the two nostrils merge), spilling into the other nostril to cause bleeding from both sides. Blood can also drip back into the throat or down into the stomach, causing a person to spit or even vomit blood.
Signs of excessive blood loss include dizziness, light-headedness, confusion, and fainting. Excessive blood loss from nosebleeds is rare.
Additional bleeding from other parts of the body, such as bleeding gums when brushing teeth, blood in urine or bowel movements, or easy bruising may indicate an inability of the blood to clot. Additional bleeding or easy bruising can be a sign of a more significant medical problem.
When to Seek Medical Care for a Nosebleed
Call a doctor about nosebleeds:
If you have repeated episodes of nosebleeds
If you have additional bleeding from places other than the nose, such as in the urine or stool
If you bruise easily
If you are on any blood-thinning drugs, including aspirin or warfarin (Coumadin)
If you have any underlying disease that may affect blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot)
If you recently had chemotherapy
Go to the hospital for nosebleeds if:
You are still bleeding after pinching the nose for 10 minutes.
You are having repeated episodes of nosebleeds over a short time.
You feel dizzy or light-headed or like you are going to pass out.
You have a rapid heartbeat or trouble breathing.
You are coughing up or vomiting blood.
You have a rash or temperature greater than than 101.4°F (38.5°C).
Your doctor instructs you to go to a hospital's emergency department.