Nosebleeds are a common occurrence and in most cases do not pose a serious problem. This condition, known as epistaxis, is usually associated with causes such as dry nasal mucosa, colds, rhinitis, sinusitis, or minor injuries. However, frequent, very intense episodes or those that do not stop within a few minutes require attention and may necessitate medical evaluation.
Children aged 2 to 10 are most susceptible to this condition. In this age group, the nasal lining is thinner and more sensitive, and the habit of poking one's nose with a finger is common, which can cause minor damage and rupture blood vessels. Older adults are also at increased risk, partly due to more fragile blood vessels and frequent use of medications such as anticoagulants and anti-inflammatory drugs.
Other factors contributing to epistaxis include cold and dry climates, vigorous blowing of the nose, local trauma, prolonged use of nasal decongestant sprays, and changes in atmospheric pressure, such as during diving or travel to areas with significantly different altitudes.
In most cases, the bleeding is isolated and stops spontaneously. During an episode, it is recommended to sit up and gently lean the head forward. As explained by Dr. Luciano Gregorio from the Brazilian Association of Otorhinolaryngology and Cervicofacial Surgery (ABORL-CCF): 'It is ideal to ask the person to sit up and gently tilt their head forward, rather than backward, as many believe, because an elevated head does not control the bleeding and forces fluid down the throat, and the person may swallow blood.'
Next, pinch the soft part of the nose with fingers, like tweezers, for about 3–5 minutes. Otolaryngologist Pedro Wey from Einstein Hospital in Israel recommends: 'Placing cotton swabs in the nostrils is also a good idea. It is also recommended to use a vasoconstrictor with a cotton swab to make treatment more effective, apply a cold compress to the nose, and avoid blowing the nose forcefully in the following hours.'
Maintaining adequate moisture in the nasal lining and the surrounding environment can also help prevent new episodes, especially during periods of dry climate.
When to See a Doctor
If the bleeding does not stop after 15–30 minutes of compression, seek medical attention. Assessment is also important if episodes recur or are very intense, or if they are accompanied by other symptoms such as purple spots on the body, bleeding in other areas, nasal congestion, or a family history of blood clotting disorders.
During a consultation, an otolaryngologist can determine the source of the bleeding and whether it is anterior or posterior. Anterior epistaxis occurs in the front part of the nose, where there is a high concentration of fragile blood vessels, and accounts for most cases—about 90%, according to Wey. It is usually easier to control.
If necessary, the doctor may perform chemical coagulation of the bleeding vessel. Topical ointments or gels for moisturizing the nasal lining and specific treatments for conditions that contribute to epistaxis, such as rhinitis, sinusitis, and dry nose, may also be prescribed.
Posterior epistaxis occurs in a deeper area of the nose and is generally more serious. The bleeding can be severe and lead to significant blood loss, requiring emergency care. A doctor from Einstein explains: 'This type of bleeding is usually very intense, leading to significant blood loss, and usually requires surgery to locate the bleeding site and perform ligation of the bleeding artery or electrical coagulation of the vessel. Or both methods.'
Even if there is no emergency, recurring nosebleeds should not be ignored. According to the doctor, they can be related to relatively common issues such as untreated allergic rhinitis and chronic sinusitis, as well as deviated nasal septum, uncontrolled arterial hypertension, and blood clotting disorders.
In less frequent cases, recurrent epistaxis may be linked to nasal or sinus tumors. Therefore, recurrence of episodes is one of the main signs that the cause needs to be investigated.