X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
Enter email and you're done. No subscription, no credit card.
Search, tap and you're done. Over 3,400 medicines.
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
In over 90 percent of cases the bleeding comes from the front part of the nasal septum, the Kiesselbach plexus. There a fine network of vessels lies just under a thin mucosa that tears easily. These front bleeds are mostly harmless and easy to stop yourself. Less often, especially in older people, the bleeding comes from the back of the nose. It is often heavier, harder to stop and usually belongs in medical hands.
The triggers can be divided into local and general causes:
| Group | Typical triggers |
|---|---|
| Local (in the nose) | Dry mucosa from heating air, nose-picking, vigorous blowing, small injuries, a foreign body (in children), infections, an allergic rhinitis or a sinus infection |
| General (in the body) | Blood-thinning medicines, clotting disorders, a strongly raised blood pressure and rare vascular conditions |
By far the most common is irritated or dried-out mucosa. Dry heating air in winter, frequent nose-blowing during a cold or picking the nose are often enough for a fine vessel to burst. In children, a foreign body pushed into the nose is not unusual on top of this. The general causes include, besides blood thinners, congenital or acquired clotting disorders and, rarely, a hereditary vascular condition (Osler's disease), in which nosebleeds keep recurring. The doctor investigates such rarer causes if the nosebleed is unusually frequent or heavy or occurs together with other signs of bleeding.
A common misconception concerns blood pressure: high blood pressure is usually not the actual cause of a nosebleed, but it can prolong and worsen an existing bleed. Anyone who struggles with their blood pressure will find concrete measures in the guide lowering blood pressure naturally. If a nosebleed keeps coming back and only on one side, an ENT doctor should look into the cause more closely.
For assessment it matters whether the bleeding sits at the front or the back of the nose. The front bleed from the Kiesselbach plexus makes up the vast majority. It is easy to see, can usually be stopped by pinching the nostrils and is generally harmless. The back bleed is rarer, more often affects older people, people with high blood pressure or those on blood thinners, and comes from larger vessels deeper in the nose. It often bleeds more heavily, runs into the throat rather than out the front, and is barely affected by pinching the nostrils. This is exactly why a bleed that mainly runs backwards despite correct first aid is a reason to seek medical help quickly.
Anyone who takes blood-thinning medicines often bleeds longer and more heavily when the nasal mucosa is injured. This applies both to anticoagulants such as phenprocoumon (Marcumar) and modern agents such as apixaban, and to platelet inhibitors such as aspirin and clopidogrel. Many people take them for good reason, for example with atrial fibrillation or after a thrombosis.
Three points matter here. First: the first-aid steps are the same, but you should seek medical help earlier if the bleeding does not stop quickly. Second, and this is crucial: never stop your medication on your own, as that can be more dangerous than the nosebleed itself. Once the bleeding has stopped, the therapy can usually continue, but the doctor decides. Third, interactions play a role: painkillers such as ibuprofen or aspirin can further increase the tendency to bleed. Anyone who bruises easily or bleeds frequently should have it checked, more on this under bruises.
When to see a doctor or call emergency services
Get help right away, in an emergency via 112, if the bleeding is very heavy or does not stop after 20 minutes of correct pressure, if the blood runs mainly down the back of the throat, if the nosebleed occurs after an accident or a blow to the head, or if signs of greater blood loss such as paleness, weakness, a racing heart or dizziness appear. With blood thinners and in small children with heavy bleeding, the threshold is lower.
Blood thinners safely under control
With anticoagulants in particular, reliable intake and an eye on interactions count. brite reminds you of your medicines and warns you when two of them, such as a blood thinner and a painkiller, affect each other unfavourably.
Get started for freeFree. Ad-free. GDPR-compliant, servers in Germany.
With recurring or unclear nosebleeds, the doctor starts with targeted questions: how often does it happen, how heavy is the bleeding, one or both sides, since when, and are there triggers such as dry air, vigorous blowing or a fall? Blood pressure, known clotting disorders and all medicines, especially blood thinners and painkillers, are also important. The ENT doctor then looks into the nose with a small scope (nasal endoscopy) to see the bleeding source directly. This clarifies whether there is a harmless front bleed or whether a closer assessment is needed. If a general cause is suspected, a blood test is added.
If nosebleeds keep happening, for example several times a week, there is usually a treatable cause behind it. Often it is chronically dry or irritated mucosa, frequently made worse by heating air, nasal sprays or blood-thinning medicines. An ENT doctor can specifically cauterise the responsible vessel at the Kiesselbach plexus, a short, outpatient procedure that often ends the bleeding for good. If a bleed persists or sits further back, nasal packing and further assessment help.
It is also important to consider the consequences: anyone who repeatedly loses larger amounts of blood over a longer period can develop iron deficiency. Signs such as persistent tiredness or paleness should therefore be taken seriously, more on this under iron deficiency anaemia.
If a bleed cannot be stopped yourself or keeps coming back, the ENT doctor has several options. With a clearly visible front bleeding source, the responsible vessel is cauterised, usually with a fine electric probe or a chemical agent. This is a short, outpatient procedure under local anaesthesia that often ends the bleeding for good. If it bleeds more heavily or further back, a nasal packing is inserted that compresses the vessel from inside and is removed again after one to two days. Only rarely, with bleeds that are hard to stop, is a larger procedure needed. After every treatment the rule is: do not blow your nose for a few days and care for the mucosa well.
Nosebleeds are especially common in children and almost always harmless. They usually come from the front of the nose, triggered by nose-picking, dry air or small injuries, and in small children sometimes by a foreign body. The first aid is the same as for adults: sit upright, head forward, pinch the soft part of the nose for a few minutes and calmly distract the child. In children the bleeding often stops after about 10 minutes. It is important to stay calm yourself, as this carries over. Frequent nosebleeds, very heavy bleeding or bleeding that cannot be stopped should be checked by a doctor. With repeated nosebleeds during growth spurts, a caring nasal ointment and avoiding nose-picking are often enough. Never stuff cotton wool or tissues deep into the child's nose, and do not try to remove a suspected foreign body yourself, the doctor does that.
Once the bleeding has stopped, the fresh clot needs rest to stay stable. For a few hours, better a whole day, avoid vigorous blowing, picking the nose and heavy lifting. Very hot showers, the sauna and alcohol can also widen the vessels and encourage another bleed. Care for the mucosa over the following days with a moisturising nasal ointment. If you notice persistent tiredness, paleness or dizziness after a heavy or long bleed, have your blood values checked to rule out iron deficiency.
With dryness-related nosebleeds in particular, prevention works well. Make sure there is enough humidity during the heating season, for example with a water container on the radiator. Keep the nasal mucosa moist, for example with a caring nasal ointment or a sea-salt nasal spray. Avoid vigorous blowing and nose-picking, and treat a blocked nose from a cold or allergy early. Anyone who takes blood thinners or has high blood pressure should have both well managed by a doctor. And with recurring bleeds, an early visit to the ENT doctor is worthwhile.
In the vast majority of cases a nosebleed is harmless. You should take notice, however, if it keeps recurring and only on the same side, as an ENT doctor should then rule out a local cause. If other signs of bleeding occur alongside the nosebleed, such as bleeding gums, many bruises or small wounds that bleed for a long time, a clotting disorder may be behind it. And anyone who regularly loses large amounts of blood should have their blood values checked. Such cases are rare, but they are the reason why stubborn or unusual nosebleeds should be assessed by a doctor.
With blood thinners in particular, every dose and every interaction counts. With brite you keep both under control.
This article is for general information only and does not replace medical advice, diagnosis or treatment. For heavy, unstoppable or recurring nosebleeds, and while taking blood thinners, contact a medical practice, and in an emergency call 112. Never stop blood-thinning medicines on your own.
