I have frequent nosebleeds. What causes them and are they normal? | Well actually

If you experience nosebleeds frequently, you may consider them nothing more than an annoying inconvenience.

However, while most nosebleeds are mild and benign, they shouldn't occur “if everything inside the nose is healthy,” says Dr. Patricia Loftus, an otolaryngologist at the University of California, San Francisco.

Here's what experts say about nosebleeds.

What is nosebleed?

Nosebleeds, medically known as epistaxis, come in two forms: anterior and posterior.

About 90% of nosebleeds are anterior, starting in the area between the two nostrils called the Kisselbach plexus, Loftus says. This area contains many blood vessels – small capillaries that supply the nostrils with blood and warm the air you inhale. They can break, causing bleeding that mostly comes from the nostril, although some blood may go into the mouth or throat, especially if you tilt your head back.

Posterior nosebleeds are less common and more severe. They occur when larger blood vessels located deeper in the nasal passage burst. If there is significantly more blood flowing into the back of the throat, which could lead to choking, it's a posterior nosebleed, explains Dr. Amin Javer, an otolaryngologist (ENT) and director of research at the University of British Columbia.

Posterior nosebleeds are more serious than front nosebleeds and require immediate medical attention. They are most often seen in older people, especially those taking anticoagulants, which increase the risk of bleeding.

What to do if your nose is bleeding?

When a nosebleed begins, many people instinctively tilt their head back.

“It’s the worst thing you could do,” Javer says. “You'll just start drinking blood.” Blood in the stomach causes nausea, so it is best to avoid it.

Instead, you should tilt your head forward and very gently pinch your nose, he says. A cold compress on the neck or nose can help constrict blood vessels and slow bleeding, as can a nasal decongestant such as oxymetazoline.

If you see thick clots coming out of your nose, it may bother you. But this is not necessarily a bad sign and is not unusual. “It really just shows that your blood is clotting effectively,” says Dr. Peter Manes, an ENT surgeon and director of residency training at Yale Medical School.

If your nosebleed occurs several times a week, interferes with your daily life, or lasts longer than 30 minutesthey require referral to a doctor for clinical examination.

What Causes Nosebleeds?

“One of the most common reasons [anterior] A nosebleed is when the area dries out,” explains Loftus.

In winter, dry air is especially to blame. “No matter how much rain it rains outside, our heaters come on, the humidity in our bedrooms goes down,” Javer says. He recommends opening a window while you sleep or purchasing a humidifier to maintain humidity levels between 40% and 50%. You can also moisten the nasal lining with a saline spray or a very thin layer of petroleum jelly inside the nostrils.

Another common cause of nosebleeds is “digital manipulation, which is a nice way of saying nose picking or nose scratching,” Loftus says. The nose is delicate, and even a slight bump or scratch can burst a capillary and cause bleeding.

Inflammation from allergy or viral infections can make the lining more brittle and prone to cracking. Physical activity sometimes plays a role too. Exercises, especially those that combine effort with poses that bring your head below heart level, such as downward dog, can increase pressure on the face and cause bleeding.

Medications and supplements add another layer of risk. Prescription blood thinners and aspirin increase the likelihood of bleeding, and some herbal supplements have a similar effect. “Ginseng, garlic, ginkgo—some of these herbal remedies can thin the blood,” says Manes.

Why do I often have nosebleeds?

“If you have nosebleeds every day and you don't know what's causing it, you need to get tested,” Loftus says. “Even if it doesn't bother you that much, it's enough to see a doctor.”

Manes agrees that nosebleeds can become “normal” and easy to dismiss as minor, but sometimes they signal more serious problems.

Heavy nosebleeds may indicate that your blood isn't clotting properly, Loftus says. The doctor may ask about alcohol use or other factors to determine whether the problem is liver related.

Hormonal changes during pregnancy may play a role. Loftus says the pregnancy-induced surge in hormones such as estrogen and progesterone is associated with a higher likelihood of lobular capillary hemangioma, “usually a fairly small lesion in the nose” that can cause nosebleeds. These neoplasms are not inherently dangerous, but should be examined by a doctor.

If you're in your 20s and suddenly start having frequent and severe nosebleeds, you may be among the estimated one in 5,000 people with hereditary hemorrhagic telangectasia (HHT), a genetic vascular abnormality that often appears at a young age and requires treatment. Without medical care, patients with HHT can “die from nosebleeds,” Javer says.

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Frequent unilateral nosebleeds—bleeding from only one nostril—are a warning sign for doctors. This pattern may indicate a tumor or polyp, especially if it is accompanied by symptoms on one side of the face, such as an inability to breathe through the nose; facial pain or pressure; or unilateral ear pain, numbness or vision changes, Loftus says. “This needs to be checked,” she says.

How do doctors treat nosebleeds?

Many nosebleeds can be treated at home. But if you have persistent, frequent, or heavy nosebleeds that are disrupting your daily life, or if you suspect you have a back bleed, seek medical help.

If you show up to the emergency room or doctor with an active nosebleed, you can expect a few things.

First, there's “a thorough examination of the nasal cavity to determine the source of the bleeding,” says Manes. Most bleeding can be stopped by using a tampon – inserting a nasal tampon (which is different from a menstrual product).

“The doctor may cauterize the bleeding area,” says Manes. The procedure stings, but numbing cream may help relieve the pain.

Your vitals may be checked and blood drawn to look for problems such as anemia or bleeding disorders. If symptoms indicate a sinus mass, a CT scan or MRI may be recommended. And if you've lost a significant amount of blood, you may need a transfusion.