Persistent or Frequent Nosebleeds: Causes, Treatments, and When to Seek Help

Nosebleeds (medically known as epistaxis) are common, but when they occur frequently or last for many days, they can be a sign of an underlying issue. This comprehensive guide explores the causes, treatments, and warning signs of prolonged nosebleeds.

Why Do Nosebleeds Happen?

The nose contains many tiny blood vessels, especially in the front part of the nasal septum (Kiesselbach’s plexus). These vessels are fragile and can rupture due to dryness, trauma, or medical conditions.

Common Causes of Frequent or Prolonged Nosebleeds

1. Dry Air and Environmental Factors

• Low humidity (winter, desert climates, air-conditioned rooms) dries out nasal membranes.


• Heating systems can worsen dryness.


• Allergens (dust, pollen) irritate nasal passages.

2. Nasal Irritation or Trauma

• Nose-picking (common in children).


• Forceful nose-blowing (during colds or sinus infections).


• Nasal injuries (even minor bumps or scratches).


• Foreign objects (common in toddlers).

3. Infections and Allergies

• Colds, sinusitis, or flu inflame nasal passages.


• Chronic allergies lead to repeated irritation.


• Bacterial infections (rare but possible).

4. Medications and Blood Thinners

• Anticoagulants (warfarin, heparin, rivaroxaban).


• NSAIDs (aspirin, ibuprofen, naproxen).


• Nasal steroid sprays (if overused or misdirected).

5. Structural Abnormalities

• Deviated septum (crooked nasal structure).


• Nasal polyps or tumors (rare but serious).


• Previous nasal surgery (e.g., rhinoplasty).

6. High Blood Pressure (Hypertension)

• Doesn’t cause nosebleeds directly but can make them harder to stop.


• More common in older adults with uncontrolled hypertension.

7. Blood Disorders

• Hemophilia (inherited clotting disorder).


• Von Willebrand disease (bleeding disorder).


• Thrombocytopenia (low platelet count).


• Leukemia (rare but possible in recurrent cases).

8. Liver Disease

• Impairs clotting factor production.

9. Chemical Irritants

• Smoking or secondhand smoke.


• Industrial chemicals (ammonia, solvents).


• Illicit drug use (cocaine damages nasal tissue).

When to See a Doctor

Seek medical attention if:

• ? Bleeding lasts longer than 20-30 minutes despite pressure.


• ? Bleeding is heavy (soaking multiple tissues).


• ? You feel dizzy, weak, or faint (signs of blood loss).


• ? Nosebleeds occur several times a week.


• ? You have unexplained bruising or bleeding gums.


• ? You take blood thinners or have a history of clotting disorders.

How to Stop a Nosebleed: Immediate First Aid

1. Sit upright and lean slightly forward (prevents blood from flowing into the throat).


2. Pinch the soft part of the nose (just below the bony bridge) for 10-15 minutes.


3. Apply ice wrapped in a cloth to the nose and cheeks.


4. Avoid tilting your head back (can cause choking or vomiting).


5. Use a saline nasal spray or petroleum jelly to keep nostrils moist.

Medical Treatments for Chronic Nosebleeds

• Nasal cauterization (silver nitrate or electrical sealing of blood vessels).


• Nasal packing (gauze or special sponges to apply pressure).


• Medications (topical tranexamic acid for clotting).


• Surgery (for structural issues like a deviated septum).

Preventing Future Nosebleeds

• Use a humidifier in dry environments.


• Avoid nose-picking and aggressive blowing.


• Stay hydrated to keep mucous membranes moist.


• Apply saline gel or petroleum jelly inside nostrils.


• Manage allergies with antihistamines (under doctor’s advice).

When to Visit an ENT Specialist

An Ear, Nose, and Throat (ENT) doctor should evaluate:

• Recurrent nosebleeds without an obvious cause.


• Suspected nasal polyps or tumors.


• Bleeding disorders or medication-related cases.