Nosebleeds (epistaxis) are common, affecting approximately 60% of people at some point. While most instances are minor and easily stopped, frequent or chronic nosebleeds can disrupt daily life and signal an underlying health concern. Seeking a permanent solution requires moving beyond immediate first aid to identify the root cause and explore long-term strategies and medical interventions.
Identifying the Underlying Causes of Chronic Nosebleeds
Chronic nosebleeds arise from local factors affecting the nasal lining or systemic issues impacting blood clotting. The most common site for bleeding is the anterior nasal septum, an area rich in fragile blood vessels known as Kiesselbach’s plexus. Because these vessels lie close to the surface, they are highly susceptible to irritation and rupture.
Local causes often involve extreme dryness, which occurs in arid climates or during winter months when indoor heating reduces air moisture. This dryness causes the delicate nasal mucous membranes to crack, making them prone to bleeding. Mechanical trauma, such as forceful nose blowing or nose picking, directly damages these exposed vessels. Structural issues, like a deviated septum, can also contribute by directing air flow unevenly, causing localized drying and irritation.
Systemic conditions can increase the likelihood of recurrent bleeding. Certain medications, particularly anticoagulants (blood thinners) and NSAIDs like aspirin, reduce the blood’s clotting capacity. High blood pressure (hypertension) can also be associated with nosebleeds. Less common but serious systemic causes include underlying bleeding or clotting disorders, such as hemophilia or von Willebrand disease, and specific vascular abnormalities like hereditary hemorrhagic telangiectasia (HHT).
Home and Lifestyle Adjustments for Long-Term Prevention
After identifying localized causes like dryness and minor trauma, practical adjustments can stabilize the nasal environment. The primary goal is to maintain moisture within the nasal cavity to prevent the fragile lining from cracking. Running a cool-mist humidifier, especially overnight, adds moisture to the ambient air, counteracting the drying effects of heating or air conditioning.
Direct nasal lubrication provides an important defense against dryness. Apply a thin layer of petroleum jelly, a specialized nasal gel, or an antibiotic ointment just inside the nostrils using a cotton swab. This creates a protective moisture barrier and should be done two to three times daily, avoiding insertion past a quarter-inch. Using saline nasal sprays or rinses multiple times a day also helps soothe and rehydrate the mucous membranes.
Gentle nasal hygiene is necessary to avoid damaging exposed blood vessels. Avoid forceful sneezing or blowing the nose too vigorously, as the pressure can rupture fragile capillaries. If blowing the nose is necessary, do so gently, one nostril at a time, to minimize internal trauma. Reducing nose picking, particularly in children, is also a key behavioral change to protect the vulnerable anterior septum.
Definitive Medical Procedures for Recurrence
When recurrent nosebleeds persist despite consistent home care, professional medical intervention is necessary. The most common and effective in-office procedure for anterior nosebleeds is nasal cauterization, which involves sealing the specific bleeding vessel.
Chemical cauterization uses silver nitrate, applied directly to the bleeding point after local anesthetic is administered. The chemical creates scarring in the small arteries and veins, minimizing blood flow and preventing rebleeding. Alternatively, bipolar electrocautery uses an electric current to generate heat and seal the vessel. To prevent complications like septal perforation, physicians typically cauterize only one side of the nasal septum at a time.
For severe or persistent bleeding, especially posterior nosebleeds originating deeper in the nasal passage, surgical options may be required. A septoplasty corrects a deviated septum, reducing chronic irritation and dryness. In refractory cases, sphenopalatine artery ligation may be performed. This surgery involves tying off or cauterizing the sphenopalatine artery, a major blood supply source for the back of the nose, which often controls severe posterior epistaxis successfully.
When to Seek Urgent Medical Attention
While most nosebleeds are minor, certain situations require immediate medical evaluation. Seek urgent care if the nosebleed cannot be stopped after 15 to 20 minutes of continuous pressure. A persistent bleed lasting this long suggests a larger or deeper vessel is involved, requiring professional treatment like nasal packing or cauterization.
Heavy blood loss is another sign of urgency, especially if the amount lost is estimated to be more than one cup. Bleeding that begins after a significant head injury or facial trauma also requires immediate attention, as it could indicate a skull fracture or internal damage. Symptoms accompanying the nosebleed, such as dizziness, weakness, fainting, or difficulty breathing, suggest severe blood loss or a systemic event. Anyone taking blood-thinning medication or diagnosed with a clotting disorder should seek emergency assistance for any nosebleed that does not quickly resolve.