Experiencing a nosebleed during a workout can be startling. This bleeding, known medically as epistaxis, is a common occurrence, especially during sustained exertion. Exercise-induced nosebleeds are typically not a sign of a serious underlying condition. They usually originate from the front part of the nasal septum and are easily managed with simple first-aid techniques.
How Exercise Affects Nasal Blood Vessels
Physical exertion triggers physiological changes to optimize blood flow to working muscles and the brain. As you exercise, your heart rate increases, and your systemic blood pressure temporarily rises to meet the demand for oxygen and nutrients. This surge in circulatory pressure is the primary internal factor contributing to a nosebleed during a workout.
The nose contains a network of superficial capillaries concentrated in the anterior septum, known as the Kiesselbach’s plexus. Because these vessels lie close to the surface of the thin nasal lining, they are highly susceptible to rupture from internal pressure changes. The mechanical stress from the increased blood flow can cause these fragile vessels to break, resulting in a nosebleed.
Paradoxically, exercise simultaneously causes a sympathetic response that constricts the blood vessels in the nasal lining. This vasoconstriction often makes nasal passages feel clearer during a workout, as the lining shrinks to allow more airflow. However, this constrictive effect does not always override the mechanical strain of the elevated blood pressure, allowing vulnerable vessels in the Kiesselbach’s plexus to rupture.
External Factors That Increase Risk
While the physiological pressure change is the mechanism, external and environmental conditions often make the nasal lining more vulnerable. Exercising in environments with low humidity, such as cold winter air or heated indoor spaces, causes the nasal mucosa to dry out. A dry membrane easily cracks, exposing superficial blood vessels to damage and increasing the likelihood of bleeding when pressure rises.
Altitude also plays a role, as the air is typically drier and the lower atmospheric pressure contributes to nasal dryness. Allergies or a recent respiratory infection, like a cold, can also heighten the risk because they cause inflammation and irritation of the nasal lining. This inflammation makes the fragile capillaries in the Kiesselbach’s plexus susceptible to rupture.
Certain medications can exacerbate the bleeding tendency during exercise. Blood-thinning medications, such as aspirin or warfarin, reduce the blood’s ability to clot, causing any break in a vessel to bleed more heavily. Furthermore, overuse of topical decongestant nasal sprays can cause a rebound effect that irritates and thins the nasal lining, contributing to increased fragility.
Stopping a Bleed and Preventing Recurrence
If a nosebleed occurs, the immediate goal is to apply direct pressure to the bleeding site to allow a clot to form. Sit upright and lean slightly forward to prevent blood from draining down the back of the throat, which can cause nausea or vomiting. Gently blow the nose once to clear any large blood clots, as these can prevent the vessels from sealing.
Use your thumb and index finger to firmly pinch the soft, fleshy part of the nose just above the nostrils, ensuring you are compressing the nasal septum. Maintain continuous pressure for a minimum of 10 to 15 minutes, breathing steadily through your mouth during this time. Releasing the pressure prematurely to check the bleeding can disrupt the delicate clotting process, requiring you to start the time over.
For long-term prevention, focus on maintaining moisture in the nasal passages, especially before a workout. Applying a thin layer of petroleum jelly or a saline nasal gel just inside the nostrils helps lubricate the membrane. Using a humidifier in your bedroom or exercise room can combat the drying effects of indoor heating. Staying well-hydrated is also beneficial. After a nosebleed has stopped, avoid strenuous activity, bending down, or blowing your nose forcefully for at least 24 hours to prevent re-bleeding.
When to Seek Medical Guidance
While most exercise-related nosebleeds are benign, certain signs suggest a medical evaluation is necessary. Seek immediate medical care if the bleeding persists continuously for longer than 20 minutes despite correctly applying pressure. Similarly, a nosebleed involving a greater amount of blood or one that interferes with your breathing should be addressed urgently.
Talk to a healthcare provider if you experience frequent nosebleeds, such as multiple times per week, even if you can stop them easily. This frequency may indicate underlying nasal dryness or, less commonly, an unmanaged health condition like high blood pressure. A medical assessment is also warranted if you are currently taking blood-thinning medication, or if the bleeding is accompanied by symptoms like easy bruising, dizziness, or paleness.