Seeing streaks of blood or a minor nosebleed when blowing your nose, especially with a respiratory illness like COVID-19, can be startling. This minor bleeding, medically known as epistaxis, is a common side effect of the inflammation and congestion associated with severe upper respiratory infections. It usually originates from the anterior part of the nasal septum. Understanding the causes and management of this symptom can provide reassurance.
Why Respiratory Infections Cause Nasal Bleeding
The interior of the nose contains Kiesselbach’s plexus, a dense network of tiny, fragile blood vessels lying close to the surface of the nasal lining. When the SARS-CoV-2 virus enters the body, it targets the nasal passages, triggering a significant inflammatory response called rhinitis.
This inflammation causes nasal tissues to swell and become engorged with blood. The increased blood flow makes the blood vessels in the nasal septum thinner and more delicate. Even a small amount of pressure or trauma can cause these fragile vessels to rupture.
The COVID-19 infection also increases pro-inflammatory chemical messengers, like cytokines, within the nasal mucosa. This heightened irritation further compromises the integrity of the blood vessel walls. The nasal lining is left in a highly sensitized state, easily damaged by external forces.
Specific Triggers for Bloody Discharge
Once nasal vessels are inflamed, several factors can trigger visible bleeding. The most frequent cause is forcefully blowing the nose to clear congestion, which generates sudden pressure against the compromised capillary walls. This mechanical stress often breaks the superficial vessels in Kiesselbach’s plexus.
Environmental factors like dry air also play a major role, especially in heated indoor spaces with low humidity. Dry air dehydrates the mucus layer, causing the nasal lining to crack and crust over. When this dried tissue is disturbed, the underlying fragile capillaries are easily exposed and bleed.
The repeated use of nasal sprays, including decongestants or steroid sprays, can further dry out the nasal mucosa. Oxygen therapy for severe COVID-19 symptoms may also increase nasal dryness from non-humidified air delivered via a nasal cannula. Additionally, trauma from recent nasal swabbing can irritate inflamed tissues, causing a minor bleed when the nose is blown.
Immediate Steps for Managing Minor Bleeding
When blood appears, manage the acute bleed by sitting upright and leaning slightly forward to prevent blood from draining down the throat. Use the thumb and index finger to firmly pinch the soft, lower part of the nose just above the nostrils for at least five to ten minutes continuously. This direct pressure helps the small vessel form a clot.
After the bleeding stops, focus on keeping the nasal passages moist to prevent recurrence. Using a saline nasal spray several times a day helps rehydrate the mucus membranes. Placing a humidifier in your bedroom can counteract the drying effects of indoor air.
Applying a small amount of a nasal emollient, such as petroleum jelly, just inside the nostrils with a cotton swab creates a protective barrier against dryness. When clearing congestion, avoid vigorous blowing; instead, gently exhale through each nostril separately to reduce internal pressure.
When Nasal Bleeding Requires Medical Attention
While most bloody discharge with a respiratory infection is minor and self-limiting, certain signs indicate the bleeding is more serious and requires professional evaluation. Seek immediate medical attention if the bleeding is heavy or lasts longer than 20 minutes despite continuous pressure. Bleeding that is rapid, involves a large volume of blood, or drains heavily down the back of the throat suggests a posterior nosebleed, which is less common but more severe.
Other red flags include feeling dizzy, lightheaded, or weak, which are signs of significant blood loss. If nosebleeds become frequent, occurring multiple times a week without a clear cause, or are accompanied by unexplained bruising or other bleeding, consult a healthcare provider. This is important for individuals taking blood-thinning medications, as their ability to clot is compromised.