Epistaxis recurrent

Overview

Recurrent epistaxis means having nosebleeds that keep coming back. A nosebleed happens when a blood vessel inside your nose breaks and bleeds. Most nosebleeds are not serious and stop on their own.

Yes, nosebleeds are very common. Most people have at least one in their lifetime. Recurrent nosebleeds are also common, especially in children and older adults.

Nosebleeds can affect people of all ages, but they are more common in children (ages 2–10) and older adults (ages 50+). They also happen more often in people with dry nasal passages, allergies, or those taking certain medications.

Symptoms

Common symptoms

• Blood flowing from one nostril, sometimes both
• A feeling of liquid dripping in the back of the throat
• Bright red blood, usually not painful

Symptoms in children

• Often happens from digging or picking the nose
• Usually from the front of the nose and stops quickly
• May be linked to colds or dry indoor air

Symptoms in older adults

• May be linked to high blood pressure or blood-thinning medications
• Bleeding can be heavier and harder to control
• May come from the back of the nose (posterior) which can be more serious

Causes

Main causes

• Dry air (indoor heating, dry climate) that dries out the nasal lining
• Picking or scratching the inside of the nose
• Blowing the nose too hard or frequently
• Injury to the nose (from a fall or accident)
• Allergies, colds, or sinus infections that irritate the nose
• High blood pressure (especially in older adults)
• Blood clotting disorders (like haemophilia or von Willebrand disease)
• Medications that thin the blood, such as aspirin, ibuprofen, or anticoagulants

Risk factors

• Living in a dry climate or having heated indoor air
• Regular use of blood-thinning medications
• Having allergies, a deviated septum, or nasal polyps
• Smoking or being exposed to second-hand smoke (irritates the nose)
• Pregnancy (hormones can make nasal blood vessels swell)
• Heavy alcohol use (can affect blood clotting)

When to see a doctor

See a doctor urgently if:

• You have a nosebleed that won’t stop after 20 minutes of direct pressure
• You are taking blood thinners and have a heavy nosebleed
• You feel weak, dizzy, or short of breath after a nosebleed

Book a routine appointment if:

• You have frequent nosebleeds (more than once a week) that bother you
• The nosebleeds are not heavy but keep coming back for weeks
• You want to check for an underlying cause, like high blood pressure or a clotting problem

Diagnosis

A healthcare provider will ask about your symptoms, medications, and medical history. They will look inside your nose with a small light and speculum to find the bleeding point.

Tests that may be done

• Nasal endoscopy – a thin, flexible tube with a camera to see deeper into the nose
• Blood tests – to check for anaemia or clotting problems
• Blood pressure measurement – to rule out hypertension

What to expect at your appointment

The exam is brief and not painful. You may be asked to sit in an exam chair while the doctor gently looks in your nose. If a bleeding site is found, the doctor can often treat it right away.

Treatment

Treatment for recurrent nosebleeds aims to stop the bleeding when it happens and prevent future episodes. Most can be managed at home, but persistent cases may need medical procedures.

Self-care at home

• Sit up straight and lean forward – this keeps blood from going down your throat.
• Pinch the soft part of your nose just below the bone for 10–15 minutes without letting go.
• Apply a cold compress or ice pack to the bridge of your nose to help shrink blood vessels.
• Keep your head above your heart – do not lie down or tilt your head back.
• Avoid blowing your nose for several hours after a nosebleed.

Medical treatments

If self-care does not work, a doctor may apply a chemical called silver nitrate to cauterise (seal) the bleeding blood vessel. For heavier bleeding, they may place a nasal pack (special gauze or sponge) to apply pressure. In some cases, medicines that help blood clot may be used on the nose. These treatments are done in a clinic or emergency department.

When is surgery considered?

Surgery is rarely needed. It may be considered if nosebleeds are very frequent or severe and do not respond to other treatments. A procedure where the blood vessel is tied off (ligation) or blocked (embolisation) can be done by an ear, nose and throat (ENT) specialist.

Living with this condition

Living with recurrent nosebleeds means being prepared. Keep a small supply of tissues, a cold pack, and medication (if prescribed) handy. Learn how to stop a nosebleed correctly so you can act quickly.

Lifestyle tips

• Use a saline (saltwater) nasal spray or gel to keep the inside of your nose moist.
• Run a humidifier, especially in your bedroom at night, to add moisture to the air.
• Avoid picking or blowing your nose too hard.
• Avoid heavy lifting or strenuous exercise that increases blood pressure during a nosebleed.

Diet and exercise

No special diet is proven to prevent nosebleeds, but eating a balanced diet supports overall health. Avoid taking aspirin or ibuprofen unless prescribed, as these can make bleeding worse. Gentle exercise is fine, but avoid activities that involve straining or risk of facial injury.

Mental health and emotional wellbeing

Frequent nosebleeds can be worrying and may cause anxiety, especially if they happen in public or interrupt sleep. It helps to remind yourself that most nosebleeds are harmless. If the worry affects your daily life, talk to your doctor for reassurance.

Prevention

You can reduce the chance of recurrent nosebleeds by keeping your nasal passages moist, not picking your nose, and avoiding trauma. If dry air is the cause, using a humidifier and saline spray can help a lot.

Vaccines

Omit

Screening programmes

Omit

Complications

If left untreated

• Anaemia (low red blood cells) if blood loss is frequent and heavy
• Blood clots in the nose that can cause breathing problems (rarely serious)
• In rare cases, heavy bleeding that requires emergency treatment

Long-term outlook

The outlook for recurrent nosebleeds is very good. Most people can manage them with simple home care or with a short treatment at the doctor’s office. Even severe cases are usually treatable. Nosebleeds rarely lead to long-term problems.

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