Nosebleed in older adults

Overview

A nosebleed is bleeding from the inside of your nose. In older adults, the lining of the nose can become thinner and drier, making it easier for small blood vessels to break and bleed.

Yes, nosebleeds become more common as people age. About 60% of older adults will have at least one nosebleed.

Older adults, especially those over 65. People who take blood-thinning medicines, have high blood pressure, or have dry nasal passages are more likely to have nosebleeds.

Symptoms

Common symptoms

• Blood dripping from one or both nostrils
• A feeling of liquid running down the back of the throat (postnasal drip)
• Blood in the mouth or spitting up blood

Symptoms in children

• This article focuses on older adults, not children. For children, nosebleeds are usually from the front of the nose and often stop quickly.

Symptoms in older adults

• Heavier bleeding that may come from the back of the nose
• Bleeding that is harder to stop
• Bleeding that happens without a clear cause, such as dry air

Causes

Main causes

• Dry air (especially in heated homes or winter) that dries out the nasal lining
• High blood pressure (hypertension) – can make bleeding more likely or harder to stop
• Blood-thinning medicines (anticoagulants or antiplatelet drugs) – these are common in older adults
• Nose picking or blowing the nose too hard
• Injury to the nose or face

Risk factors

• Age over 65 – nasal lining thins naturally
• Using oxygen therapy or a CPAP mask – can dry out the nose
• Allergies or sinus infections that cause persistent nose blowing
• Alcohol use – can interfere with blood clotting

When to see a doctor

See a doctor urgently if:

• Bleeding that doesn't stop after 20 minutes of applying pressure
• Bleeding that is very heavy (soaking a cloth quickly)
• You feel weak, dizzy, or have chest pain with the nosebleed
• You take blood-thinning medicine and can't stop the bleeding

Book a routine appointment if:

• Nosebleeds happen more than once a week without a clear reason
• You have other symptoms like easy bruising or bleeding gums
• You want to discuss preventing future nosebleeds

Diagnosis

A doctor will ask about your health, medicines, and how often nosebleeds happen. They will look inside your nose with a small light (called a nasal speculum) to find the source of bleeding.

Tests that may be done

• Blood pressure check – high blood pressure can cause or worsen nosebleeds.
• Blood tests – to check for bleeding or clotting problems, especially if you bruise easily.
• Nasal endoscopy – a thin, flexible tube with a camera to look deeper inside the nose.

What to expect at your appointment

The doctor will likely use a numbing spray and a light to look inside your nose. This is not painful but may feel a bit uncomfortable. If they see a bleeding spot, they may seal it with a chemical or heat (cautery). The whole visit usually takes 15–30 minutes.

Treatment

Treatment for nosebleeds in older adults focuses on stopping the bleeding, preventing it from coming back, and addressing any underlying causes.

Self-care at home

• Sit upright and lean forward – do not lean back or tilt your head back.
• Pinch the soft part of your nose (just below the hard bridge) for at least 10–15 minutes without stopping.
• Apply an ice pack (wrapped in a cloth) to the bridge of your nose.
• Avoid blowing your nose or straining for 24 hours after a nosebleed.

Medical treatments

A doctor may use a chemical or electrical tool to seal the bleeding blood vessel (cautery). They might also place a special packing or balloon inside the nose to apply pressure. In some cases, they may use a gel or cream that helps the blood clot. If you take blood thinners, the doctor will work with you to manage these medicines safely.

When is surgery considered?

Surgery is rarely needed, but if nosebleeds are severe and do not respond to other treatments, a doctor may recommend a procedure called 'arterial ligation' or 'embolisation' to block the blood supply to the bleeding area.

Living with this condition

Nosebleeds can be inconvenient but they are usually manageable. Learn the correct first aid steps so you feel confident if one happens. Carry a small pack of tissues or a cloth with you. Keep your home air moist with a humidifier.

Lifestyle tips

• Use a saline spray or gel to keep the inside of your nose moist.
• Avoid picking your nose or blowing your nose too forcefully.
• If you use a CPAP machine, consider a heated humidifier attachment.

Diet and exercise

A balanced diet with enough vitamin C and K (found in fruits and vegetables) can support normal blood clotting. Stay well hydrated. Avoid heavy lifting or straining during exercise, as this can increase blood pressure.

Mental health and emotional wellbeing

Recurring nosebleeds can cause worry or frustration, especially if they happen unexpectedly. It's natural to feel anxious. Remind yourself that most nosebleeds are harmless. If anxiety affects your daily life, talk to your doctor.

Prevention

Yes, many nosebleeds can be prevented by keeping the nasal lining moist, avoiding nose picking, and managing high blood pressure.

Complications

If left untreated

• Blood loss leading to anaemia (low red blood cells) over time
• Swallowing large amounts of blood can cause vomiting or black stools
• In rare cases, severe bleeding may require emergency blood transfusion

Long-term outlook

The outlook for nosebleeds in older adults is very good. Most are temporary and can be managed with simple care. With the right treatment and prevention steps, most people can greatly reduce how often nosebleeds happen and live normally.

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