Nosebleeds, also known as epistaxis, are a common problem that most people will experience at some point in their lives. But at what point do nosebleeds go from being an occasional annoyance to a more serious issue that requires medical attention? This article will explore how often nosebleeds can be considered too frequent and when it’s time to see a doctor.
What Causes Nosebleeds?
Before looking at nosebleed frequency, it’s helpful to understand what causes them in the first place. There are several potential causes of nosebleeds:
- Dry air – Dry, cold winter air can dry out and irritate the nasal membranes, causing cracks and bleeding.
- Nasal irritation – Things like colds, allergies, nose blowing, and even fingernail picking can irritate the delicate nasal tissues.
- Injury – Any injury to the nose from a fall, hit, etc can damage blood vessels and lead to bleeding.
- Medications – Blood thinners and NSAIDs like aspirin make it easier for nasal tissues to bleed.
- Nasal structural problems – Deviated septums, nasal polyps, or other anatomical issues may increase bleed risk.
- High blood pressure – The force of blood flow through vessels can cause leakage.
- Blood clotting disorders – Hemophilia and other conditions prevent proper clotting.
- Nose picking – Picking the nose can damage the nasal lining and blood vessels.
For most healthy people, the most common causes are nasal dryness, irritation, and minor trauma from nose blowing. More serious or chronic cases may be due to anatomical issues, clotting problems, or high blood pressure requiring medical treatment.
What’s Considered Normal?
Most people will experience a nosebleed a couple times a year on average. Experts say getting 1-2 nosebleeds per month is still considered normal and not a major concern in healthy individuals.
Nosebleeds most often occur in younger children aged 2-10 years and older adults over age 50. This is because young children commonly pick their noses and irritate the sensitive nasal tissue. Older adults often experience dryer nasal passages and have higher rates of blood pressure issues.
Though monthly nosebleeds can be considered normal, the frequency may vary based on the individual. Those with chronic nasal allergies or who live in dry climates may find more frequent nosebleeds normal during certain seasons or conditions.
When To See a Doctor
While the occasional nosebleed is no big deal, more frequent bleeding may be a sign of an underlying issue requiring medical care. Experts recommend seeing a doctor if you experience:
- More than 1 nosebleed per week
- Nosebleeds that last longer than 20 minutes
- Large volume nosebleeds that cause significant blood loss
- Frequent nosebleeds without any apparent cause
Seeking prompt medical care is especially important if frequent heavy nosebleeding is accompanied by symptoms like dizziness, lightheadedness, or rapid heart rate, which may indicate significant blood loss.
Causes of Frequent Nosebleeds
There are various possible medical causes behind frequent nosebleeds to be evaluated:
- Nasal irritation – Chronic allergies, frequent colds, sinus infections, nose blowing, and nose picking can all irritate nasal tissues.
- Anatomical defects – Septal deformities, nasal polyps, or turbinate swelling may contribute to frequent bleeding.
- Low humidity – Dry nasal air allows crusting and cracking of nasal tissue.
- Medications – Blood thinners and NSAIDs make blood vessel leakage more likely.
- High blood pressure – May cause vessel and tissue damage in the nose over time.
- Blood disorders – Clotting factor deficiencies prevent proper clot formation.
- Liver disease – Reduced production of clotting factors by the liver.
- Blood cancers – Leukemia and other cancers affect platelet and white blood cell levels.
A doctor can perform a physical exam and order blood tests to pinpoint any anatomical, hematological, or other medical issues contributing to frequent nosebleeds.
When To Go to the Emergency Room
Most nosebleeds can be treated at home with simple first aid measures like applying pressure, using nasal decongestants, and moisturizing the nasal passages. However, some severe nosebleeds require emergency medical treatment.
Go to the emergency room right away if you experience:
- Bleeding that does not stop after 30 minutes of direct pressure
- Significant blood loss leaving you dizzy or lightheaded
- Bleeding that recurs shortly after stopping
- Nosebleeds following a head injury or trauma
At the ER, doctors can pack the nasal cavity to apply pressure on bleeding vessels, cauterize blood vessels using silver nitrate, or perform other interventions to stop severe nosebleeds refractory to home treatment.
Preventing Frequent Nosebleeds
You can take steps to lower your risk of frequent bothersome nosebleeds:
- Use saline nasal spray and gel to keep nasal passages moisturized.
- Run a humidifier, especially during dry winter months.
- Avoid aggressive nose blowing and picking.
- Treat any chronic nasal allergies with antihistamines or nasal steroids.
- Have any anatomical defects like septal deviations repaired.
- Take blood pressure medications as prescribed.
Making lifestyle modifications can help reduce nosebleed frequency for many people before needing to resort to medical interventions.
Home Treatment for Nosebleeds
When a nosebleed occurs, you can take the following steps to stop bleeding at home:
- Sit upright and lean forward to prevent swallowing blood.
- Pinch the soft lower part of the nose shut. Apply firm steady pressure without releasing for 5-10 minutes. This helps form a clot.
- Place an ice pack across the nose bridge to constrict blood vessels.
- Use nasal decongestant spray after bleeding stops to reduce rebleeding risk.
- Don’t pick or blow nose for several hours after bleeding stops.
- Run a cool mist humidifier to keep nasal passages moist.
If home treatment fails to stop bleeding after 30 minutes, seek medical help immediately.
Medical Treatments for Chronic Nosebleeds
If nosebleeds remain frequent despite home treatment methods, a doctor may recommend:
- Cauterization – Burning blood vessels to prevent recurrence.
- Nasal packing – Packing gauze or special dressings inside the nasal cavity to apply internal pressure.
- Medications – Estrogen creams or tranexamic acid to promote clotting.
- Surgery – Septoplasty, turbinate reduction, or polyp removal to correct anatomical issues.
- Blood pressure control – Medications to treat high blood pressure reducing vessel trauma.
- Humidification – Ongoing use of nasal saline and humidifiers.
Most chronic nose bleeds can be reduced or eliminated through a combination approach tailored to each patient’s underlying causes.
When to See an ENT Doctor
If you continue experiencing frequent troublesome nosebleeds despite home remedies and primary care doctor visits, seeing an ear, nose and throat (ENT) specialist is advisable. ENTs have specialized training in diagnosing and treating nasal and sinus conditions.
See an ENT if you have:
- Nosebleeds several times per month
- Nosebleeds lasting longer than 30 minutes
- Failed treatments from your primary doctor
- Signs of an anatomical abnormality like septal deviation
- Nasal pain, congestion, or sinus infections accompanying nosebleeds
ENTs can perform more specialized nasal exams using scopes to identify any anatomical factors contributing to recurrent nosebleeds. They may recommend treatments like cautery, medicated nasal packs, or surgery that general practitioners do not perform.
When to Consider Pediatric ENT Evaluation
Children who experience frequent or severe nosebleeds should see a pediatric ENT for evaluation. Pediatric specialists are trained on conditions affecting nosebleeds in children like:
- Nasal irritation from allergies or frequent upper respiratory infections
- Nose picking habits
- Anatomical issues like vascular malformations
- Genetic conditions affecting clotting
Pediatric ENTs specialize in minimizing discomfort and using interventions appropriate for delicate pediatric nasal tissues. Getting the right diagnosis and care can help resolve chronic childhood nosebleeds.
The Bottom Line
Occasional nosebleeds are very common and usually nothing to worry about. But frequent nosebleeds, especially heavy or long-lasting ones, may indicate an underlying medical issue needing treatment.
See a doctor if you experience more than 1 nosebleed per week or bleeding that is heavy or persists longer than 20-30 minutes. Frequent nosebleeds should prompt medical evaluation to identify and address the root cause.
With the right diagnosis and treatment plan, bothersome recurrent nosebleeds can often be well controlled. Don’t hesitate to see an ENT specialist if nosebleeds remain frequent despite treatment from your primary care provider.