Most nosebleeds (or epistaxes) begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. Nosebleeds coming from the front of the nose (anterior nosebleeds) often begin with a flow of blood out one nostril when the patient is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rubbing it inside the nose, especially on the middle portion of the nose (the septum).

• Stay calm, or help a young child stay calm – an agitated person may bleed more profusely than someone who’s been reassured and supported
• Keep head higher than the level of the heart – sit up
• Lean slightly forward so the blood won’t drain in the back of the throat
• Gently blow any clotted blood out of the nose – spray a nasal decongestant in the nose
• Using the thumb and index finger, pinch all the soft parts of the nose. Do not pack the inside of the nose with gauze or cotton
• Hold the position for five minutes – if it’s still bleeding, hold it again for an additional 10 minutes

More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat, even if the patient is sitting or standing.

Obviously, when lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow toward the back of the throat, especially if coughing or blowing the nose. It is important to distinguish between the anterior and posterior nosebleeds since posterior nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

• Allergies, infections, or dryness that cause itching and lead to picking of the nose
• Vigorous nose-blowing that ruptures superficial blood vessels
• Clotting disorders that run in families or are due to medications
• Drugs (such as anticoagulants or anti-inflammatories)
• Fractures of the nose or the base of the skull – head injuries that cause nosebleeds should be regarded seriously
• Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose
• Tumors, both malignant and non-malignant, have to be considered, particularly in the older patient or in smokers

If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose, before making a treatment recommendation. Two of the most common treatments are cautery and packing the nose. Cautery is a technique in which the blood vessel is burned with an electric current, silver nitrate, or a laser. Sometimes, a doctor may pack the nose with a special gauze or an inflatable latex balloon to put pressure on the blood vessel.