Care During Chemotherapy and Beyond

Nosebleeds (Epistaxis)

What Are Nosebleeds (Epitaxis)?

Nosebleeds occur when there is enough trauma or injury to the tissues in your nose to cause it to bleed. This is also called epistaxis.

Bleeding in the front of the nose will cause you to see the blood more easily. These nosebleeds are usually more common.

Bleeding in the back of the nose may result in slow but steady bleeding. This is more severe than bleeding in the front of your nose.  Nosebleeds of this type are usually a result of injury, such as being hit on the head by a blunt object, or from contact sports.

Causes of Nosebleeds:

  • People with low blood platelets, or a bleeding disorder, are more likely to have nosebleeds (epistaxis). 
  • High blood pressure. 
  • You have had trauma or injury to the head, face or nose areas, from an accident or from falling down. 
  • You may have been struck by a blunt object.
  • You may cause damage to the membranes in your nose from blowing your nose, picking your nose, or blowing your nose forcefully. This is especially common if the lining of your nose is irritated from a virus or bacterial infection (or the common cold). If you have had prior problems with nosebleeds, you may be at risk for them to recur. 
  • Breakdown of the membranes, or irritation of the membranes, may be a result of dry or non-humidified air. People will encounter nosebleeds more often in the winter months, when the air is drier. 
  • People who have frequent nosebleeds, or begin bleeding easily, may have problems with how their blood clots, or a tendency bleeding easily as well. If you notice that you are bruising or bleeding easily, notify your health care provider so that you can be evaluated for potential bleeding problems.

Symptoms of Nosebleeds:

  • You may have nosebleeds frequently or begin bleeding easily. This may be a sign of a blood clotting disorder or low blood platelets.
  • You may have tiny red dots on your skin, called petechiae (pe- TEEK- ee- ay). These are commonly found on your lower legs. This is a sign of low blood platelets
  • You may be overly tired, or very weak (fatigued), if you have anemia due to your bleeding problems, or another underlying disorder. It may be hard for you to do any of your normal activities.
  • For many individuals, frequent, unexplained bruising or nosebleeds are the first sign of a bleeding disorder. Some people feel relatively well, with no other symptoms of bleeding problems. 

Things You Can Do To Manage Nosebleeds:

If you have nosebleeds:

  • Do not lie down. Sit straight up in bed or in a chair, so that if blood is going down the back of your throat, you do not cough or choke. 
  • Using your thumb and index (first) finger, pinch your nose. Hold pressure for at least 10 minutes, holding your head up straight, tilting it back slightly, if tolerated. 
  • If you are bleeding in the front of your nose, place a moist cotton ball in your nose. Do not remove the cotton ball if you think the bleeding is stopped.  If a blood clot has formed, you may dislodge it. 
  • If you have nosebleeds that do not stop after 15 or 20 minutes at the most, and especially if you have low blood platelets or a blood clotting disorder, you should seek emergency assistance.
  • If you notice that you are bruising or bleeding easily, notify your health care provider of potential bleeding problems.
  • If you have pain, you may take Acetaminophen (Tylenol®) up to 4000 mg per day (two extra-strength tablets every 6 hours).  As with all medications, you should check with your health care provider before taking any medications. 
  • If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, or accentuate your bleeding problems.
  • Make sure you tell your doctor, as well as all health care providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  Do not take aspirin or products containing aspirin unless your health care provider permits this. 

Drugs or Recommendations That May Be Prescribed By Your Doctor:

Treatment for nosebleeds consists of  identifying and treating the cause of the nosebleed. If nosebleeds are due to trauma, applying ice packs, pressure and Tylenol for comfort is suggested. If nosebleeds persist after 15 minutes, you may have significant damage.

Seek emergency assistance if you have unexplained nosebleeds.  You may have an underlying bleeding disorder, such as low blood platelets, blood clotting disorder or problems with your blood clotting factors. Your health care provider may treat your disorder with additional medications such as:

  • Nasal sprays - such as normal saline sprays, may work to moisten, irrigate or "flush" the mucous membranes inside your nose. If you have frequent nosebleeds, your doctor may prescribe this. Discuss with your doctor or health care provider the proper technique and dosage schedule for your medication (each is different). A common nasal spray may include Ocean spray.
  • Tylenol - If you have pain at the site where you bleeding problems, you may take Acetaminophen (Tylenol) up to 4000 mg per day (two extra-strength tablets every 6 hours). It is important not to exceed the recommended daily dose of Tylenol, as it may cause liver damage. Discuss this with your health care provider.
If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, and accentuate bleeding problems. 

When to Contact Your Doctor or Health Care Provider:

  • If nosebleeds do not stop after 15 minutes.
  • Bleeding that does not stop after a few minutes, or new, unexplained bruising.

Other Common Bleeding Problems:
Bruising (Hematoma) |
Injury | Nosebleeds (Epistaxis) | Rectal BleedingVaginal Bleeding

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about epistaxis and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice. is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit