The nasal cavity contains a high proportion of blood vessels for the relative size of this facial structure. The septum is the tissue that divides the nose into two passages. There are two general locations of injuries to the nasal septum that causes nosebleeds:

  1. The anterior nasal septum is the more common area for a nosebleed. This is a result of injury to the frontal portion of the nose and typically causes blood to flow out of the nostrils.
  2. The posterior nasal septum is a less common location for a nosebleed. In posterior epistaxis, there is injury to the upper, rear portion of the nose and typically causes blood to backflow towards the back of the mouth and throat.


The following are the most common reasons why a nose would bleed:

  • Dryness – The most common cause of a nosebleed is drying of the nasal membranes. This frequently occurs in the winter months, when many people breathe the dry, warm air produced by artificial heat.
  • Trauma – An obvious cause of epistaxis, nose trauma can be a result of nose picking, foreign bodies in the nose, forceful nose blowing or sneezing and receiving a hard impact to the nose or head.
  • Irritant Inhalation – Repeatedly inhaling an irritant such as ammonia, sulfuric acid, medicated nasal sprays or cocaine is a cause of epistaxis.
  • Hypertension – Uncontrolled high blood pressure makes highly vascularized areas (including the nose) prone to bleeding.
  • Inflammation – An inflamed and irritated nose due to an upper respiratory infection, allergies or sinus irritation can result in epistaxis.
  • Tumor – While not a common cause, a benign or malignant tumor of the nose or sinuses may cause a nosebleed.
  • Medications – Medications that interfere with blood clotting, such as anticoagulants and non-steroidal anti-inflammatory drugs can make it easy for a nose to bleed.
  • Other systemic conditions – Some conditions make a person more susceptible to nosebleeds such as HIV/AIDS, pregnancy, leukemia, liver disease and hemophilia.

What to do?

If you or your client experiences a nosebleed, the symptoms can likely be stopped in your office. If epistaxis occurs in your massage space, make certain to follow universal precautions regarding contact with blood. These precautions include using gloves, proper hand washing, laundering, and disposal procedures.

Most anterior nosebleeds stop within 20 minutes without the need for professional medical intervention. Experts recommend the following steps be taken:

  1. Remain calm. Anxiety around a nosebleed will upset the bleeder, possibly encouraging further bleeding.
  2. Sit upright. The bleeder should sit up and lean forward with the mouth open. In this position, they can spit out any blood instead of swallowing it. Swallowing blood may cause nausea and vomiting.
  3. Remove any objects. If possible, check to see if there is an object inside the bleeder’s nose, and remove it as necessary.
  4. Pinch the nose. Pinch the soft part of the nose together between the thumb and index finger for at least five minutes. Repeat as necessary until the bleeding stops.
  5. Apply ice. Crush ice and place in a plastic bag or washcloth before applying to the nose and cheeks.
  6. Be gentle. Once the bleeding stops, refrain from picking or blowing the nose. Breathe through the mouth for a while and avoid straining, bending or lifting.

Epistaxis Prevention

If you or any of your clients are prone to nosebleeds, there are some preventative measures that can reduce their recurrence:

  • Open your mouth when sneezing so air can escape through the mouth instead of the nose.
  • To moisturize dryness, use a humidifier for the air and petroleum jelly or vitamin E oil on the inside of the nose.
  • Avoid nose picking.
  • Avoid lifting heavy items.
  • Avoid straining during a bowel movement.
  • If hypertension is the culprit, work with a physician to control it.

Seeking Help

While a massage therapist can typically handle nosebleeds, it is important to know when a physician’s referral is required. Seek a physician’s help immediately when:

  • The nosebleed continues after 20 minutes of continuous pressure application.
  • There are unexplained bruises on other parts of the body.
  • The nosebleed is accompanied by nausea and/or vomiting.
  • The nosebleed is accompanied by weakness, dizziness or excessive perspiration.
  • The nosebleed is accompanied by chest pain or shortness of breath.
  • The nosebleed is accompanied by syncope (fainting), or feeling like syncope could occur.

Being informed and prepared to handle the common winter occurrence of nosebleeds will boost your confidence when this situation arises. Additionally, your client’s trust in you will continue to deepen as you demonstrate a firm and calm command of the body’s nuances.

Recommended Study:

Anatomy and Pathology
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Infectious Disease: Hepatitis