We’ve all seen the stress-induced nosebleed happening on the big screen. Often a character under some sort of pressure will experience a nosebleed, whether a small trickle of blood or a gushing tap. In the recent movie Emma (the Jane Austen adaptation), the main character develops a nosebleed when she is asked for her hand in marriage… but does this ever really happen?

Here, we are looking at what actually causes nosebleeds, whether or not they are dangerous, if they can indeed be caused by stress alone, how to stop them in the moment, and how to prevent them long-term.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about stress, we’re here to help.

Remember, according to the NHS you should go to A&E if:

• Your nosebleed lasts longer than 10-15 minutes
• There is an excessive amount of blood
• You are swallowing a large amount of blood that makes you vomit
• The bleeding started after a blow to your head
• You're feeling weak or dizzy
• You're having difficulty breathing

What causes nosebleeds?

The medical term for nosebleeds is ‘epistaxis’, and they tend to occur because the inside of the nose is delicate and easily damaged. Simple things like picking your nose, blowing too hard into a tissue, or allowing it to become too dry can cause nosebleeds for some people.

Then there are the nosebleeds that occur deeper inside the nose. Things like a nose injury and high blood pressure can cause this, and in these cases medical attention may be required. Certain medical conditions can affect blood vessels and how the blood clots, and some medicines can lead to nosebleeds, too.

Most children who experience a lot of nosebleeds will grow out of them by around age 11, but other people who may experience nosebleeds more often than others include elderly people and pregnant women.

In some cases, the cause of a nosebleed is unknown, and this is where some people believe stress could be the culprit. More on this later.

Are nosebleeds dangerous?

Nosebleeds often look worse than they are. They aren’t typically a sign of anything serious, and can be treated at home. In many cases, they will stop bleeding on their own.

As above, there are two types of nosebleed:

• Anterior nosebleeds — These occur near the front of the nose and can be caused by something as simple as a scratch inside your nose, or the mucous membrane becoming too dry. This kind of nosebleed is rarely anything to worry about.
• Posterior nosebleeds — These occur in the back of the nasal cavity, and depending on the underlying cause, they can be more serious and may require medical help.

If you experience regular unexplained nosebleeds, it is best to see your GP to make sure everything is OK. Also, if you experience symptoms of anaemia like palpitations, shortness of breath or pale skin, visit your GP to rule out any underlying issues.

You should also speak to your GP about any nosebleeds you experience while on blood-thinning medications such as warfarin, or if you have a medical condition that prevents your blood from clotting as it should, like haemophilia.

According to the NHS, there are a few scenarios where an A&E visit may be more appropriate for a nosebleed. These include:

• If your nosebleed lasts longer than 10-15 minutes
• If there is an excessive amount of blood
• If you are swallowing a large amount of blood that makes you vomit
• If the bleeding started after a blow to your head
• If you are feeling weak or dizzy
• If you are having difficulty breathing

Could high blood pressure be the cause of my nosebleed?

Possibly. Stress can cause high blood pressure, and high blood pressure can in turn cause a nosebleed, which could explain why many people associate stress with their nosebleeds. According to studies, chronic stress has been thought to be a risk factor for hypertension, also known as high blood pressure, with one study of 16,801 patients with epistaxis finding that it was positively associated with hypertension, among other health conditions like obesity, chronic sinusitis and other disorders of the nose and nasal sinuses.

Interestingly, the study also included anxiety disorder as a condition positively associated with epistaxis. This would suggest that as well as hypertension being a possible cause of nosebleeds, anxiety could be too.

So, stress can cause nosebleeds?

It’s the big question; can a nosebleed be brought on by stress? The short answer is… maybe. While there is plenty of anecdotal evidence to suggest stress and anxiety could trigger a nosebleed for some people, the more likely reason is that stress and anxiety tend to be associated with certain behaviours, health conditions and medications that can lead to nosebleeds.

For example, one study found 58.8% of migraine sufferers reported nosebleeds occurring simultaneously with their migraines. So if stress usually causes migraines for you, and your migraines lead to a nosebleed, you may begin to correlate stress with your nosebleeds.

Similarly, if stress causes you to pick or blow your nose more often, this can cause an anterior nosebleed. Or if you travel on a plane and develop a nosebleed, you may associate this with the travel stress you are feeling, when in fact it could be caused by the high altitude. In many cases, a nosebleed is simply an annoying side effect of another issue that is causing your stress.

However, one study of 121 habitual nose-bleeders found that although in most cases nosebleeds seemed to be spontaneous, participants noted that the common cold, stress and tiredness were frequently experienced before the onset of a nosebleed.

To summarise, there is some evidence to suggest stress could be an underlying cause of nosebleeds, however more research is needed.

How to stop a stress-induced nosebleed

Whatever the cause of your nosebleed, the physical advice from the NHS is usually the same; sit down, lean forward instead of back, and pinch your nose above your nostrils for around 10-15 minutes. Keep breathing through your mouth while doing this. You may find it helpful to hold an ice pack (or something frozen wrapped in a towel) against the top of your nose to reduce the blood flow.

If you believe your nosebleed has been brought on by stress, a mindful activity could help you de-stress quickly. Try to focus on making your breathing slow and gentle, and take yourself out of any stressful situation you may be in, especially if people around you become panicked at the sight of blood. Find somewhere quiet and spend some time alone or with a trusted loved one to help relax and stop the bleeding.

How to prevent stress-induced nosebleeds

If you suspect your nosebleeds are being brought on by stress, you may need to find ways to address the underlying cause of your stress rather than the nosebleed itself.

There are lots of ways to do this, and everyone must find their own specific activities or thought patterns that will help de-stress their individual situation. Here are some examples of great stress-busting activities to try:

• Be active by going to the gym, running, doing gentle yoga, walking or simply moving your body in some way
• Meditate or try breathwork practices to calm your mind
• Write down things you are grateful for
• Do an activity that makes you laugh and smile, such as watching a comedy show or playing with your dog
• Listen to relaxing, calming music
• Talk to someone you trust about how you are feeling
• Make time to do things you enjoy around work and other potentially stressful commitments
• Spend time outside in nature (as recommended by the CDC)
• Reach out for help from a qualified professional with experience helping people with stress-related issues (such as a therapist or other mental health professional)

Should I see a doctor about my nosebleeds?

If your nosebleeds are regular and you are not sure what could be causing them (even if you suspect it could be stress), it is always best to speak to your GP so they can check that there is nothing physically wrong with your nasal cavity, or any underlying health conditions that could be contributing to your nosebleeds.

How do I manage my stress?

Some of the above methods of stress-reduction could help you, but remember stress is a very individual experience for everyone, so some trial and error could be required in order to find the de-stressing tactics that work for you. Once you find some, create a ‘toolbox’ of stress-busting techniques you can implement regularly to avoid stress long-term.

If you’re interested in reading more de-stressing tips, take a look at our article; 8 tried and tested ways to calm your mind and 8 more that are more niche. If you would like to work with a professional with experience in addressing stress issues, we can help. Our free 15 minute consultation will help discover more about your stress and point you in the direction of the best specialist to help you overcome this.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private mental health assessments and reviews, to finding qualified and approved mental health professionals for the support you need: join us today.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.