Pregnancy Nosebleed and Blocked Nose: Causes and Care

A pregnancy nosebleed is common and usually harmless. Pregnancy increases the volume of blood in your body and makes the tiny blood vessels inside your nose swell, so they break more easily. The same changes cause a stuffy, blocked nose for many mums, known as rhinitis of pregnancy. Most nosebleeds stop with simple first aid: sit down, lean forward and pinch the soft part of your nose for 10 to 15 minutes.

Go to A&E if a nosebleed lasts longer than 10 to 15 minutes despite pressure, is very heavy, or comes with dizziness or breathing difficulty. Below is how to stop a nosebleed, how to prevent them and how to ease a blocked nose safely.

Why nosebleeds happen during pregnancy

The inside of your nose has a rich network of fragile blood vessels close to the surface. During pregnancy:

• Your blood volume rises considerably, putting more pressure on these small vessels.
• Hormones such as oestrogen increase blood flow to the lining of your nose and make it swell.
• The lining becomes more delicate, so blowing, sneezing or rubbing can make it bleed.

In Singapore, other triggers include hours in dry air-conditioning, colds and allergies such as dust mites, and haze season. The NHS lists pregnancy among the things that make nosebleeds more likely. They can happen in any trimester and usually stop after your baby is born.

How to stop a nosebleed: step by step

1. Sit down and lean forward. Do not tilt your head back, as blood can run down your throat and make you feel sick.
2. Pinch the soft part of your nose, just above the nostrils, not the bony bridge.
3. Hold firmly for 10 to 15 minutes without letting go to check. Breathe through your mouth.
4. Use a cold compress or an ice pack wrapped in a cloth on the bridge of your nose if you like.
5. Spit out any blood in your mouth rather than swallowing it.
6. Afterwards, take it easy for the rest of the day. Avoid blowing your nose, bending over, heavy lifting or very hot drinks, which can restart the bleeding.

When nosebleeds need a check-up

An occasional small nosebleed is not a cause for worry. See your gynae or GP if:

• You get nosebleeds often, for example several times a week.
• You also bruise easily, have bleeding gums that are getting worse, or notice small red or purple spots on your skin. These may need a blood test to check your platelets and clotting.
• You are taking any medicine that affects clotting, including aspirin prescribed in pregnancy. Do not stop it without advice, but let your doctor know.
• You have high blood pressure readings, or nosebleeds come with a severe headache, blurred vision, swelling or pain below your ribs. These are warning signs of pre-eclampsia that need urgent assessment, whether or not you have a nosebleed.
• You feel tired, breathless or look pale, which could mean anaemia.

Bleeding gums are also common in pregnancy for similar reasons. Keep up with brushing and see your dentist; dental check-ups are safe while pregnant.

Preventing nosebleeds

• Keep the inside of your nose moist. A saline spray a few times a day helps, especially if you spend long hours in air-conditioning.
• Consider a humidifier in an air-conditioned bedroom, cleaned regularly, or set the air-con a little warmer.
• Blow gently, one nostril at a time, and sneeze with your mouth open.
• Avoid picking or rubbing your nose, and keep nails short.
• A thin layer of petroleum jelly just inside the nostrils can soothe dry, cracked lining.
• Drink plenty of water, which matters even more in Singapore’s heat.
• Protect against haze by staying indoors with windows closed when the PSI is high.

Rhinitis of pregnancy: the constantly blocked nose

Many women find their nose feels stuffy for weeks at a time during pregnancy, without a cold or obvious allergy. This is pregnancy rhinitis, caused by the same hormonal swelling of the nasal lining. It can start in any trimester, often gets worse later on and usually clears within about two weeks of giving birth.

Signs it is pregnancy rhinitis

• A blocked or runny nose for six weeks or more
• No fever, sore throat or body aches, which suggest an infection
• No obvious seasonal or allergic trigger, although allergies can co-exist
• Snoring or mouth breathing at night

What helps

• Saline sprays or rinses are safe and can clear mucus and reduce swelling. Use sterile or cooled boiled water for rinses, never water straight from the tap.
• Raise your head at night with an extra pillow or wedge.
• Gentle exercise, such as a walk, can temporarily open the nasal passages.
• Nasal strips worn at night help some women.
• Steam from a warm shower can ease congestion; avoid leaning over very hot water, which can scald.

A blocked nose can make sleep harder in late pregnancy. Our guide to pregnancy insomnia has more tips for better nights. Loud snoring with gasping or pauses in breathing should be mentioned to your doctor.

Is it a cold, flu or something else?

If you have a fever, cough, sore throat, aching body or feel generally unwell, it is more likely an infection than pregnancy rhinitis. See your doctor, particularly if you have a fever of 38°C or higher, or feel short of breath. Flu can be more serious in pregnancy, which is why the flu vaccine is recommended. See our guide to vaccines during pregnancy.

For other common changes you may notice, such as pregnancy headaches, heartburn or sharp twinges low in your tummy, our trimester guides cover what is normal and what is not.

The bottom line

Nosebleeds and a stuffy nose are common, mostly harmless side effects of pregnancy hormones and extra blood volume. Stop a nosebleed by sitting forward and pinching the soft part of your nose for 10 to 15 minutes, keep your nose moist in air-conditioned rooms, and use saline for congestion. Go to A&E if a nosebleed will not stop or is very heavy, and see your doctor for frequent nosebleeds, easy bruising or any warning signs of high blood pressure. The NHS has a clear guide to nosebleed first aid.