Instruction: what to do if a dog's nose is bleeding.

1. Initial Assessment

1.1 Remaining Calm

When a dog’s nose begins to bleed, the first and most critical response is to keep composure. A calm demeanor prevents escalation of the animal’s stress, which can increase bleeding. As a veterinarian, I advise the following immediate actions, performed without hesitation:

Take a slow, steady breath before approaching the dog.
Speak in a low, reassuring voice; sudden loud tones may startle the animal.
Position yourself at the dog’s side rather than directly in front, reducing perceived threat.
Gently grasp the muzzle if the dog attempts to bite, using a calm grip to avoid panic.

After stabilizing the situation, assess the source of the hemorrhage. Apply light pressure with a clean gauze pad for 5‑10 minutes, maintaining a steady hand. Throughout the process, monitor the dog’s breathing and heart rate; any signs of shock-pale gums, rapid pulse, or weakness-require immediate veterinary attention.

Remaining composed also enables clear communication with any bystanders or emergency services, ensuring that instructions are conveyed accurately. The ability to stay unruffled directly influences the effectiveness of first‑aid measures and improves the dog’s chances of a swift recovery.

1.2 Observing the Bleeding

When a canine’s nasal bleeding begins, immediate visual assessment determines the urgency of intervention. Observe the source, rate, and quality of the hemorrhage.

Identify whether blood emerges from one nostril or both; unilateral flow often signals local trauma, while bilateral discharge may indicate systemic involvement.
Note the color: bright red suggests arterial pressure, whereas darker hues point to venous leakage.
Measure the flow: a steady stream lasting more than a minute, or intermittent spurts, signals a higher risk of significant blood loss.
Record the duration: bleeding that persists beyond five minutes without natural cessation warrants prompt veterinary evaluation.
Look for accompanying signs such as facial swelling, discharge of mucus or pus, coughing, or signs of distress, which can reveal underlying infection or injury.

Documenting these parameters enables a clear report to the veterinarian and facilitates rapid, targeted treatment.

1.2.1 Severity of Bleeding

Assessing the seriousness of a canine nasal hemorrhage is the first critical step in any response. Severity can be grouped into three levels:

Mild - Blood drips slowly, stops within a few minutes, and the dog remains active and alert.
Moderate - Bleeding persists for more than five minutes, may be profuse but does not obscure breathing, and the animal shows signs of discomfort or mild lethargy.
Severe - Continuous flow overwhelms the nostrils, interferes with respiration, and the dog exhibits marked weakness, pale gums, or collapse.

Determine the category by observing flow rate, duration, and the dog’s overall condition. A rapid, uncontrolled loss of blood, combined with respiratory distress or systemic signs such as pale mucous membranes, indicates severe bleeding that requires immediate veterinary intervention. Moderate bleeding warrants prompt professional assessment, while mild cases can often be managed at home with pressure application and monitoring.

Tailor the response to the identified level: apply gentle pressure for mild cases, seek veterinary care within an hour for moderate situations, and contact emergency services without delay for severe hemorrhages. Continuous monitoring of vital signs-heart rate, gum color, and breathing pattern-should accompany any intervention.

1.2.2 Duration of Bleeding

When a dog’s nostril begins to ooze blood, the length of the episode provides the first clue about severity. A brief spurt that stops within a few seconds typically reflects a minor mucosal irritation or a small superficial vessel. In such cases, gentle cleaning with a damp cloth and observation for the next 15‑20 minutes are sufficient.

If bleeding persists beyond one minute, the likelihood of a deeper injury or a coagulation disorder increases. Continuous flow for 2‑5 minutes warrants immediate pressure application: place a clean gauze pad over the nostril and hold firm pressure for at least three minutes while the dog remains calm.

Bleeding that does not cease after 10 minutes, or that recurs after an initial pause, signals a potentially life‑threatening condition such as a nasal tumor, foreign body, or severe trauma. At this stage, contact a veterinary professional without delay; transport the animal to an emergency clinic if the hemorrhage intensifies or the dog shows signs of weakness, rapid breathing, or pale gums.

Key time thresholds to remember:

< 30 seconds: Minor irritation; clean and monitor.
1-5 minutes: Apply pressure; reassess after stopping.
> 10 minutes: Seek veterinary care immediately.

Accurate timing, combined with rapid response, reduces the risk of shock and improves outcomes for the canine patient.

2. Immediate First Aid

2.1 Applying Pressure

When a canine experiences nasal hemorrhage, the first critical intervention is direct pressure to stem blood loss.

Place a clean, sterile gauze pad or a folded paper towel over the bleeding site.
With one hand, hold the pad firmly; with the other, apply steady, firm pressure directly to the nose.
Maintain pressure for a minimum of five minutes without checking for improvement; releasing prematurely can restart bleeding.
If bleeding persists after five minutes, replace the pad with a fresh sterile layer and repeat the pressure cycle.

The material used must be absorbent and free of loose fibers that could be inhaled. Avoid excessive force that could damage nasal cartilage; the pressure should be sufficient to compress vessels without causing pain beyond the bleeding area. Monitor the dog for signs of shock-pale gums, rapid heartbeat, or lethargy-and be prepared to elevate the head slightly to reduce venous pressure if tolerated.

If bleeding continues beyond fifteen minutes despite repeated pressure, or if the dog shows signs of respiratory distress, immediate veterinary evaluation is required. Professional care may involve cauterization, nasal packing, or diagnostic imaging to identify underlying trauma or disease.

2.2 Keeping the Dog Calm

When a dog’s nose begins to bleed, the animal’s stress level can exacerbate blood loss and hinder assessment. Maintaining a calm demeanor in the pet is the first priority.

First, approach the dog slowly, speaking in a low, steady voice. Sudden movements or loud tones trigger the fight‑or‑flight response, raising heart rate and potentially increasing bleeding. Keep your own posture relaxed; dogs often mirror the energy of their handler.

Second, create a quiet environment. Turn off televisions, music, and other sources of noise. If possible, move the dog to a dimly lit, low‑traffic area to reduce visual stimuli. Close doors to limit external traffic and prevent other animals from approaching.

Third, use gentle physical contact to reassure the animal. A light hand on the shoulder or a slow, soothing stroke along the neck can lower cortisol release. Avoid pressing on the nose or attempting to stop the bleed with forceful pressure, as this can cause additional discomfort.

Fourth, employ a calming aid if the dog is highly anxious. Options include:

A pheromone diffuser (e.g., Adaptil) placed nearby.
A short‑acting, vet‑prescribed anxiolytic administered orally or via injection.
A calming chew containing L‑theanine or valerian, provided the veterinarian has approved its use.

Finally, monitor the dog’s breathing and heart rate while maintaining the tranquil setting. If the animal shows signs of shock-pale gums, rapid pulse, or lethargy-escalate care immediately by contacting a veterinarian and preparing for transport.

By controlling the environment, using soft communication, and applying appropriate calming measures, you minimize stress‑induced complications and create optimal conditions for effective medical intervention.

2.3 Monitoring Breathing

When a canine experiences a nasal hemorrhage, the respiratory system may be compromised by blood loss, airway obstruction, or underlying trauma. Immediate assessment of breathing determines whether the dog can maintain adequate oxygen delivery and guides further emergency measures.

Observe the thorax for rhythmic rise and fall. Normal adult dogs breathe 10-30 times per minute; count breaths for a full minute to detect tachypnea or bradypnea. Note any irregularities such as shallow, rapid breaths or prolonged pauses. Listen for abnormal sounds-wheezes, crackles, or gurgling-that may indicate blood entering the airway or pulmonary involvement. A stethoscope placed on the left and right thoracic windows provides a clearer assessment of lung fields and heart rate.

Check mucous membrane color and capillary refill time. Pale or cyanotic gums, delayed refill (>2 seconds), and lethargy suggest hypoxia or shock. If the dog displays labored breathing, use a clean, dry cloth to gently clear visible blood from the nostrils, avoiding deep insertion that could push blood further into the airway. Position the animal in a calm, upright stance to promote unobstructed airflow.

Critical actions if breathing is impaired

Apply gentle pressure to the nostrils to stem bleeding while monitoring airway patency.
Administer oxygen via a mask or nasal cannula if available; increase flow if respiratory distress escalates.
Prepare for rapid transport to veterinary care; inform the clinic of observed respiratory rates, sounds, and any interventions performed.

Continuous monitoring until professional help arrives is essential. Record changes in rate, effort, and sound quality every 2-3 minutes; any deterioration warrants immediate escalation of care.

3. When to Seek Veterinary Care

3.1 Persistent Bleeding

Persistent nasal hemorrhage in a dog signals a failure of the normal clotting process. Blood that continues to flow after five minutes of firm pressure, appears bright red, or reappears after an initial stop requires immediate escalation.

Apply sterile gauze directly to the nostril, maintain constant pressure for at least three minutes.
If bleeding persists, introduce a cold compress on the bridge of the nose to induce vasoconstriction while keeping the animal’s head slightly elevated.
Avoid inserting any objects into the nasal cavity; external manipulation may worsen trauma.

When manual control does not achieve hemostasis within ten minutes, contact a veterinarian without delay. Professional care may involve nasal packing with absorbable material, electrocautery of the bleeding vessel, or administration of systemic tranexamic acid. Diagnostic work‑up should include a complete blood count, coagulation profile, and imaging to identify underlying causes such as tumor, foreign body, or severe infection.

During transport, keep the dog calm, limit movement, and maintain a cool environment to reduce blood flow. Provide a clear description of the incident, duration of bleeding, and any observed nasal discharge to facilitate rapid assessment.

Preventive strategies include regular dental examinations, environmental safety checks to eliminate sharp objects, and routine health screenings for clotting disorders. Early detection of nasal lesions through periodic visual inspection can reduce the likelihood of prolonged bleeding episodes.

3.2 Accompanying Symptoms

When a canine experiences nasal bleeding, the presence of additional clinical signs often points to the underlying cause and influences the urgency of treatment. Rapid assessment of these accompanying symptoms is essential for effective management.

Typical concurrent signs include:

Persistent sneezing or nasal discharge that may be clear, serous, or purulent.
Visible swelling or bruising around the muzzle, eyes, or forehead.
Blood in the oral cavity, on the tongue, or in the vomit, suggesting posterior bleeding.
Coughing or gagging, indicating possible aspiration of blood.
Lethargy, reduced appetite, or reluctance to move, which can signal systemic involvement.
Fever or elevated heart rate, reflecting inflammation or infection.
Unusual behavior such as agitation, restlessness, or signs of pain when the nose is touched.

Less common but critical indicators are:

Bleeding from other sites, such as gums or ears, suggesting a clotting disorder.
Neurological signs-head tilt, circling, or loss of balance-potentially linked to intracranial pathology.
Pale mucous membranes, denoting significant blood loss.

Identifying the combination of these symptoms helps differentiate between trauma, neoplasia, infectious rhinitis, foreign bodies, or coagulopathies. Immediate veterinary consultation is warranted if any of the following are observed: uncontrolled bleeding, signs of shock (weak pulse, rapid breathing), neurological deficits, or systemic illness such as fever or lethargy. Prompt professional evaluation enables targeted diagnostics, including blood work, imaging, and possible surgical intervention, thereby improving the prognosis for the affected dog.

3.2.1 Difficulty Breathing

When a canine nose bleed occurs, the most urgent concern is whether the animal can breathe freely. Blood may flow backward into the nasopharynx, causing obstruction or irritation that leads to labored respiration. Recognizing and addressing this symptom promptly can prevent secondary complications such as aspiration pneumonia.

Key indicators of respiratory distress include rapid or shallow breathing, audible wheezing, open‑mouth panting, and visible effort to inhale. If any of these signs appear, act immediately:

Keep the dog’s head elevated to discourage blood from draining into the throat.
Gently wipe the nostrils with a clean, damp cloth to remove excess blood, taking care not to push material deeper.
Apply gentle pressure to the bleeding site for 5‑10 minutes while monitoring breathing.
If the dog continues to struggle for air, place the animal in a quiet, well‑ventilated area and avoid stressors that could worsen airway swelling.
Contact a veterinarian without delay; convey that the dog exhibits nasal bleeding accompanied by difficulty breathing, and be prepared to transport the pet promptly.

While minor bleeds may resolve with basic first‑aid, any sign of compromised breathing warrants professional evaluation. Early intervention reduces the risk of blood entering the lungs and supports a quicker recovery.

3.2.2 Swelling

Swelling around a bleeding canine nose often indicates tissue trauma, infection, or vascular injury. Prompt assessment determines whether the condition can be managed at home or requires professional veterinary intervention.

First, examine the affected area. Look for:

Localized puffiness or firmness extending beyond the nostril margins.
Discoloration suggesting bruising or hematoma formation.
Warmth or tenderness when gently pressed.

If swelling is mild and the bleeding has stopped, apply a cold compress for 10‑15 minutes, repeating every hour for the first six hours. The cold stimulus reduces vascular leakage and limits edema. Ensure the compress is wrapped in a clean cloth to avoid direct skin contact and prevent frostbite.

When swelling persists, enlarges, or is accompanied by continuous bleeding, respiratory distress, or behavioral changes, contact a veterinarian immediately. Persistent edema may compress nasal passages, impair airflow, or signal deeper injury such as a fractured nasal bone. Veterinary care may involve:

Diagnostic imaging (radiographs or CT) to identify fractures or foreign bodies.
Administration of anti‑inflammatory medication to control edema.
Suturing or drainage of hematomas if necessary.
Stabilization of bleeding vessels using cauterization or ligation.

After veterinary treatment, follow the prescribed medication schedule, keep the dog’s environment calm, and avoid activities that could stress the nasal region. Regular inspection of the nose during recovery helps detect early signs of re‑bleeding or infection. Maintaining a clean, dry habitat and monitoring for allergens reduces the risk of recurrent swelling and hemorrhage.

3.2.3 Other Injuries

When a dog presents with nasal bleeding, the clinician must also evaluate for accompanying trauma that can exacerbate blood loss or compromise airway function.

First, perform a rapid visual inspection of the muzzle, eyes, and oral cavity. Look for lacerations, puncture wounds, swelling, or displaced teeth that may be sources of additional hemorrhage. Palpate the nasal bridge and surrounding facial bones for tenderness or crepitus, indicating possible fracture.

Second, assess respiratory status. Observe the rate and effort of breathing, listen for abnormal sounds, and ensure the airway remains unobstructed. If swelling or blood obstructs the nostrils, gently clear the passage with sterile gauze, avoiding deep insertion that could worsen tissue damage.

Third, check for ocular involvement. Blood may track to the eyes, masking corneal abrasions or globe rupture. Flush each eye with sterile saline and examine for redness, discharge, or pupil irregularities.

Fourth, evaluate systemic signs. Measure heart rate, capillary refill time, and mucous membrane color to detect hypovolemia. If the dog shows tachycardia, pale gums, or prolonged capillary refill, initiate fluid therapy promptly.

Fifth, document the extent of all injuries. Use a concise checklist:

Nasal lacerations or punctures
Facial bone fractures (maxilla, mandible, nasal bones)
Dental trauma (broken or loose teeth)
Ocular damage (corneal ulcer, hyphema)
Oral cavity injuries (palate lacerations, tongue lacerations)
Signs of shock (tachycardia, weak pulses, pale mucosa)

Once the inventory is complete, prioritize interventions. Control active bleeding with direct pressure using sterile gauze, apply a mild pressure bandage if necessary, and consider a topical hemostatic agent for small lacerations. Stabilize fractures with splinting or temporary immobilization pending veterinary imaging. Administer analgesics and, if indicated, broad‑spectrum antibiotics to prevent secondary infection.

Finally, arrange for definitive veterinary care. Transport the dog calmly, maintaining airway patency and continuous monitoring of vital signs. Prompt professional assessment will address both the nasal hemorrhage and any coexisting injuries, reducing the risk of complications and improving recovery prospects.

3.3 Known Underlying Conditions

Bleeding from a dog’s nose often signals an underlying health issue rather than an isolated incident. Recognizing the most common predisposing conditions helps prioritize diagnostic steps and treatment plans.

Traumatic injury - lacerations, fractures, or blunt force to the facial region damage nasal vessels and mucosa, producing acute hemorrhage.
Coagulopathy - disorders such as hemophilia, von Willebrand disease, or liver‑derived clotting deficiencies impair hemostasis and lead to persistent oozing.
Infectious agents - bacterial rhinitis, fungal infections (e.g., Aspergillus spp.) and parasitic infestations inflame mucosal tissue, causing fragile vessels that rupture easily.
Neoplastic growths - benign polyps, malignant tumors (nasal carcinoma, adenocarcinoma) erode blood vessels as they expand, resulting in intermittent or continuous bleeding.
Autoimmune vasculitis - immune‑mediated destruction of vascular walls (e.g., systemic lupus erythematosus) creates spontaneous hemorrhage without external trauma.
Vascular malformations - congenital or acquired arteriovenous fistulas present as localized, often pulsatile, bleeding sources.
Foreign bodies - grass awns, splinters, or inhaled debris perforate the nasal lining, provoking localized bleeding and secondary infection.
Systemic hypertension - elevated arterial pressure strains delicate nasal capillaries, making them prone to rupture under minimal stress.

Identifying any of these conditions through physical examination, imaging, laboratory testing, or cytology directs appropriate intervention and reduces the risk of recurrent epistaxis.

4. Potential Causes of Nosebleeds

4.1 Trauma

When a dog’s nasal bleeding results from trauma, rapid assessment and targeted care are essential. First, isolate the animal in a calm environment to reduce stress and prevent further injury. Apply gentle pressure to the nostrils using a clean gauze pad for 5‑10 minutes; this often stops superficial bleeding. If the source remains active, inspect the muzzle for lacerations, punctures, or fractured bone fragments. Visible wounds require immediate cleaning with sterile saline and a light antiseptic, followed by a sterile dressing to protect the area.

If bleeding persists despite pressure, consider internal trauma such as a fractured nasal cavity or torn blood vessels. In such cases:

Immobilize the dog to limit movement.
Elevate the head slightly to reduce venous pressure.
Contact a veterinarian without delay; convey details of the incident, observed injuries, and any first‑aid measures already applied.

While awaiting professional help, monitor vital signs: heart rate, respiratory effort, and level of consciousness. Rapid pulse, pale gums, or collapse indicate significant blood loss and demand emergency intervention. Do not attempt to insert objects into the nostrils or use topical vasoconstrictors without veterinary guidance, as these can exacerbate tissue damage.

Post‑trauma care includes prescribed antibiotics to prevent infection, pain management, and possibly imaging studies (radiographs or CT scans) to evaluate skeletal damage. Follow the veterinarian’s instructions for wound care, activity restriction, and follow‑up examinations to ensure complete recovery.

4.2 Foreign Objects

When a dog’s nasal bleeding is traced to a foreign object, immediate assessment and intervention are essential to prevent further trauma and infection. First, restrain the animal calmly to limit movement and reduce stress on the nasal passages. Conduct a visual inspection of the nostrils using a bright light; if the object is visible and not deeply embedded, attempt gentle removal with sterilized tweezers, taking care not to squeeze the tissue.

If the foreign body is not apparent, or if removal attempts cause additional bleeding, cease manipulation and seek veterinary care without delay. The veterinarian will likely perform a rhinoscopy or radiographic imaging to locate hidden fragments such as splinters, grass awns, or small stones. Sedation may be required to allow thorough examination and safe extraction.

After successful removal, follow these steps to support healing:

Apply a sterile, non‑adhesive dressing to the nostril to absorb residual blood.
Administer prescribed antibiotics to prevent bacterial invasion, especially if the object was contaminated.
Use a short course of anti‑inflammatory medication to reduce swelling and discomfort, as advised by the veterinarian.
Monitor the dog for signs of recurrence, such as repeated bleeding, sneezing, or nasal discharge, and report any changes promptly.

Preventive measures include regular inspection of the dog’s environment for sharp debris, avoiding walks in areas with dense vegetation, and keeping the animal’s muzzle free of toys or objects that could be accidentally inhaled. Maintaining these practices reduces the risk of foreign objects causing nasal hemorrhage and promotes overall respiratory health.

4.3 Infections

Nasal hemorrhage in dogs can be a symptom of underlying infection. Bacterial, fungal, or parasitic agents may inflame the nasal mucosa, erode blood vessels, and trigger bleeding. Recognizing infection‑related causes is essential for effective intervention.

First, assess the dog's overall condition. Fever, nasal discharge that is purulent, thick, or contains blood‑tinged mucus, and facial swelling suggest an infectious process. Conduct a thorough physical examination, focusing on the nasal cavity and oral cavity for lesions or ulcers.

Diagnostic steps include:

Cytology of nasal swab to identify bacteria, yeast, or parasites.
Culture and sensitivity testing to determine appropriate antimicrobial therapy.
Imaging (radiographs or CT) to detect sinus involvement or bone changes.
Blood work to evaluate systemic infection markers.

Treatment protocol:

Initiate empiric broad‑spectrum antibiotics or antifungal agents based on the most likely pathogens; adjust according to culture results.
Administer anti‑inflammatory medication to reduce mucosal swelling and limit further vessel damage.
Provide supportive care: maintain hydration, ensure a humid environment, and use saline nasal flushes to clear debris.
Monitor bleeding frequency and severity; if hemorrhage persists, consider local hemostatic measures such as cauterization or application of a topical clotting agent under veterinary supervision.

Prevention focuses on minimizing exposure to infectious agents. Regular vaccination against canine respiratory pathogens, prompt treatment of upper respiratory infections, and avoidance of contaminated environments reduce the risk of nasal infection. Routine dental care also prevents oral bacteria from migrating to the nasal passages.

If infection is ruled out but bleeding continues, explore alternative causes such as trauma, coagulopathies, or neoplasia. Prompt veterinary evaluation remains the cornerstone of managing nose bleeding in dogs, ensuring that infectious etiologies are identified and addressed swiftly.

4.4 Tumors

When a dog presents with epistaxis, one potential underlying cause is a nasal tumor. Tumors of the nasal cavity, including adenocarcinomas, squamous cell carcinomas, and osteosarcomas, can erode blood vessels and produce persistent bleeding. Early identification of a neoplastic source is critical for effective management.

Initial assessment should include a thorough physical examination, focusing on the nasal passages for masses, swelling, or discharge. Palpation may reveal firm tissue irregularities. Obtain a complete blood count and coagulation profile to rule out systemic bleeding disorders that could exacerbate tumor‑related hemorrhage.

Diagnostic imaging provides definitive information. Recommended steps:

Radiography - lateral and dorsoventral views identify bony destruction and soft‑tissue opacity.
Computed tomography (CT) - offers high‑resolution detail of tumor extent, bone involvement, and vascular supply.
Biopsy - performed endoscopically or via a percutaneous approach, yields histopathology for tumor classification.

If imaging confirms a neoplastic lesion, treatment options depend on tumor type, size, and stage. Surgical excision may be feasible for localized masses, often combined with pre‑operative embolization to reduce intra‑operative bleeding. Radiation therapy provides palliation or curative intent for incompletely resectable tumors. Chemotherapy is indicated for certain carcinomas and sarcomas, typically as adjunctive therapy.

While definitive therapy proceeds, control active bleeding:

Apply direct pressure with a sterile gauze pack for a few minutes.
Use a topical vasoconstrictor (e.g., phenylephrine) sparingly, avoiding excessive systemic absorption.
Administer an intravenous fluid bolus to maintain blood pressure if hypovolemia is suspected.
Consider tranexamic acid to stabilize clot formation, monitoring for thrombotic complications.

Follow‑up includes repeat imaging every 3-6 months to assess treatment response and detect recurrence. Owner education should emphasize monitoring for recurrent epistaxis, nasal discharge changes, or facial swelling, prompting immediate veterinary evaluation.

4.5 Blood Clotting Disorders

Bleeding from the nasal cavity can be a symptom of an underlying coagulation disorder. When a dog presents with a nosebleed, consider the following points related to blood‑clotting deficiencies.

The most common inherited disorders affecting clot formation are hemophilia A, hemophilia B, and von Willebrand disease. These conditions reduce the activity of factor VIII, factor IX, or von Willebrand factor, respectively, leading to prolonged bleeding after minor trauma. Acquired disorders, such as immune‑mediated thrombocytopenia or liver disease, also impair clotting and may manifest as epistaxis.

Initial assessment should include:

Visual inspection of the nostrils to identify active bleeding sites.
Measurement of heart rate, respiratory rate, and mucous membrane color to evaluate shock.
Rapid collection of blood for complete blood count, platelet count, prothrombin time, activated partial thromboplastin time, and von Willebrand factor assay.
Application of gentle pressure to the affected nostril for 5-10 minutes using a clean gauze pad.

If bleeding persists after direct pressure, administer a short‑acting vasoconstrictor (e.g., oxymetazoline) sparingly to the mucosa, avoiding excessive dosing. Intravenous fluids may be required to maintain perfusion, and tranexamic acid can be given to inhibit fibrinolysis when clotting factors are deficient.

Definitive management depends on the identified disorder:

Replace missing clotting factors with plasma or specific factor concentrates for hemophilia.
Provide desmopressin (DDAVP) to increase von Willebrand factor levels in mild cases.
Treat immune‑mediated thrombocytopenia with corticosteroids or other immunosuppressants.
Address liver dysfunction through dietary modification and hepatoprotective medications.

After stabilization, schedule a follow‑up evaluation to monitor coagulation parameters and adjust therapy. Owner education should emphasize avoidance of nasal trauma, regular veterinary screening for clotting abnormalities, and immediate veterinary consultation if epistaxis recurs.

4.6 High Blood Pressure

High blood pressure in dogs, also known as systemic hypertension, can precipitate epistaxis. Elevated arterial pressure damages delicate nasal vessels, leading to spontaneous bleeding. Recognizing hypertension as a possible cause of nasal hemorrhage allows owners to intervene promptly and seek veterinary care.

Typical indicators of canine hypertension include increased thirst, frequent urination, lethargy, and occasional retinal hemorrhages. Blood pressure measurement using Doppler or oscillometric devices confirms the condition; values above 160 mm Hg generally signify hypertension requiring treatment.

When a dog’s nose begins to bleed, the following actions are recommended:

Apply gentle pressure with a clean gauze pad for 1-2 minutes to reduce blood flow.
Keep the animal calm; stress can raise blood pressure further.
Inspect the nostrils for visible trauma; if none is present, consider hypertension as a likely factor.
Contact a veterinarian immediately; describe the bleeding episode, any known hypertension, and recent medication changes.
Transport the dog with minimal handling, maintaining a quiet environment during the journey.

Veterinary management of hypertension involves identifying underlying causes (renal disease, endocrine disorders, heart disease) and initiating antihypertensive therapy, commonly with amlodipine or ACE inhibitors. Regular blood pressure monitoring and dosage adjustments are essential to prevent recurrent epistaxis.

Owners should maintain a record of blood pressure readings, medication schedules, and any bleeding incidents. Prompt response to nasal bleeding coupled with systematic hypertension control reduces the risk of severe hemorrhage and improves overall health outcomes.

4.7 Toxin Exposure

Toxin exposure is a frequent trigger for canine epistaxis. Ingested, inhaled or dermally absorbed poisons can damage nasal mucosa, disrupt clotting mechanisms, or cause systemic coagulopathy, leading to bleeding from the nose.

Typical toxic agents include anticoagulant rodenticides, certain insecticides, heavy metals such as lead, and plant alkaloids found in lilies, foxglove or oleander. Even household cleaners containing bleach or ammonia may irritate the nasal passages and provoke hemorrhage.

When a dog presents with a bleeding nose, immediate assessment should focus on identifying possible toxin sources. Rapid removal of the offending substance, decontamination and stabilization are essential before veterinary evaluation.

First‑aid actions

Isolate the dog from the suspected toxin and remove contaminated clothing or accessories.
Rinse the nostrils gently with lukewarm saline solution to clear irritants; avoid forceful flushing that could worsen bleeding.
Apply gentle pressure to the bridge of the nose with a clean gauze pad for 5-10 minutes to help clot formation.
Monitor for additional symptoms such as lethargy, vomiting, pale gums, or uncontrolled bleeding; record the time of onset and any known exposures.
Contact a veterinarian or an emergency poison control hotline promptly, providing details of the toxin, amount, and elapsed time.

Veterinary treatment may involve intravenous fluids, vitamin K1 administration for anticoagulant poisoning, blood transfusions, or specific antidotes for identified toxins. Diagnostic tests, including coagulation profiles and toxicology screens, help confirm the cause and guide therapy.

Preventive measures reduce the risk of toxin‑induced nosebleeds. Secure all chemicals, rodenticides and poisonous plants away from pets. Use pet‑safe cleaning products, and supervise outdoor activities to avoid accidental ingestion of harmful substances. Regular veterinary check‑ups can detect early signs of clotting disorders that predispose to epistaxis.

5. Veterinary Diagnosis and Treatment

5.1 Physical Examination

When a canine presents with epistaxis, the immediate physical assessment determines the urgency of intervention and guides subsequent care.

First, evaluate the animal’s airway and breathing. Observe for coughing, gagging, or labored respiration, which may indicate blood aspiration. If the dog is struggling to breathe, administer oxygen and consider suction of the nasal passages to clear obstructing clots.

Second, locate the bleeding source. Gently lift the nasal bridge and visually inspect both nostrils. Use a bright light and a small speculum, if available, to examine the mucosa for lacerations, ulcerations, or foreign bodies. Note the side and extent of hemorrhage; unilateral bleeding often points to localized trauma, while bilateral flow suggests systemic coagulopathy.

Third, palpate the facial bones and nasal cartilage. Apply light pressure along the nasal dorsum to detect fractures, crepitus, or swelling. Assess the surrounding tissues for signs of edema, discharge, or bruising that may accompany underlying skeletal injury.

Fourth, assess hemodynamic status. Measure heart rate, capillary refill time, and mucous membrane color. Rapid pulse, pale gums, or prolonged refill indicate significant blood loss and require fluid resuscitation. Record temperature to rule out fever, which could accompany infection or inflammation.

Fifth, perform a brief systemic review. Auscultate the thorax for abnormal sounds, palpate the abdomen for tenderness, and examine the limbs for lameness that might suggest a more extensive trauma. Document any concurrent wounds, such as mouth or oral cavity injuries, that could contribute to the bleeding.

Finally, record findings in a structured format: location and severity of bleed, visible lesions, facial integrity, vital parameters, and any additional injuries. This concise documentation supports decision‑making for diagnostics (e.g., CBC, coagulation panel, radiographs) and informs the treatment plan, whether it involves local hemostasis, wound closure, or emergency stabilization.

5.2 Diagnostic Tests

When a canine presents with epistaxis, accurate identification of the underlying cause relies on a systematic series of diagnostic investigations. Initial assessment includes a thorough physical examination and stabilization of hemorrhage, after which specific laboratory and imaging studies are performed.

A complete blood count evaluates red‑cell loss, anemia severity, and platelet quantity. Coagulation profiling-prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels-detects clotting disorders such as hemophilia, von Willebrand disease, or disseminated intravascular coagulation. Serum biochemistry screens for hepatic or renal dysfunction that may impair clotting factor synthesis. Urinalysis can reveal protein loss associated with systemic coagulopathies.

Imaging techniques clarify structural abnormalities. Lateral and dorsoventral skull radiographs identify fractures, foreign bodies, or neoplastic masses. Computed tomography provides detailed cross‑sectional views of the nasal cavity, sinus involvement, and potential bone erosion. Magnetic resonance imaging is indicated when soft‑tissue lesions or intracranial extension are suspected.

Direct visualization of the nasal passages enhances diagnostic precision. Rigid or flexible rhinoscopy permits inspection of mucosal integrity, identification of bleeding sites, and targeted tissue sampling. Cytology of nasal discharge or biopsied material distinguishes inflammatory, infectious, or neoplastic processes. Aerobic and anaerobic cultures guide antimicrobial selection when bacterial infection is evident.

The following checklist summarizes essential diagnostic tests for a dog with a bleeding nose:

Complete blood count (CBC) with platelet count
Prothrombin time (PT) and activated partial thromboplastin time (aPTT)
Serum fibrinogen concentration
Comprehensive serum chemistry panel
Urinalysis with protein assessment
Skull radiographs (lateral and dorsoventral)
Computed tomography (CT) of the nasal cavity and sinuses
Magnetic resonance imaging (MRI) if soft‑tissue involvement is suspected
Rhinoscopic examination with targeted biopsies
Cytological evaluation of nasal samples
Aerobic and anaerobic bacterial cultures

Interpretation of these results directs definitive therapy, whether surgical, medical, or supportive, and minimizes the risk of recurrent hemorrhage.

5.2.1 Blood Work

When a canine patient arrives with epistaxis, the first diagnostic priority is to assess the blood. Laboratory evaluation reveals whether the hemorrhage stems from systemic disorders rather than a localized trauma.

Key components of the work‑up include:

Complete blood count (CBC). Detects anemia, leukocytosis, or thrombocytopenia that may compromise clot formation.
Coagulation profile. Prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen level identify deficiencies in clotting factors or consumptive coagulopathies.
Serum chemistry panel. Evaluates liver and kidney function, electrolyte balance, and markers of inflammation that can influence bleeding risk.
Blood smear examination. Allows visual confirmation of platelet morphology and detection of infectious agents such as hemotropic parasites.
Specific disease screens. Tests for vector‑borne illnesses (e.g., Ehrlichia, Anaplasma), immune‑mediated thrombocytopenia, or neoplastic markers when indicated.

Interpretation follows a logical sequence. A low platelet count combined with prolonged PT/aPTT suggests a primary clotting defect, prompting immediate plasma or platelet transfusion. Normal coagulation values with anemia point to chronic blood loss, requiring fluid therapy and possible endoscopic evaluation of nasal passages. Elevated liver enzymes alongside coagulopathy may indicate hepatic insufficiency, directing treatment toward hepatic support and vitamin K supplementation.

Timely blood work guides therapeutic decisions, reduces the risk of uncontrolled hemorrhage, and assists in identifying underlying conditions that could recur. Clinicians should obtain samples before initiating any hemostatic drugs to ensure accurate baseline values.

5.2.2 X-rays or CT Scans

When a canine presents with epistaxis, imaging can reveal underlying structural or pathological causes that are not apparent on physical examination. X‑ray and computed tomography (CT) are the primary modalities for this purpose.

X‑ray evaluation provides a quick overview of the nasal cavity, frontal sinuses, and adjacent bone structures. It can identify fractures, foreign bodies, dental disease, or large neoplasms. The technique requires lateral and dorsoventral views; exposure settings are adjusted for the animal’s size to minimize radiation dose while preserving diagnostic detail.

CT offers superior cross‑sectional detail, allowing detection of small tumors, inflammatory masses, and subtle bone erosion. Multiplanar reconstructions differentiate soft‑tissue lesions from vascular abnormalities. Contrast enhancement clarifies vascular patterns, aiding in the distinction between hemorrhage and tumor vascularity.

Key considerations for selecting imaging:

Clinical urgency - severe, uncontrolled bleeding warrants immediate X‑ray; CT is reserved for cases where X‑ray is inconclusive or detailed anatomy is needed.
Animal stability - sedation or general anesthesia may be required for CT; ensure cardiovascular status can tolerate the procedure.
Diagnostic goal - use X‑ray for trauma assessment; employ CT for suspected neoplasia, chronic sinusitis, or complex sinus anatomy.
Availability and cost - X‑ray is widely accessible and less expensive; CT may be limited to specialty centers.

Interpretation of images should focus on:

Disruption of nasal septum or turbinates.
Presence of radiopaque foreign material.
Irregular bone margins indicating osteolysis.
Soft‑tissue masses with heterogeneous attenuation.
Contrast enhancement patterns suggestive of vascular lesions.

Findings guide subsequent management: surgical intervention for fractures, endoscopic removal of foreign bodies, targeted chemotherapy or radiation for neoplasia, and appropriate medical therapy for inflammatory conditions. Imaging results must be integrated with clinical signs and laboratory data to formulate a comprehensive treatment plan.

5.2.3 Endoscopy

When a dog presents with nasal hemorrhage, visualizing the internal structures is essential for identifying the source. Endoscopy provides a direct view of the nasal cavity, turbinates, and nasopharynx, allowing precise assessment and targeted treatment.

The procedure begins with sedation or general anesthesia to ensure the animal remains still and pain‑free. A rigid or flexible endoscope, typically 2.7-4 mm in diameter, is introduced through the nostril after gentle decongestion with a saline or vasoconstrictive spray. Continuous irrigation maintains a clear field and reduces blood obscuration.

Key diagnostic objectives include:

Locating active bleeding vessels or lesions.
Detecting foreign bodies, tumors, or mucosal ulcers.
Assessing mucosal integrity and inflammatory changes.

Therapeutic actions performed during endoscopy may involve:

Cauterization of identified bleeding points using laser or bipolar probes.
Biopsy of suspicious tissue for histopathology.
Removal of small foreign material with grasping forceps.
Application of hemostatic agents directly onto bleeding sites.

Post‑procedure care consists of monitoring for recurrent bleeding, administering analgesics, and prescribing antibiotics if infection risk is present. Follow‑up endoscopic examinations are recommended at two‑week intervals until the mucosa demonstrates complete healing.

Endoscopic evaluation should be considered whenever epistaxis persists beyond 24 hours, recurs, or is accompanied by unilateral discharge, facial swelling, or systemic signs. Its ability to combine diagnosis and immediate intervention makes it a valuable component of comprehensive canine nasal hemorrhage management.

5.3 Treatment Options

When a canine presents with nasal hemorrhage, immediate intervention focuses on controlling bleeding, assessing underlying causes, and providing supportive care.

Apply direct pressure using a clean gauze pad. Hold for 5-10 minutes without interruption; this often arrests minor bleeding.
Elevate the head slightly to reduce venous pressure. A wedge or rolled towel beneath the neck accomplishes this without compromising airway patency.
Administer a topical vasoconstrictor (e.g., a diluted epinephrine solution) only if pressure fails and under veterinary guidance. Excessive use can induce tissue necrosis.
Implement systemic therapy when hemorrhage persists: intravenous crystalloids to maintain perfusion, followed by tranexamic acid (10 mg/kg IV) to inhibit fibrinolysis. Dosage adjustments depend on the dog’s weight and renal function.
Conduct diagnostic work‑up after stabilization. Blood panel (CBC, coagulation profile), radiographs, and possibly CT imaging identify trauma, tumors, foreign bodies, or coagulopathies. Targeted treatment-surgical removal of a mass, antibiotics for infection, or correction of clotting disorders-addresses the root cause.

Post‑stabilization care includes monitoring for re‑bleeding, providing a quiet environment, and restricting activity for 24-48 hours. Follow‑up examinations verify resolution and guide long‑term management.

5.3.1 Medication

When a dog presents with epistaxis, immediate attention to medication can stabilize the situation and prevent complications. First‑line pharmacologic intervention focuses on controlling hemorrhage and addressing underlying causes.

Topical vasoconstrictors: Apply a sterile cotton swab soaked in a dilute solution of epinephrine (1:10,000) to the bleeding site for no more than 30 seconds. Limit use to avoid mucosal irritation; repeat only if bleeding persists after a brief interval.
Tranexamic acid: Administer orally or intravenously at 10 mg/kg every 8 hours for short‑term control of fibrinolysis. Monitor renal function and discontinue if signs of thrombosis appear.
Corticosteroids: Use prednisolone (0.5-1 mg/kg PO once daily) when inflammation or immune-mediated vasculitis is suspected. Taper gradually to avoid adrenal suppression.
Antibiotics: Provide broad‑spectrum coverage (e.g., amoxicillin‑clavulanate 20 mg/kg PO BID) if secondary bacterial infection is evident or the nasal mucosa is compromised.
Analgesics: Offer NSAIDs such as meloxicam (0.1 mg/kg PO once daily) only after confirming normal platelet function and renal parameters; otherwise choose opioid analgesics (e.g., buprenorphine 0.01 mg/kg IM q8‑12 h).

Systemic medications must be prescribed after a complete blood count, coagulation profile, and, when possible, imaging to rule out neoplasia or trauma. Dosages should be adjusted for the dog's weight, age, and concurrent conditions. Always verify that the selected drug is approved for canine use and that the owner receives clear instructions on administration, potential side effects, and the need for follow‑up evaluation.

5.3.2 Surgery

As a veterinary surgeon, I assess bleeding from the nasal passages of dogs with a focus on determining whether conservative measures have failed and surgical intervention is warranted. Indications include persistent hemorrhage despite pressure, packing, or pharmacologic vasoconstriction; identified vascular lesions such as arterial rupture or tumor; and traumatic damage that cannot be controlled by non‑surgical means.

Pre‑operative evaluation begins with stabilization of the patient’s airway, circulation, and oxygenation. Intravenous fluids correct hypovolemia; blood typing and cross‑matching prepare for possible transfusion. Diagnostic imaging-plain radiographs, computed tomography, or endoscopic examination-identifies the bleeding source and assesses structural integrity. Coagulation profiles rule out systemic clotting disorders that could compromise surgical success.

Surgical techniques selected for canine nasal bleeding include:

Direct arterial ligation of the ethmoidal or sphenopalatine vessels when the source is identified.
Laser or electrocautery ablation of localized vascular lesions or tumors.
Partial turbinectomy to remove damaged mucosal tissue and expose bleeding points.
Nasal cavity packing with absorbable hemostatic material combined with sutured mucosal flaps for diffuse oozing.

The operative sequence follows a standardized protocol. General anesthesia is induced with agents that maintain cardiovascular stability. A sterile dorsal approach provides access to the nasal cavity; endoscopic guidance ensures precise localization. Hemostasis is achieved through vessel ligation, cauterization, or application of topical hemostatic agents. After bleeding control, the nasal mucosa is approximated with absorbable sutures, and a temporary packing material may be placed to support clot formation.

Post‑operative care emphasizes monitoring for re‑bleeding, respiratory distress, and infection. Analgesics administered at regular intervals prevent pain‑induced hypertension that could disrupt clot integrity. Broad‑spectrum antibiotics reduce the risk of secondary bacterial invasion. The dog is confined to a quiet environment with limited activity for 7-10 days; water intake is restricted for the first 24 hours to minimize pressure changes in the nasal passages. Follow‑up endoscopic examinations at 2‑week intervals confirm wound healing and detect any recurrence.

When surgery addresses the primary bleeding source and postoperative protocols are adhered to, most dogs recover without long‑term complications. Recurrence rates are low for isolated arterial lesions but higher for neoplastic origins, necessitating ongoing surveillance and possible adjunctive therapies.

5.3.3 Supportive Care

When a dog experiences nasal hemorrhage, immediate supportive measures are essential to stabilize the patient while the underlying cause is investigated. First, place the animal in a quiet, low‑stress environment; restraint should be gentle but firm to prevent accidental injury. Apply direct pressure to the nostrils using a clean gauze pad or a folded cloth for 5-10 minutes. If bleeding persists, a mild compressive bandage around the muzzle can help maintain pressure without obstructing breathing.

Maintain airway patency by monitoring respiratory effort and ensuring the dog can breathe freely. Position the head slightly elevated to reduce venous pressure in the nasal vessels. Administer supplemental oxygen via a mask or nasal cannula if signs of hypoxia appear, such as rapid breathing or pale gums.

Fluid therapy supports circulation and compensates for blood loss. A balanced crystalloid solution (e.g., Lactated Ringer’s) given intravenously at a rate of 10 mL/kg bolus, followed by maintenance infusion, helps preserve perfusion. In cases of significant hemorrhage, consider a blood transfusion after cross‑matching, adhering to standard veterinary protocols.

Pain control contributes to reduced stress and lower blood pressure, which can lessen bleeding. A single dose of a short‑acting opioid (e.g., buprenorphine 0.01 mg/kg IM) or a non‑steroidal anti‑inflammatory drug, if not contraindicated, provides analgesia. Monitor temperature; treat hypothermia with warming blankets or a heat lamp, as low body temperature can impair coagulation.

Regularly assess vital signs-heart rate, respiratory rate, capillary refill time, mucous membrane color-to detect early signs of shock. Document the amount and duration of bleeding, any changes in behavior, and response to interventions. This systematic supportive care creates a stable platform for diagnostic testing and definitive treatment of the underlying etiology.

6. Prevention and Long-Term Management

6.1 Regular Veterinary Check-ups

Regular veterinary examinations are essential for preventing and managing nasal hemorrhage in dogs. Routine visits enable early identification of conditions that can cause bleeding, such as clotting disorders, nasal tumors, infections, or trauma. Early detection allows timely intervention, reducing the likelihood that a minor issue escalates into an emergency.

During a standard check‑up, the veterinarian will:

Perform a thorough physical examination, focusing on the nasal cavity and surrounding structures.
Conduct blood tests to evaluate platelet count, clotting factors, and overall organ function.
Recommend imaging studies (radiography or CT) if structural abnormalities are suspected.
Update vaccinations and parasite control, which can indirectly affect mucosal health.
Review the dog’s diet and supplement regimen to ensure adequate nutrients that support vascular integrity.

Scheduling appointments at least once a year for healthy adults and more frequently for senior or high‑risk breeds maintains a baseline of health data. Consistent monitoring of weight, blood pressure, and respiratory sounds provides additional clues about potential bleeding sources.

Owners should keep records of previous examinations, test results, and any observed nasal discharge. Presenting this information to the veterinarian during each visit streamlines the diagnostic process and facilitates targeted treatment plans.

By integrating regular veterinary assessments into a dog’s care routine, owners minimize unexpected nosebleeds and ensure that any underlying pathology is addressed before it becomes critical.

6.2 Safe Environment

Veterinary professionals advise that a secure setting is essential when treating a canine nasal hemorrhage. The environment must limit stress, prevent accidental injury, and allow clear observation of the bleeding site.

Isolate the dog in a quiet room away from loud noises and other animals.
Remove sharp objects, loose cords, and slippery rugs that could cause the dog to fall or aggravate the wound.
Place a non‑slip mat on the floor to give the dog stable footing.
Ensure adequate lighting so the bleeding area is visible without the need for the handler to lean over the animal.
Keep a clean towel, sterile gauze, and disposable gloves within arm’s reach.
Position the dog on its side or in a comfortable sternal recumbency to reduce head movement.

During the initial response, the handler should:

Approach calmly, speaking in a low tone to avoid startling the dog.
Apply gentle pressure to the nostril with a sterile gauze pad for several minutes, watching for reduction in blood flow.
Avoid inserting fingers or instruments into the nasal passage, which could worsen the bleed or introduce infection.
Monitor the dog's breathing; if the dog shows signs of distress, seek veterinary care immediately.

After the bleeding subsides, maintain a safe zone by:

Keeping the dog confined to a single, clutter‑free area for at least 24 hours.
Limiting physical activity and preventing the dog from jumping or playing roughly.
Observing the nose for recurrent bleeding or discharge, and recording any changes for the veterinarian.

A controlled environment reduces the risk of secondary injuries and supports effective hemostasis, facilitating a smoother recovery for the dog.

6.3 Managing Underlying Health Issues

When a canine presents with epistaxis, the immediate goal is to stop the bleeding, but the long‑term success depends on identifying and treating the root cause. Underlying disorders can range from coagulopathies to neoplasia, and each requires a specific management plan.

First, obtain a thorough medical history. Record recent trauma, surgical procedures, medication changes, and any known clotting disorders. A detailed account of the bleeding pattern-frequency, duration, and volume-helps narrow potential etiologies.

Second, conduct a focused physical examination. Inspect the nasal cavity for masses, foreign bodies, or ulcerations. Palpate lymph nodes and assess mucous membrane color and capillary refill to gauge circulatory status. Document any concurrent signs such as coughing, facial swelling, or lethargy, which may indicate systemic involvement.

Third, run targeted diagnostics. Recommended tests include:

Complete blood count and serum biochemistry to detect anemia, platelet abnormalities, or organ dysfunction.
Coagulation profile (PT, aPTT) and fibrinogen levels to uncover clotting defects.
Nasal endoscopy or radiography to visualize internal lesions.
Cytology or biopsy of suspicious tissue for definitive tumor identification.
Infectious disease panels when bacterial, fungal, or parasitic infections are suspected.

Fourth, implement disease‑specific therapy. For coagulopathies, administer appropriate plasma products, vitamin K, or specific clotting factor concentrates. In cases of neoplasia, consider surgical excision, radiation, or chemotherapy based on tumor type and staging. Chronic inflammatory or infectious conditions respond to anti‑inflammatory drugs, antibiotics, or antifungal agents as indicated by culture results. Adjust or discontinue any medications known to impair clotting, such as NSAIDs or corticosteroids, after consulting a veterinarian.

Fifth, establish a monitoring schedule. Re‑evaluate bleeding tendency, blood work, and imaging results at regular intervals to assess treatment efficacy and adjust protocols promptly. Provide owners with clear instructions on recognizing early signs of recurrence and when to seek urgent care.

By systematically addressing the underlying health issue, clinicians reduce the likelihood of repeated nosebleeds and improve overall prognosis for the dog.