🐾 Bloody Nose (Epistaxis) in Dogs and Cats

By Dr Duncan Houston, DVM – Revised: June 26, 2024 | 2025 Update

Seeing your pet with a bloody nose can be alarming—and even more so when it's not just a one‑off sneeze‑drip but a steady flow. As your veterinarian, I'm here to walk you through understanding what’s going on, what you can do at home, and when to head straight to emergency care.

1. Quick First‑Aid at Home 🧊

If your dog or cat starts bleeding from the nose and it doesn’t stop quickly, follow these steps:

• Stay calm: Your anxiety raises your pet’s blood pressure, worsening the bleeding.
• Apply cold: An ice pack over the bridge of the nose helps constrict vessels and slow bleeding—just make sure airways stay clear.
• Avoid snubbing inside the nose: Cotton balls or swabs can trigger sneezing, making it worse.
• Consider Afrin (oxymetazoline): A small squirt may help narrow blood vessels—ask your vet first.
• Recurring bleeds? Ask about Yunnan Baiyo, a clot‑supporting herbal remedy.
• If bleeding continues or breathing is difficult: Head straight to your vet or emergency clinic!

Heads‑up: Pets often swallow blood, which can cause black stool or vomit with clots. This is usually from nasal bleeding, not the digestive tract.

2. What to Tell Your Vet 📋

Before you arrive, having answers to these questions helps us zero in on the cause:

• Medications—especially NSAIDs like aspirin that affect clotting?
• Exposure to rat poison or rodents?
• Facial swelling, asymmetry, eye issues?
• Any injuries or rough play?
• Foxtails or foreign objects in the nose?
• Sneezing, rubbing, or nasal discharge?
• Signs of pale gums (from blood loss)?
• Other bleeding (under the skin, black stool)?
• Is it a recurring problem or a first episode?
• Is blood coming from one or both nostrils?

3. Starting Diagnostics: Non‑Invasive Tests 🩸

Once your vet examines your pet, here are the tests we typically consider first:

3.1 Bloodwork & Urinalysis

A complete blood panel helps assess overall health and indicates blood loss. Platelet counts and coagulation tests (PT, PTT, ACT, buccal bleeding time) check clotting ability.

3.2 Fungal Testing

Fungal infections like Cryptococcus (especially in cats) or Aspergillus and Penicillium (mainly in dogs) can cause nosebleeds. Blood and urine antigen or antibody tests may confirm or rule these out.

3.3 Hyperviscosity Syndrome

High blood protein thickens circulation and ruptures tiny vessels—possible in conditions like multiple myeloma or ehrlichiosis.

3.4 Blood Pressure

High blood pressure (hypertension) can rupture small vessels in the nose, eyes, or brain—especially in older pets.

3.5 Tick‑borne Diseases

Infections like ehrlichiosis, anaplasmosis, or babesia can lower platelets and predispose to bleeding.

4. Potential Causes of Nosebleeds

Let’s break down common culprits into categories:

• Clotting disorders: rodenticide, von Willebrand’s disease, hemophilia, liver failure, DIC
• Low platelets: immune‑mediated thrombocytopenia, tick‑borne diseases, bone marrow problems, drug reactions, FIV in cats
• Localized nasal issues: tumors, trauma, tooth roots or abscesses, foreign bodies, idiopathic rhinitis
• Systemic factors: hypertension, hyperviscosity, cancer, fungal infections

5. When Anesthesia & Imaging Are Needed 🏥

If initial tests suggest a local problem, we may recommend further evaluation under anesthesia:

• Chest X‑rays: To look for spread of tumors or fungal disease.
• Oral exam: Dental disease or tumors can bleed into the nose.
• Nasal imaging: X‑rays first, then CT/MRI for detailed views.
• Rhinoscopy/endoscopy: Direct viewing and possible biopsy.

We might gently flush nasal passages too—though this can cause bleeding and should be done thoughtfully.

6. Deep Diagnostics & Referral

If there’s no clear answer yet, specialist care may involve:

• Endoscopy: Visual exam and biopsy under guidance.
• Surgery: Rarely, to remove unreachable foreign objects or tissue samples.

7. Real‑World Data: What Causes Nosebleeds?

A study of 176 dogs with epistaxis revealed:

• 30% – nasal tumors
• 29% – trauma
• 17% – idiopathic nasal inflammation
• 10% – low platelets
• 3% – clotting disorders
• 2% – hypertension
• 2% – tooth abscess

Interestingly, fungal infections weren’t prominent in this group—emphasizing regional differences.

8. Prognosis & Treatment

Treatment depends entirely on the diagnosis:

• Tumors: Surgery, radiation, or palliative care
• Clotting issues: Antidotes (for poisons), plasma, or vitamin K
• Platelet disorders: Immune suppression, antibiotics, supportive care
• Hypertension: Blood pressure medications
• Fungal disease: Long‑term anti‑fungals
• Idiopathic rhinitis: Supportive care, sometimes steroids
• Foreign body: Removal and antibiotics

9. When to Worry – and What to Do

If a nosebleed lasts more than 5 minutes, or breathing becomes difficult, this is an emergency—seek veterinary care immediately. If bleeding recurs, even if brief, make an appointment to investigate.

10. Final Thoughts 🧠

Epistaxis in pets can stem from something as simple as a play injury or something as complex as cancer. The good news: many causes are treatable—especially when caught early. Your role as a pet parent is essential: stay calm, apply first‑aid, share medication/toxin history, and follow through with diagnostics.

If you're ever unsure—or if your furry companion is showing any signs of recurrence—reach out to your veterinarian. Prompt action can make all the difference. 🫶