Nasal congestion and discharge (a runny nose) are extremely common problems that commonly occur together but occasionally occur alone.
Causes of Nasal Congestion and Discharge
Common causes
The most common causes of nasal congestion and discharge are
Viral upper respiratory infections (colds)
Less common causes
Less common causes include
Sinus infection (sinusitis)
Foreign object (body) in the nose
Overuse of decongestant sprays
Fluid sometimes drains from an infected sinus.
Children sometimes put a foreign object in their nose. If adults do not see them doing this, the first sign may be a foul-smelling nasal discharge due to infection and irritation from the foreign object. Rarely, adults with mental disorders insert foreign objects in their nose.
People with vasomotor rhinitis have a recurrent watery nasal discharge that occurs usually in response to ambient changes in temperature, pressure, and humidity.
Some Causes and Features of Nasal Congestion and Discharge
Cause | Common Features* |
|---|---|
Acute sinusitis (a sinus infection that just started) | A mucus- and pus-filled discharge, often from only one side of the nose Sometimes a foul or metallic taste in the mouth, facial pain or headache, and redness or tenderness over the cheeks or above the eyebrows No itching and no eye or throat irritation |
A watery discharge, sneezing, and watery, itchy eyes Pale, soft, swollen membranes lining the nose (nasal mucosa), seen during the examination Symptoms that often occur during certain seasons or after exposure to possible triggers | |
Chronic rhinitis in which the mucous membrane thins (atrophies) and hardens, causing the nasal passages to widen (dilate) and dry out Crusts inside the nose and an offensive odor | |
Decongestant sprays if overused | Congestion that returns when the decongestant wears off (rebound congestion) Pale, extremely swollen nasal mucosa No discharge |
A foreign object in the nose, mainly in children | Often a foul-smelling, sometimes blood-tinged discharge from one side of the nose |
A recurring watery discharge, sneezing, and red, swollen nasal mucosa No identifiable triggers | |
Viral upper respiratory infections | A discharge that may be watery or sticky, a sore throat, a general feeling of illness (malaise), and red nasal mucosa |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | |
Evaluation of Nasal Congestion and Discharge
Not all episodes of nasal congestion and discharge require immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation.
Warning signs
In people with nasal congestion and discharge, certain symptoms and characteristics are cause for concern. They include
Discharge from only one side of the nose, particularly if it contains pus or blood
Facial pain, tenderness, or both
When to see a doctor
People should see a doctor right away if either of the following occurs:
They have warning signs.
Their caregiver thinks they may have put something in their nose.
People who have nasal congestion and discharge but no warning signs should call their doctor. They may not need to be seen, particularly if they have typical cold symptoms and are otherwise healthy.
What the doctor does
Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause of the nasal congestion and discharge and the tests that may need to be done.
During the medical history, doctors ask about the following:
The nature of the discharge (such as whether it is watery, sticky, pus-filled, or bloody) and whether it is present most or all of the time (chronic) or comes and goes
Symptoms of possible causes, including fever and face pain (sinusitis); watery, itchy eyes, itchy nose, sneezing (allergies); and sore throat, a general feeling of illness (malaise), fever, and cough (viral upper respiratory infection),
Whether people have allergies, diabetes, or a weakened immune system and whether they have been using decongestant sprays
If the discharge comes and goes, doctors try to determine whether it relates to where the person lives, the season, or exposure to potential triggers (such as pets or dust).
During the physical examination, doctors look at the following:
The face for redness over the sinuses just above the eyebrows (frontal sinuses) and the sinuses in the cheekbones (maxillary sinuses)
The membranes lining the nose (nasal mucosa) for color (whether they are red or pale), swelling, color and nature of the discharge, and (particularly in children) whether there is any foreign object
The presence of polyps, which are fleshy growths in the nose either on direct examination or by using a rhinoscope (endoscope of the nose)
Doctors may also tap their finger over the sinuses to check for tenderness.
Testing
Testing is usually not needed for nasal symptoms unless severe sinusitis is suspected in a person with diabetes or a weakened immune system or with symptoms that do not resolve after treatment. In such cases, computed tomography (CT) and biopsy is usually done. In patients with chronic or seasonally recurring nasal symptoms, allergy testing in the blood or skin may be done.
Treatment of Nasal Congestion and Discharge
The best way to treat nasal congestion and discharge is to treat the underlying disorder.
Nasal congestion and discharge caused by a viral infection are primarily managed by using a home humidifier (for example, cool-mist vaporizers or humidifiers) and nasal saline spray, followed by an antihistamine that does not cause many side effects (for example, cetirizine or fexofenadine) as needed. Sometimes, the antihistamine diphenhydramine is used, but that medication can cause side effects including tiredness, confusion, nervousness, and agitation.
Nasal congestion and discharge caused by allergies are treated with antihistamines. Nasal corticosteroid sprays (for example, fluticasone) also help relieve symptoms.
Chronic rhinosinusitis with nasal polyps are treated with intranasal corticosteroids and antibiotics as needed.
People should avoid using decongestants, even though they can temporarily relieve congestion. Decongestants can increase blood pressure and heart rate and cause rebound congestion (the return of congestion that is worse than before the medication was first used). Rebound congestion can lead to people using the decongestant in a vicious circle of persistent, worsening congestion. This situation (rhinitis medicamentosa) may persist for some time, and people may misinterpret it as a continuation of the original problem rather than as a consequence of treatment.
Antihistamines are not recommended for children under 2 years and decongestants are not recommended for children under 6 years.
Treatment in older adults
Antihistamines can have sedating and anticholinergic effects (such as confusion, blurred vision, and loss of bladder control). These effects are more common among and more troublesome in older adults. Older antihistamines should be used in decreased dosages or avoided altogether.
Key Points
Most nasal congestion and discharge are caused by an upper respiratory infection or allergies.
In children, doctors consider the possibility of a foreign object in the nose.
Doctors also consider the possibility of rebound congestion in people who overuse decongestant sprays.
