Find information on medical topics, symptoms, drugs, procedures, news and more, written in everyday language.

* This is the Consumer Version. *

Nasal Congestion and Discharge

by Marvin P. Fried, MD

Nasal congestion and discharge (runny nose, rhinorrhea) are extremely common problems that commonly occur together but occasionally occur alone.

Causes

Common causes

The most common causes (see Some Causes and Features of Nasal Congestion and Discharge) are the following:

  • Viral upper respiratory infections (colds—see Common Cold)

  • Allergic reactions

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 do 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 put objects in their nose.

People who use nasal decongestant sprays for more than 1 or 2 days often experience significant rebound congestion (the return of congestion that is worse than before) when the effects of the drug wear off. People then continue 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 a consequence of treatment.

Evaluation

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

  • Face pain, tenderness, or both

When to see a doctor

People who have warning signs and those whose caretakers think may have put something in their nose should see a doctor right away. 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 (see Some Causes and Features of Nasal Congestion and Discharge).

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 (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 nose and the area over the sinuses

  • 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

Doctors also tap their finger over the sinuses to look for tenderness.

Some Causes and Features of Nasal Congestion and Discharge

Cause

Common Features *

Tests

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 doctor's examination

Possibly CT if people have diabetes, a weakened immune system, or signs of a serious illness

Allergies

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

A doctor's examination

Decongestant sprays if overused

Congestion that returns when the decongestant wears off (rebound congestion)

Pale, extremely swollen nasal mucosa

No discharge

A doctor's examination

A foreign object in the nose, mainly in children

Often a foul-smelling, sometimes blood-tinged discharge from one side of the nose

A doctor's examination

Vasomotor rhinitis (see Rhinitis)

A recurring watery discharge, sneezing, and red, swollen nasal mucosa

No identifiable triggers

A doctor's examination

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

A doctor's examination

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

CT = computed tomography.

Testing

Testing is generally not needed for acute nasal symptoms unless severe sinusitis is suspected in a person with diabetes or a weakened immune system. These people usually should have a computed tomography (CT) scan.

Treatment

The best way to treat nasal congestion and discharge is to treat the underlying disorder. There are two basic approaches to relieving the symptoms:

  • Decongestants (spray or pills)

  • Antihistamines (pills)

Decongestant sprays typically contain oxymetazoline. Decongestants taken by mouth include pseudoephedrine. Decongestant sprays should not be used for more than a day or 2 to avoid the problem of rebound congestion.

Antihistamines can be taken for symptoms due to viral infection and allergic reactions. Doctors often recommend diphenhydramine for people with colds. For people with allergies, other antihistamines that have fewer side effects, such as fexofenadine, are used. Nasal corticosteroid sprays (such as mometasone) also help allergic conditions.

Decongestants and antihistamines are not recommended for children under 6 years of age.

Essentials for Older People

The main concerns with older people involve treatment. 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 people. Antihistamines should be avoided or used in decreased dosages. Pseudoephedrine, a decongestant, stimulates the heart rate and increases blood pressure. If pseudoephedrine is needed, it should be taken at the lowest effective dose.

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.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • No US brand name
  • AFRINOL, SUDAFED
  • ALLEGRA
  • ELOCON, NASONEX