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 Symptoms of Nose and Throat Disorders: Some Causes and Features of Nasal Congestion and Discharge) are the following:

• Viral upper respiratory infections (colds—see Viral Infections: Common Cold)
• Allergic reactions

Less common causes: Less common causes include

• Sinus infection (sinusitis)
• Foreign body in the nose
• Overuse of decongestant sprays

Fluid sometimes drains from an infected sinus. Children sometimes put a foreign body 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 body. 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 Symptoms of Nose and Throat Disorders: 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 body

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

PrintOpen table in new window
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 body 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 Nose and Sinus Disorders: 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 oxymetazolineSome Trade Names
AFRIN DRISTAN 12-HR NASAL SPRAY OCUCLEAR
. Decongestants taken by mouth include pseudoephedrineSome Trade Names
AFRINOL SUDAFED
. 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 diphenhydramineSome Trade Names
BENADRYL
for people with colds. For people with allergies, other antihistamines that have fewer side effects, such as fexofenadineSome Trade Names
ALLEGRA
, are used. Nasal corticosteroid sprays (such as mometasoneSome Trade Names
ELOCON NASONEX
) 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. PseudoephedrineSome Trade Names
AFRINOL SUDAFED
, a decongestant, stimulates the heart rate and increases blood pressure. If pseudoephedrineSome Trade Names
AFRINOL SUDAFED
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 body in the nose.
• Doctors also consider the possibility of rebound congestion in people who overuse decongestant sprays.

Last full review/revision July 2012 by Marvin P. Fried, MD