Merck Manual

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Nasal Congestion and Discharge

(Runny Nose; Rhinorrhea)

By

Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Full review/revision Sep 2021 | Modified Sep 2022
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Topic Resources

Nasal congestion and discharge are extremely common problems that commonly occur together but occasionally occur alone.

Causes of Nasal Congestion and Discharge

Common causes

Less common causes

Less common causes include

Fluid sometimes drains from an infected sinus.

The Nose
VIDEO

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 3 to 5 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.

People with vasomotor rhinitis have a recurrent watery nasal discharge that occurs without any known triggers.

Table

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

  • Face pain, tenderness, or both

When to see a doctor

People who have warning signs Warning signs Nasal congestion and discharge are extremely common problems that commonly occur together but occasionally occur alone. The most common causes of nasal congestion and discharge are the following... read more 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 Some Causes and Features of Nasal Congestion and Discharge Some Causes and Features of 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 (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

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

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 or for those with symptoms that do not resolve with treatment. These people usually should have a computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more Computed Tomography (CT) (CT) scan.

Treatment of Nasal Congestion and Discharge

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.

Treatment in older people

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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus
Contac Cold 12 Hour, Dimetapp Decongestant, Drixoral, ElixSure Cold, ElixSure Congestion, Entex, Genaphed , KidKare , Myfedrine, NASAL Decongestant, Nasofed, Nexafed, PediaCare Infants' Decongestant, Pseudo-Time, Silfedrine, Sudafed, Sudafed 12 Hour, Sudafed 24 Hour, Sudafed Children's Nasal Decongestant, Sudafed Congestion, Sudafed Sinus Congestion, Sudogest, Sudogest 12 Hour, Sudogest Children's , Tylenol Children's Simply Stuffy, Zephrex-D
Aid to Sleep, Alka-Seltzer Plus Allergy, Aller-G-Time , Altaryl, Banophen , Benadryl, Benadryl Allergy, Benadryl Allergy Children's , Benadryl Allergy Dye Free, Benadryl Allergy Kapgel, Benadryl Allergy Quick Dissolve, Benadryl Allergy Ultratab, Benadryl Children's Allergy, Benadryl Children's Allergy Fastmelt, Benadryl Children's Perfect Measure, Benadryl Itch Stopping, Ben-Tann , Compoz Nighttime Sleep Aid, Diphedryl , DIPHEN, Diphen AF , Diphenhist, DiphenMax , Dytan, ElixSure Allergy, Genahist , Geri-Dryl, Hydramine, Itch Relief , M-Dryl, Nighttime Sleep Aid, Nytol, PediaCare Children's Allergy, PediaCare Nighttime Cough, PediaClear Children's Cough, PHARBEDRYL, Q-Dryl, Quenalin , Siladryl Allergy, Silphen , Simply Sleep , Sleep Tabs, Sleepinal, Sominex, Sominex Maximum Strength, Theraflu Multi-Symptom Strip, Triaminic Allergy Thin Strip, Triaminic Cough and Runny Nose Strip, Tusstat, Unisom, Uni-Tann, Valu-Dryl , Vanamine PD, Vicks Qlearquil Nighttime Allergy Relief, Vicks ZzzQuil Nightime Sleep-Aid
Allegra, Allegra Allergy 12 Hour , Allegra Allergy 24 Hour, Allegra Children's Allergy , Allegra Children's Allergy ODT, Allegra ODT, Allergy Relief, Children's Allergy
Asmanex, Asmanex HFA, Elocon, Nasonex, Propel, Propel Contour, PROPEL Mini, PROPEL Mini with Straight Delivery System, SINUVA
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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