Nasal congestion is a blocked or stuffy feeling in your nose. It is caused by many different conditions. Some of these conditions settle on their own; others may need treatment.
There are several self-help strategies which work well to relieve nasal congestion. There are also sprays, tablets and medicines available over-the-counter or on prescription, which may make you more comfortable.
What is nasal congestion?
Nasal congestion is a blocked, stuffy or bunged-up feeling in your nose. There are many causes for this. Depending on the cause, it can last a short while (a few days) or can be persistent. Nasal congestion can affect people of any age. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.
Nasal congestion is a symptom, not a disease. Your blocked or stuffy nose is the problem you are aware of. The condition which causes it is the disease or illness. Some of these conditions are discussed in the section below. Depending on the condition which is causing your nasal congestion, you may have other symptoms along with the blocked nose.
What causes nasal congestion?
The most common causes of nasal congestion are explained further below and are:
- Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis.
- Allergies including hay fever.
- Persistent rhinitis.
- Nasal polyps.
Other less common causes of nasal congestion include:
- Swollen adenoid glands.
- Injuries to the nose.
- Foreign bodies in the nose.
- Rebound congestion after stopping decongestant medication.
- Tumours of the sinuses or inside of the nose.
- Side-effects of some medication.
The common cold
Most of us will have experienced nasal congestion with a common cold. Colds and other upper airways (respiratory) infections are caused by germs (viruses or occasionally bacteria). These infections cause a blocked nose or runny nose along with other symptoms. You may feel unwell or tired. You may have a headache or temperature (fever). You may have a cough. There may be a discharge from your nose. This may be clear, yellow or green. It may be very watery, or may be thick and sticky.
Symptoms usually clear up after a few days. It may be helpful to take some medication to make you feel better while you wait for your immune system to fight off the germs. Over-the-counter medicines such as paracetamol or ibuprofen may be helpful. You may wish to use a decongestant medicine for the blocked nose. These are discussed further in the treatment section below. See separate leaflet called Common Cold (and Other Upper Respiratory Tract Infections) for more details.
Flu is another infection with a virus. It is similar to the common cold but tends to make people feel very much more unwell with high fevers and exhaustion. There are usually aches and pains as well. There may be sneezing or a runny or blocked nose with flu. Treatment is usually similar to that for the common cold. However, some more vulnerable people may need an antiviral treatment, such as oseltamivir (trade name Tamiflu®) and zanamivir (trade name Relenza®). These are only used for people who are at risk of developing complications from flu. See separate leaflet called Influenza and Flu-like illness for more details.
The sinuses are small, air-filled spaces inside the cheekbones and forehead. They make some mucus which drains into the nose through small channels. Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting 1-4 weeks) but some may go on to a more persistent (chronic) sinusitis.
The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus. This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and fever.
Hay fever is caused by an allergy to pollen, and is a common cause of a blocked or stuffy nose. If you have hay fever, you usually also have itchy, watery eyes and sneeze a lot. Depending on which pollen you are allergic to, you will have symptoms for one particular part of each year. In the UK, this is typically late spring to early summer.
The usual treatment for hay fever is antihistamines (as tablets, medicines or sprays), steroid nasal sprays or steroid nasal drops. See separate leaflet called Hay Fever for more details.
Rhinitis is swelling (inflammation) of the tissues lining the inside of the nose. It can be due to allergies (allergic rhinitis) or other causes (non-allergic rhinitis). In addition to pollen, other allergies can cause nasal congestion. Common allergic causes are:
- The house dust mite (a tiny creature found in dust).
- Pets, particularly cats.
- Wood dust.
- Certain plants.
Symptoms are similar to those of hay fever. It may be possible to have tests, such as skin prick tests or blood tests to see what you are allergic to (the allergen). The treatment is to avoid the allergen if possible. If this is not possible, treatment is similar to that for hay fever.
Non-allergic persistent rhinitis
There are a number of non-allergy causes of persistent inflammation of the inside of the nose, causing symptoms of nasal congestion. These include:
- Constant exposure to fumes such as smoke or chemical fumes.
- An overactive thyroid gland.
- Temperature changes.
- Unusual side effects of some medication - for example:
- Anti-inflammatory painkillers such as aspirin or ibuprofen.
- Several treatments for high blood pressure.
- Rhinitis medicamentosa is the name given to rhinitis that can occur due to the overuse of nasal decongestant sprays. These sprays are used to help a blocked nose and they reduce swelling of blood vessels in your nose. However, if they are used for more than 5-7 days, the swelling can return again. The temptation is to use yet more decongestant and a vicious circle can be set up. A similar problem can occur in people who abuse cocaine.
Nasal polyps are fleshy, non-cancerous (benign) swellings that grow inside the nose or sinuses. The most common symptom they cause is a stuffy, runny nose. Steroid nasal drops are commonly used to shrink the polyps. An operation is sometimes needed. Nasal polyps often return after treatment, so steroid nasal sprays are sometimes used daily to prevent them from returning. See separate leaflet called Nasal Polyps for more details.
Other causes of nasal congestion
Swollen adenoid glands may cause nasal congestion, particularly in children. Adenoid glands are fleshy bits of tissue which hang down from the back of the nose. They tend to shrink during childhood. If they are very enlarged, they can cause a runny or blocked nose. They also cause snoring or noisy breathing. Children with large adenoids talk as if they have a permanent cold. Because they shrink naturally, often nothing needs to be done. However, if they are causing problems they can be removed (often with the tonsils) by an operation. See separate leaflet called Tonsils and Adenoids for more details.
If the dividing tissue between your two nostrils (nasal septum) is not straight, this can cause nasal congestion. This is called a deviated septum. It can just be the way your nose is, or it can be due to an injury or operation. After an injury to the face, for example, if a part of your nose has been bent or moved, you may have nasal congestion.
A physical blockage of the nose may also cause congestion. For example, children may get objects such as beads or peas stuck up their noses. Rarely, a tumour in the airways around the nose or sinuses may cause congestion.
What tests are needed for nasal congestion?
If you have nasal congestion, often you won't need any tests. Your doctor can often determine the cause by asking questions about your symptoms and by examining you.
If the cause is not apparent, or if your symptoms do not resolve with treatment, you may be referred to an ear, nose and throat (ENT) specialist. You may then have skin prick tests for allergy, or blood tests. The ENT specialist may also look further into the back of your nose with a flexible telescope (nasoendoscopy). Very occasionally, the specialist may arrange a CT scan or MRI scan if no cause has been found.
What is the treatment for nasal congestion?
Where possible, the cause of the nasal congestion will be treated. However, as described above, the most common causes get better on their own. Either way, there are a number of treatments which improve a blocked or stuffy or runny nose, and make you feel better. These all tend to work for a short period of time and need repeating until the cause has gone away.
Always be very careful not to burn yourself with boiling water. Put boiling water from a kettle in a large bowl or basin, and set it on a table. Sit on a chair at the table and put your face over the bowl. Breathe normally for 5 or 10 minutes. Alternatively, you can buy a steam cup from a chemist. This is a plastic cup with a lid and mask. You put boiling water in the cup, fit the lid and mask and then breathe the steam through the mask. For small children, the safest method of steam inhalation is in the bathroom. Shut the door, and then turn on the hot shower and/or hot taps. Sit with your child (outside the shower as you want the water very hot) and look at a book or play with a toy for 5 to 10 minutes.
A steam cup
Salt water (saline solutions)
Salt water (saline) may be helpful to clear a blocked nose for a short time. You can buy saline drops from a chemist or get them on prescription. They are sometimes used in babies who are congested, so they are better able to feed. There are also saline sprays and solutions which aim to wash out the passageways of the nose. These all make the gunk blocking the nose more liquid, so that it drains out more easily.
Menthol vapours, rubs and pastilles
There are many products which contain ingredients such as menthol or eucalyptus oil, which you can buy over the counter for nasal congestion. The most well known of these are Vicks® and Olbas® but there are many others which work in the same way. They are available as vapour rubs, which you rub on your chest so you breathe in the vapour, and oils which you add to hot water for steam inhalations. There are also throat sweets to suck. These soothe a sore throat but also release a vapour to help clear the nose.
Decongestant drops and sprays for the nose
Decongestant drops and sprays are very effective for a blocked nose but should only be used for a maximum of 5-7 days. If used for longer, you may have a rebound congestion when you stop them. They cannot be used by children under the age of 6. Children aged 6 to 12 may use them for up to five days if none of the options above have been helpful.
The most commonly used decongestant drops or sprays are:
They come in several different brand names and are available over the counter or on prescription.
Decongestant tablets and syrups
Decongestants in the form of tablets or liquid medicines (syrups) are thought to be safer to take for a longer time if need be. The main ones used are pseudoephedrine and phenylephrine. They come in several brand names. They are available over the counter and on prescription. Always check with your doctor or pharmacist before taking them, as they are not suitable for everyone and may interact with other medication.
Steroid sprays for the nose
Steroid sprays are often used for nasal congestion, particularly when it is caused by allergies such as hay fever or by nasal polyps. Steroid sprays work by reducing the swelling of the inside of the nose. They are available as drops or spray to be applied directly to the inside of the nose. Steroid nasal sprays are safe for adults to use in the long term if needed. There are several types of steroid spray and they come in several brands. Some are available to buy from chemists or supermarkets; for others you will need a prescription. Always check with your doctor or pharmacist before using a steroid spray for nasal congestion. See separate leaflet called Steroid Nasal Sprays for more details.
When should I see a doctor?
In many cases of nasal congestion, there is no need to see a doctor. For example, if you have a common cold with no complications, or hay fever, you can often manage this yourself. A pharmacist may be able to help advise if you need some over-the-counter medication to help with the symptoms. You should consider seeing a doctor if:
- Your nasal congestion is not getting better after a week or two despite trying the remedies suggested in this leaflet or the leaflet specific to the condition causing it.
- You are not sure what the cause is for your nasal congestion.
- You have any blood in the discharge coming from your nose.
- Only one side of your nose is blocked.
- You or your child is unwell with a high temperature (fever) as well as having nasal congestion.
- A baby has nasal congestion and is having difficulties feeding or breathing.
- You feel very unwell.
Further reading and references
; NICE CKS, July 2015 (UK access only)
; Public Health England
; NICE CKS, June 2015 (UK access only)
; NICE CKS, October 2013 (UK access only)
; NICE Evidence Services (UK access only)
; NICE CKS, August 2010 (UK access only)
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