Bunged-up nose? Experts reveal what’s causing it and remedies they use

Congestion – that bunged up, stuffy nose ­feeling – is usually a fleeting symptom of a cold which lasts for around a week and gets better on its own. But for up to 40 per cent of us, nasal congestion is caused by other triggers and can last for months on end, disrupting work, sleep and day-to-day life.

Nasal congestion occurs when the tissues lining the inside of your nose – the mucosa – become inflamed and swollen as part of your body’s defences, says Thomas Jacques, an ear, nose and throat (ENT) surgeon at St George’s ­University Hospital and the private Cadogan Clinic, both in London.

‘This leads to blockage and an increased production of mucus – the latter occurs to help “flush away” whatever triggered the congestion in the first place.

‘But this combination restricts air flow, leading to the area feeling blocked and making it difficult to breathe through your nose.’

The congestion also prevents odour molecules from reaching the sensory neurons – nerve cells high in the nasal cavity that send on signals to the brain. As a result, you may lose your sense of smell and taste.

New research suggests other ­factors are at play in congestion, specifically imbalances in the ‘nasal microbiome’.

Found in the nasal passages, this is a community of microbes and its careful balance between good and bad bacteria plays an integral role in how our respiratory system functions, regulating inflammation and defending against infection.

Genes, the environment, smoking and, of course, viruses, are thought to affect the nasal microbial ­balance. And the latest thinking is that when that’s disturbed, you’re more at risk of respiratory infections.

For instance in a study published in the Journal of Asthma and Allergy last year, researchers found the nasal microbiome of 45 patients with allergic rhinitis (i.e. hay fever) had more Ralstonia bacteria than those of ‘healthy’ patients.

Researchers are also investigating new treatments such as probiotics administered nasally as a spray – and even the transplant of other people’s mucus – to restore the balance (this follows a 2023 study by Lund University in Sweden, where a mucus transplant both relieved the congestion of patients with blocked noses and increased microbial diversity in their nasal passages).

But with such a range of potential triggers, how can you tell what’s causing your congestion – and what’s the best treatment? We asked our experts to explain all.

(Note, if you’re suffering from ­congestion for more than three weeks, consult a doctor.)

IF YOU HAVE: Short-term congestion, with fever and headache.

IT COULD BE: Cold or flu.

There are around 160 strains of the common cold virus – the most common cause of short-term nasal congestion, says Mr Jacques. He suggests the best treatment is a sea-water spray to help with the congestion. Paracetamol or ibuprofen can ease fever and headache.

‘The distinction between a cold and flu is that flu makes you feel awful – exhausted, achy and unable to fully function,’ says Mr Jacques. ‘It will also last longer, up to two weeks, whereas a cold lasts around a week.’ Treatment for flu tends to be the same as for a cold.

IF YOU HAVE: Congestion with loss of smell, heavy feeling behind the eyes and/or pain in the face.

IT COULD BE: Sinusitis (inflammation of the sinuses).

Acute sinusitis (lasting less than four weeks) is estimated to affect up to 15 per cent of people in the UK at any one time.

‘This frequently follows a cold, as the inflammation and swelling end up blocking the sinuses, the air-filled cavities in the cheekbones and forehead which drain into the nose, which leads to a secondary infection,’ says Mr Jacques.

It may feel worse when you bend down – this is because the increased blood flow toward your head in this position leads to the already inflamed blood vessels in the sinuses expanding and throbbing.

Painkillers and decongestants can treat it. If it lasts more than three weeks and is accompanied by severe pain or fever, you may need antibiotics (to treat a bacterial infection).

When symptoms continue for more than three months, it’s known as long-term (chronic) sinusitis.

In some patients with chronic sinusitis, the constant inflammation can lead to nasal polyps – benign growths inside the nose or the sinuses, which can worsen the ­congested feeling by blocking the airflow even further.

As nasal polyps are not often ­visible, diagnosis involves nasal endoscopy (a narrow tube with a tiny camera to look inside the nose) – or CT scans, if the polyps are deep inside the sinuses.

Treatment may include nasal ­steroids, which reduce inflammation and shrink the polyps – or ­surgery to remove them.

IF YOU HAVE: Sneezing and itchy, watery eyes accompanying your congestion.

IT COULD BE: Allergy.

Also known as allergic rhinitis, hay fever affects 10 to 15 per cent of children and 26 per cent of adults, according to Allergy UK.

Here, the congestion is caused by the body’s reaction to an allergen, such as pollen (pollen allergy sufferers are typically only affected late spring to early summer in the UK), dust, mould or pet hair.

The body responds by releasing histamine. As well as causing the nasal lining to swell, leading to congestion, this irritates the blood vessels and nerves in the eyes making them itch and water, which is the body’s way of trying to wash the allergen out, explains Kiran Varad, an ENT surgeon at Royal Surrey NHS Trust and the private New Victoria Hospital.

‘Once the source of the allergy has been identified [usually by a skin-prick or blood test], treatment usually involves antihistamines to block the body’s natural chemical response or steroid nasal sprays or drops.’

IF YOU HAVE: Congestion after changing medication.

IT COULD BE: Side-effect of prescription and over-the-counter pills.

Numerous medications can lead to that congested feeling, including ACE inhibitors, beta blockers, aspirin and ibuprofen, explains Jonathan Joseph, a consultant rhinologist and skull-base surgeon at the Royal National Ear, Nose and Throat Hospital and The London Clinic.

Antidepressants such as SSRIs (e.g. sertraline and escitalopram) can have the same effect – as can medicines that treat erectile ­dysfunction, such as Viagra and Cialis. ‘The mechanism for this may vary,’ says Mr Joseph.

In ACE inhibitors, for instance, the same mechanism that lowers blood pressure also prevents the breakdown of bradykinin, a ­substance that causes blood ­vessels to dilate. This can irritate the nasal passages of people who are sensitive, causing congestion.

In the case of aspirin, it increases levels of inflammatory leukotrienes – which irritate the nasal lining. ‘If the side-effect of congestion is severe, talk to your doctor about changing the dose or swapping to another medication,’ says Mr Joseph.

IF YOU HAVE: Continued congestion despite regularly using decongestant sprays.

IT COULD BE: Rebound congestion.

Decongestant sprays ­containing oxymetazoline or ­phenylephrine can clear that bunged-up feeling – ‘they basically shrink inflamed blood vessels to reduce the swelling in the nose within ­minutes’, says Mr Joseph.

However, use them for too long – i.e. more than seven days – and they can lead to rebound congestion. ‘Here, the blood vessels become sensitised and swell back up as soon as the medication wears off, leading to people using more spray,’ he adds.

‘If you’ve been using them for more than seven days, it’s ­important to gradually reduce their use, possibly supplementing them with steroid sprays – which are safer for long-term use. Speak to your doctor or pharmacist.’

IF YOU HAVE: Congestion just around that time of the month.

IT COULD BE: Hormone related.

‘The fluctuation of hormones during menstruation can lead to a bunged-up feeling in the nose,’ says Mr Varad.

in a study of 40 women, published in the Polish Journal of Otolaryngology earlier this year, nasal airflow was tested at different stages of the menstrual cycle. Results showed that during the luteal phase – the second half of the menstrual cycle, just after ovulation – airflow through the nose was significantly reduced.

The high levels of oestrogen and progesterone are thought to ­trigger the widening of blood ­vessels in the nose (possibly a mechanism designed to support the demands on the body during reproduction), leading to swelling and inflammation, adds Mr Varad. For the same reason, some women can feel it in pregnancy. The ­symptom usually resolves when hormone levels balance out again.

IF YOU HAVE: Congestion when outside temperature changes.

IT COULD BE: Hypersensitivity in the nose.

A change in temperature – cold or hot – can be enough to trigger that bunged-up nose.

‘It’s thought to have something to do with the nerve endings in the nose being hypersensitive and overreacting in some people,’ says Mr Joseph. Other triggers include strong-smelling perfumes, tobacco smoke and pollution.

Try to avoid the trigger – and ease symptoms with decongestants and saline sprays.

Red flags

‘Congestion is rarely a sign of anything serious and can usually be managed at home,’ says Mr Jacques. ‘But it is worth seeing a doctor if the congestion doesn’t get better after three weeks.

‘Other reasons to get checked out would be if the congestion is more noticeable on one side or if there’s pain or bleeding from the nose – particularly if it is rapidly worsening,’ he adds.

Congestion alongside changes in vision (such as double vision) as well as a loss of smell also need to be looked at.

Our nostrils take turns breathing 

‘Known as the nasal cycle, airflow is always greater in one nostril than the other and this alternates every few hours,’ says rhinologist Jonathan Joseph.

This natural cycle of rest and filtering air is managed by the blood flow in the nostril membranes: at any given point, one nostril is full of blood – so more congested and ‘blocked’ – whilst the other one remains open, or ‘decongested’.

The cycle only really becomes noticeable when you’re feeling congested, as the blood flow to the nose increases even more.

Why sex could help

It might be the last thing you feel like, but a 2021 study showed that the ability to breathe through the nose improved significantly for up to an hour after sex with orgasm – to the same degree as having used a nasal decongestant, reported the Ear, Nose and Throat Journal.

This may be because blood vessels in the nose work in a similar way to erectile and labial tissue, explains ENT surgeon Kiran Varad.

When you’re aroused, your adrenaline levels rise and the blood vessels constrict, meaning less blood flow to the nose and less inflammation.

 Remedies that work

What the experts use

‘Day and Night Nurse are my go-to medications for a cold,’ says consultant rhinologist and surgeon Jonathan Joseph. One of the active ingredients is pseudoephedrine, a decongestant that helps by narrowing the nasal blood vessels, reducing swelling.

ENT surgeon Kiran Varad says: ‘As I suffer from a big dust-mite allergy, I find nasal steroid sprays are the most effective for me as it’s not always easy to avoid the triggers.

‘If I’ve got a cold that’s not budging, over-the-counter Otrivine or Sudafed decongestant sprays are also very effective, although it’s important to not use them for longer than is recommended.’ ENT surgeon Thomas Jacques uses natural sea-water spray such as Sterimar – ‘it helps with all type of congestion. You can buy it off the shelf; it washes away allergens and mucus’.

DIY remedies that work

Home remedies are often enough to ease that snotty feeling and sometimes even clear it without the need for medication. Here, Mr Varad explains which remedies might be worth a try:

Drink lots of fluid: If you’re bunged up, fluid can help to loosen things; increasing hydration helps make mucus less thick and sticky and easier to clear from the body. Drinking hot liquids has the added benefit of the steam helping to loosen the congestion.

Sleep with your head elevated: Throughout the day gravity is continually trying to help the sinuses drain. The moment you lie down, however, mucus pools and with nowhere to go, that congested feeling can become even worse.

Sleeping with your head elevated – using an extra pillow to prop up your head – can help with that drainage and relieve any sinus pressure, too.

Take a hot shower: Congestion is the result of the nasal tissue being inflamed. Spending time in a hot shower can help – but the benefits may be short-lived.

Eat something spicy: For short-term relief, capsaicin – the compound found in chilli peppers – may help.

A 2015 Cochrane Review, analysing four studies, showed capsaicin helped reduce nasal symptoms for up to 36 weeks after treatment in people with chronic non-allergic rhinitis.

So hot sauces, chillis, curries and salsa that contain chilli peppers could be worth a try.

Note, this can stimulate mucus production, so you may need tissues to deal with the subsequent runny nose.