Epistaxis (Nose Bleeds)

Most nosebleeds (80%) are anterior nosebleeds, which means the bleeding comes from the wall between the two nostrils (the lower septum), just inside your nose. This part of the nose, known as Little’s area, contains many delicate blood vessels that can be easily damaged.

The cause of anterior nosebleeds is sometimes unknown, but they can be caused by several things, including:

• picking your nose, particularly if you scratch the inside of your nose with a sharp fingernail
• blowing your nose very hard
• a minor injury to your nose
• a blocked or stuffy nose often caused by an infection such as a cold or flu
• sinusitis – an infection of the small, air-filled cavities inside your cheekbones and forehead
• dry air or an increase in temperature drying out the inside of your nose
• hay fever or other allergies
• high altitude
• excessive use of nasal decongestants
• a crooked nasal septum that’s either present from birth (congenital) or the result of an injury (a deviated septum)
• recreational cocaine use

In the above situations, the bleeding tends to last only a short time and is usually easy to control. The bleeding may last longer and be harder to stop if you have an underlying medical condition such as heart failure, a blood clotting disorder, or are taking ‘blood-thinning’ medicines such as warfarin, Rivaroxaban or aspirin.

About 20% of nose bleeds come from arteries further back in the nose and tend to occur in men over 60 years of age with high blood pressure (hypertension) and hardening of the arteries (arteriosclerosis).

Nasal tumours can cause unilateral bleeding (i.e., from a single nostril) but are fortunately rare.

For most nosebleeds, simple first aid can usually stop the bleeding:

• If you are not feeling faint, sit up and lean slightly forward.
• With a finger and thumb, pinch the lower fleshy end of the nose, completely blocking the nostrils. It is useless to put pressure over the root of the nose or nasal bones. Usually, if you apply light pressure for 10-20 minutes, the bleeding will stop.
• If available, a cold flannel or compress around the nose and front of face will help. The cold helps the blood vessels to close down (constrict) and stop bleeding.
• If you feel faint it is best to lie flat on your side.
• After the nosebleed has stopped, for 24 hours try not to:
  • blow your nose
  • pick your nose
  • drink hot drinks or alcohol
  • do any heavy lifting or strenuous exercise
  • pick any scabs

To watch a video about how to treat your nose bleed click here.

If the bleeding eventually stops, you don’t usually need to seek medical advice however, you should talk to your GP if you experience nosebleeds frequently and aren’t able to prevent them (see below).

Preventing nosebleeds

Things you can do to prevent nosebleeds include:

• avoid picking your nose and keep your fingernails short
• blow your nose as little as possible and only very gently
• keep your home humidified
• wear a head guard during activities in which your nose or head could get injured
• always follow the instructions that come with nasal decongestants – overusing these can cause nosebleeds

Contact your GP or call the NHS 111 service if:

• you’re taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn’t stop
• you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
• a child under two years of age has a nosebleed
• you have nosebleeds that come and go regularly

Ask someone to drive you to your nearest accident and emergency (A&E) department or call 999 for an ambulance if:

• the bleeding continues for longer than 20 minutes
• the bleeding is heavy, and you’ve lost a lot of blood
• you’re having difficulty breathing
• you’re feeling faint, lightheaded, or dizzy
• you swallow a large amount of blood that makes you vomit
• the bleeding started after a blow to your head

If you see your GP or go to hospital with a nosebleed, you will be assessed to determine how serious your condition is and what’s likely to have caused it. This may involve looking inside your nose, measuring your pulse and blood pressure, carrying out blood tests and asking about any other symptoms you have.

The main treatments that your GP or hospital doctor may use to stop your nose bleeding are described below.

Antibiotic ointment

Your doctor may prescribe an antibiotic ointment. This should be applied by squeezing a pea-sized amount onto the front of the nasal septum (wall between the nostrils).

This can reduce the inflammation and crusting in the nose and reduce the severity and frequency of nosebleeds.

Antibiotic ointment is particularly effective in children.

Cautery

If your doctor is able to identify exactly where the bleeding is coming from, they may carry out a minor procedure to seal the bleeding blood vessel by cauterising (burning) it. This is normally done using a stick of a chemical called silver nitrate. A local anaesthetic will be sprayed into your nose to numb it and the silver nitrate stick will be held against the bleeding point for up to 10 seconds.

Nasal packing

If cautery is ineffective or your doctor is unable to identify a specific bleeding point, they may recommend packing your nose with gauze or special nasal sponges to stop the flow of blood by applying pressure to the source of the bleeding.

Packing will usually be carried out after local anaesthetic has been sprayed into your nose. The gauze or sponges often need to be left in place for 24-48 hours before being removed by a health professional. You’ll usually need to be admitted to hospital to be monitored during this time.

Further treatment

If the treatments above don’t help, you may be referred to a hospital specialist such as an ear, nose and throat (ENT) doctor for further treatment.

Additional treatments that may be used in hospital include:

• electrocautery – an electric current running through a wire is used to cauterise the blood vessel where the bleeding is coming from
• blood transfusions – a procedure to replace the blood you’ve lost
• tranexamic acid – medication that can reduce bleeding by helping your blood to clot
• packing under anaesthetic – your nose is carefully packed with gauze while you are unconscious from general anaesthetic
• ligation – an operation using small instruments to tie off bleeding blood vessels in the back of your nose

How to treat a nosebleed | NHS

Published: 27 Jun 2017

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