Nosebleed

What to do 

Ways to help stop a nosebleed include:

• sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10 to 15 minutes
• lean forward and breathe through your mouth – this will drain blood down your nose instead of down the back of your throat
• place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose (this aims to use the coldness to reduce blood flow) - do not stop pinching the nose, as this works better
• stay upright, rather than lying down, as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding

If the bleeding stops within 15 minutes, you won't usually need to seek medical advice. In some cases you may need further treatment from your GP or in hospital (see below).

When your nosebleed stops 

After a nosebleed has stopped, try not to do the following for 24 hours:

• blow your nose
• pick your nose
• drink hot drinks or alcohol
• do any heavy lifting or strenuous exercise
• lying flat (if possible)

Also, don’t pick any scabs that form (they help it to heal and prevent infection).

After 24 hours, there are other things you can consider, such as wearing a head guard during activities in which your nose or head could get injured.

Also, always follow the instructions that come with nasal decongestants – overusing these can cause nosebleeds (ask your pharmacist if you need advice).

When to seek medical advice 

Contact your GP or call GP out of hours 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 emergency department or call 999 for an ambulance if:

• the bleeding continues for longer than 15 minutes
• the bleeding is heavy and you've lost a lot of blood
• you're having difficulty breathing
• you swallow a large amount of blood that makes you vomit
• the nosebleed developed after a serious injury, such as a car accident

Talk to your GP if you have nosebleeds often and aren't able to prevent them. They may refer you to an ear, nose and throat (ENT) specialist for an assessment.

Medical treatment 

If you see your GP or go to hospital with a nosebleed, you will be assessed to find out how serious your condition is and what's caused it.

The two main treatments a hospital doctor may use to stop your nose bleeding are cautery and nasal packing.

Cautery

If doctors can see where the blood is coming from they may seal it by applying a stick with a special chemical on it to stop the bleeding.

Nasal packing

If cautery isn’t possible, doctors might pack your nose with special sponges to stop the bleeding. You may need to stay in hospital for a day or two for this.

Causes of nosebleeds  

The inside of your nose is full of tiny, delicate blood vessels that can become damaged and bleed quite easily.

Causes of nosebleeds include:

• trauma - picking your nose, blowing your nose very hard, a minor injury to your nose, having an object inserted in the nose
• inflammation — for example infection (sinusitis) and hay fever (allergic rhinitis)
• topical drugs —decongestants, corticosteroids or drug use such as cocaine
• oral drugs - drugs used to ‘thin’ the blood - anticoagulants and antiplatelet drugs
• problems with the blood vessel walls (caused by inherited conditions or problems with the immune system)
• bleeding following a surgical operation
• tumours — benign (cancerous) and malignant (cancer) - older people are more likely to have nosebleeds associated with cancer
• nasal oxygen therapy — causes drying of the membranes in the nose, causing bleeding
• bleeding disorders - conditions that ‘thin’ the blood, making it difficult to form clots
• environmental factors — temperature, humidity, and altitude
• drinking too much alcohol

Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery or hardened arteries (atherosclerosis (arteriosclerosis).

People who  commonly get nosebleeds

Nosebleeds are fairly common. Most people will experience them every now and again. Anyone can get a nosebleed, but they most often affect:

• children between two and 10 years of age
• adults over 45 years of age
• pregnant women - the increase in hormones affects the blood vessels and can change circulation
• people who regularly take aspirin or anticoagulants, such as warfarin
• people with blood clotting disorders, such as haemophilia

Bleeding may also be heavier or last longer if you take anticoagulants, have a blood clotting disorder, or have high blood pressure (hypertension).

More useful links

• How to use your health services