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Encyclopaedia


Nosebleed

Introduction

Nosebleed

Nosebleeds can be frightening, but they aren't usually a sign of anything serious and can often be treated at home.

The medical name for a nosebleed is epistaxis.

During a nosebleed, blood flows from one or both nostrils. It can be heavy or light and last from a few seconds to 10 minutes or more.

What to do

To stop a nosebleed:

  • sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 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
  • 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 eventually stops, you won't usually need to seek medical advice. However, in some cases you may need further treatment from your GP or in hospital (see below).

Read more about treating nosebleeds.

When to seek medical advice

Contact your GP or call NHS Direct Wales on 0845 46 47 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 swallow a large amount of blood that makes you vomit
  • the nosebleed developed after a serious injury, such as a car crash

Find your nearest A&E department.

What causes nosebleeds?

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

Common causes of nosebleeds include:

  • picking your nose
  • blowing your nose very hard
  • a minor injury to your nose
  • changes in humidity or temperature causing the inside of the nose to become dry and cracked

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 and hardened arteries (atherosclerosis).

Read more about the causes of nosebleeds.

Who gets nosebleeds?

Nosebleeds are fairly common and 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
  • elderly people
  • pregnant women
  • 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).

Are nosebleeds serious?

Nosebleeds aren't usually serious. However, frequent or heavy nosebleeds may indicate more serious health problems, such as high blood pressure or a blood clotting disorder, and should be checked.

Excessive bleeding over a prolonged period of time can also lead to further problems such as anaemia.

If your GP suspects a more serious problem is causing your nosebleeds, they may refer you to an ear, nose and throat (ENT) specialist for further tests.

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
  • regularly apply petroleum jelly (such as Vaseline) to the inside of your nostrils to keep the inside of your nose moist
  • 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

Talk to your GP if you experience nosebleeds frequently and aren't able to prevent them. They may refer you to an ENT specialist for an assessment.

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Causes

Nosebleeds can be caused by a number of different things. It's not always possible to identify the exact reason why one occurs.

Nosebleeds can start just inside your nostrils (anterior) or at the back of your nose (posterior). These different types of nosebleeds tend to have different causes.

Anterior nosebleeds

The vast majority of nosebleeds are anterior nosebleeds, which means the bleeding comes from the wall between the two nose channels (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 a number of 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 nose that's either present from birth (congenital) or the result of an injury (a deviated septum)

Anterior nosebleeds are more common in children and are not usually a sign of anything serious. They can often be treated easily at home. Read more about treating nosebleeds.

Posterior nosebleeds

A small number of nosebleeds are posterior nosebleeds, which means the bleeding originates from branches of arteries that supply blood to the space inside your nose between the roof of your mouth and your brain (nasal cavity).

These nosebleeds are more common in adults than children. They can be more serious than anterior nosebleeds and bleed more heavily. Medical attention may be required.

Causes of posterior nosebleeds include:

High blood pressure (hypertension) is also more common in people with nosebleeds and may make it harder to stop the bleeding, but it's not clear whether this directly causes nosebleeds.

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Treatment

Most nosebleeds can be stopped without the need for medical attention, but occasionally further treatment may be required.

What to do

To stop a nosebleed:

  • sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 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
  • 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 eventually stops, you won't usually need to seek medical advice. However, you should still follow the recovery advice outlined below.

When to seek medical advice

Contact your GP or call NHS Direct Wales on 0845 46 47 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 (this is rare and there's a chance it's caused by something serious)
  • 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 swallow a large amount of blood that makes you vomit
  • the nosebleed developed after a serious injury, such as a car crash

Find your nearest A&E department.

Medical treatment

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 two main treatments that your GP or hospital doctor may use to stop your nose bleeding are cautery and nasal packing. These are described below.

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

Recovery

Once your nose has stopped bleeding, you should follow the advice below to reduce the risk of your nose bleeding again and to stop you picking up an infection:

  • avoid blowing or picking your nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours
  • don't remove any crusts that form inside your nose – these may be unpleasant, but they're a useful part of the healing process
  • if you need to sneeze, try to sneeze with your mouth open to reduce the pressure in your nose
  • avoid people with coughs and colds

If you see a GP or a hospital doctor about your nosebleed, they may give you a prescription for an antiseptic nasal cream once the bleeding stops. This should be applied to the inside of your nostrils several times a day for up to two weeks to help prevent further bleeding.

If your nose does start to bleed again, follow the first aid advice above and seek medical advice if the bleeding doesn't stop.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 02/03/2016 09:11:38

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