Nosebleeds can give you a shock, but they’re usually nothing to worry about.
Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP and words by Annie Hayes
What causes nosebleeds? The inside of your nose is lined with tiny, fragile blood vessels located close to the surface, and when they’re injured, they bleed easily. Nosebleeds can be alarming, but they aren’t usually a sign of anything serious and can often be treated at home.
While nosebleeds (known medically as epistaxis) are most common in children, they can also occur in adults, particularly in the elderly. They vary from minor spotting of blood to very heavy bleeds. If you experience a heavy nosebleed that doesn’t stop, seek medical assistance.
We spoke to Dr Chun Tang, GP at Pall Mall Medical, and Shaeeb Ali, advanced clinical practitioner and independent prescriber at MedsOnline247, about nosebleed causes, treatment and prevention tips:
What is a nosebleed?
A nosebleed occurs when the blood vessels in your nose become damaged. Most of the time the bleeding occurs from the front part of the nose, on the septum – the membrane that divides the nose into two halves. This is known as an anterior nosebleed. This area has a rich blood supply, the surface is thin and the blood vessels lie very close to the surface.
A posterior nosebleed occurs in the deepest part of the nose, near the throat. The blood vessels here are larger, so when they rupture it causes a heavier and more serious nosebleed with blood flowing down the back of the throat. This type of nosebleed is more common in adults, and you may need medical attention.
Are nosebleeds serious?
Nosebleeds are rarely serious, says Dr Tang, but you should seek medical help by contacting your GP or calling 111 if any of the following occurs:
- You get nose bleeds frequently.
- You have symptoms of anaemia, such as shortness of breath or heart palpitations.
- You have a blood clotting disorder or are taking blood-thinning medicine.
- A child under two years of age has a nosebleed.
Persistent bleeding that can’t be controlled may require hospital treatment. Call 999 or ask someone to take you to A&E if any of the following occurs:
- The bleeding is heavy and you have lost a lot of blood.
- You have been bleeding for longer than 20 minutes.
- Your nosebleed was caused by trauma, such as falling.
- You swallow a large amount of blood that makes you vomit.
- You are feeling weak, dizzy, sleepy or generally unwell.
- You are having difficulty breathing.
Nosebleed treatment advice
When a nosebleed strikes, blood may flow from one or both nostrils. It can be heavy or light and last anywhere from just a few seconds to 15 minutes or longer. The bleeding may be heavier or last longer if you take anticoagulants, have a blood-clotting disorder, or have high blood pressure.
To treat a nosebleed, follow these instructions:
- Sit in an upright position (or stand) with your head bent forward. Do not lie down. Sitting up means there is less blood flow through your nose for this time which helps reduce the bleeding.
- Hold the soft lower part of your nose for 10 minutes while breathing through the mouth.
- If the bleeding stops and then returns, hold your nose for a further 10 minutes. This will allow time for the blood to clot.
- Applying an ice pack wrapped in a thin cloth to prevent ice burn or frostbite to your nose may help, as may sucking a piece of ice. A bag of frozen peas makes a suitable emergency substitute. Place the cold pack over the bridge of the nose area.
- Do not blow your nose for 12 hours after the bleeding has stopped. This will help the dried blood to remain in place.
- Do not swallow the blood. It can cause you to become nauseous and vomit, or could conceal a greater blood loss.
Once the bleeding has stopped, try not to drink any alcohol or hot drinks and don’t exercise for 24 hours, says Dr Tang. ‘If you can help it, try not to pick or blow your nose or pick any scabs for as long as possible,’ he adds.
What causes nosebleeds?
There are many different causes of nosebleeds, some more serious than others. ‘The good news is that if your nosebleed is sudden or infrequent, it’s very rarely serious,’ says Dr Tang. ‘Central heating, air conditioning or living in a dry climate are all common causes of nosebleeds as dry air causes the nasal membranes – the tissue inside the nose – to dry out.’
Other common causes of nosebleeds include:
- Picking your nose
- Frequent nose blowing or blowing your nose too hard
- Repeated sneezing
- Cold air or changes in humidity
- Upper respiratory infection
- Taking decongestants or antihistamines for allergies
- An allergic reaction
- Foreign objects lodged in the nose
- A blow to the nose or damage to the mucous membrane
- Exposure to chemical irritant
- Medications, such as blood-thinning drugs and steroid nasal sprays
- Recreational drugs, such as cocaine
Frequent nosebleeds may indicate an underlying health condition, such as:
- Blood clotting disorders
- High blood pressure
- Allergic rhinitis
- Nasal polyps
- Nasal tumours
- Septal deviation
Anybody can get a nosebleed, and most people experience them at some point in their life, but they tend to be more common in children aged between two and 10 years old, the elderly, people who take aspirin or blood-thinning medicine on a regular basis, pregnant women, and people with blood-clotting disorders, says Dr Tang.
Nosebleeds can are often intermittent, and it can be difficult to determine their source. An endoscopic examination by a specialist may help in establishing potential causes.
⚠️ It is rare for children under two to get nosebleeds so a very young child may need referral to a specialist to exclude other causes of bleeding.
Heavy nosebleed treatment
If you can’t stop your nose from bleeding, contact your doctor or the emergency services. They will administer medication to make your blood vessels contract. This might be a vasoconstrictor – such as adrenaline – or a decongestant, such as xylometazoline. If the medication is effective and the bleeding stops, the doctor may cauterise the source of the bleeding to prevent it from bleeding again.
If the bleeding fails to stop, it may be necessary to put a pack into the front and potentially the back of the nose. You will usually need to be hospitalised and seen by specialist ENT (ear, nose and throat) services. The ENT team will try and locate the source of the bleeding or identify any other cause. If the source can be found, treating the area using cauterisation should solve the issue. However, in rare cases, an operation may be necessary to tie off the blood vessel that supplies the bleeding area.
Sometimes the ENT doctors apply or prescribe a cream called naseptin for the bleeding areas so they do not become infected and this reduces the chance of recurrent bleeding.
How to prevent nosebleeds
There are several things you can do to prevent nosebleeds:
✔️ Avoid damaging the nose
Avoiding physical trauma – including picking your nose – is advised to prevent nosebleeds from occurring, says Ali. Keep your hands in your pockets!
✔️ Treat dryness
Dry mucous membranes are the most common cause of a nosebleed, says Dr Tang, so keep the inside of your nose moist by using a saline nasal product or investing in a humidifier.
✔️ Check your meds
You can avoid medicines that thin the blood, such as asparin or warfarin. ‘However, it’s paramount that you always discuss changes to any medication with your doctor if you take them for a specific medical condition,’ Ali says. Antihistamines and decongestants can dry out your nose, so use them in moderation.