Nosebleeds can look frightening, but are not usually a sign of a serious problem and can often be treated with home care.
Nosebleeds can affect anyone, but are more common among young children, elderly people, pregnant women, people taking aspirin or blood thinning medication and people with blood disorders.
There are two types of nosebleeds, depending on where the blood is coming from:
- Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor.
- Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose, and higher up in the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an ENT ( ear, nose and throat) specialist.
Most commonly, trauma to the nose triggers a nosebleed. Trauma to the outside of the nose such as a blow to the face, or trauma inside the nose such as nose picking or repeated irritation from a cold, can cause a nosebleed.
Less commonly, an underlying disease process such as an inability of the blood to clot may contribute to the bleeding. Inability of the blood to clot is most often due to blood-thinning medications such as warfarin or aspirin. Liver disease can also interfere with blood clotting. Abnormal blood vessels or cancers in the nose are rare causes of nosebleeds. High blood pressure may contribute to bleeding but is not often the only reason for a nosebleed.
Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx (the area inside the nose where the two nostrils merge), spilling into the other nostril to cause bleeding from both sides. Blood can also drip back into the throat or down into the stomach, causing a person to spit or even vomit blood.
- Signs of excessive blood loss include dizziness, light-headedness, confusion and fainting. Excessive blood loss from nosebleeds does not often occur.
- Additional bleeding from other parts of the body such as in the urine or bowels or easy bruising may indicate an inability of the blood to clot. Additional bleeding or easy bruising is often a sign of a more significant medical problem.
When to seek medical advice about nosebleeds:
- If you have repeated episodes of nosebleeds
- If you have additional bleeding from places other than the nose such as in the urine or stool
- If you bruise easily
- If you are on any blood-thinning medications including aspirin or warfarin
- If you have any underlying disease that may affect your blood clotting such as liver disease, kidney disease or haemophilia (inability of blood to clot)
- If you recently had chemotherapy
Seek urgent medical advice for nosebleeds if:
- You are still bleeding after pinching the nose for 20 minutes
- You are having repeated episodes of nosebleeds over a short time
- You are dizzy or light-headed or feel like you are going to pass out
- You have a rapid heartbeat or trouble breathing
- You are spitting up or vomiting blood
- You have a rash or temperature greater than than 38°C (100.4°F)