Nosebleeds can look serious, but are not usually a sign of a major problem.
Medically a nosebleed is called epistaxis.
Nosebleeds can affect anyone, but are more common among young children aged 2-10, elderly people, pregnant women, people taking blood thinning medication and people with blood clotting disorders.
Types of nosebleed
There are two types of nosebleeds, depending on where the blood is coming from:
- Anterior nosebleeds - meaning bleeding from a blood vessel at the front of the nose. These account for more than 90% of all nosebleeds and can usually be treated at home.
- Posterior nosebleeds - meaning bleeding from an artery at the back of the nose. These are less common and tend to affect older people. These nosebleeds may need hospital treatment.
Nosebleeds can be caused by, or made more likely by:
- Trauma or accident, such as being punched in the face
- Damage to the inside of the nose, from nose picking or a cold
- Nose blowing too hard
- Dry conditions causing dry and cracked skin in the nose
- Blood clotting disorders
- Overuse of decongestants
- Use of blood-thinning medications, including aspirin or warfarin
- High blood pressure
- Abnormal blood vessels
- Some cancers.
A nosebleed usually only affects one nostril, but if there's heavy bleeding, the blood can flow back inside the nose and down the other nostril.
Blood from a nosebleed can also drop down the throat or be swallowed and the person may be seen spitting out blood or having blood in vomit.
Excess blood loss from a nosebleed is rare but can cause:
If you get a nosebleed, or are looking after someone who is having a nosebleed, steps to stop it are:
- Sit down
- Pinch the soft part of the nose above the nostrils for around 10-15 minutes using firm pressure
- Lean forward to stop blood going down the throat
- Breathe through the mouth
- Put an ice pack or bag of frozen vegetables wrapped in a cloth on the bridge of the nose
- Don't lie down, staying upright reduces blood pressure in the nose and helps reduce bleeding.
Seek medical advice about nosebleeds if:
- There are repeated nosebleeds
- There is other bleeding as well as the nosebleed
- There is shortness of breath
- There are heart palpitations
- You bruise easily
- You are taking blood-thinning medication
- You have a blood clotting condition such as haemophilia, or a condition such as liver disease or kidney disease
- You've had recent chemotherapy
- The nosebleed is in a child aged under 2 years old.
Seek urgent medical advice for nosebleeds if:
- The nosebleed lasts longer than 20 minutes even with basic treatment
- There is heavy bleeding
- There are breathing difficulties
- Lots of blood is swallowed causing vomiting
- The nosebleed is due to an accident that may have caused other injuries.
Severe nosebleeds or recurrent nosebleeds may need hospital treatment or a referral to a specialist ear, nose and throat surgeon (ENT).
A doctor will examine the nose, try to stop the bleeding by packing the nose, and may arrange blood tests for clotting problems.
Medical treatments for nosebleeds include:
- Cautery - with a chemical or electric current
- Ligation, to block blood vessels responsible for the bleeding
- Treating undiagnosed blood clotting disorders.