Nosebleed

What is nosebleed?

Most nosebleeds come from small fragile vessels at the front of the nasal septum and stop with correct first aid. The technique matters: pinch the soft part of the nose, not the bony bridge, lean forward rather than back, and hold continuously for ten to fifteen minutes without checking.

Causes

• Dry air or central heating drying the nasal lining
• Nose picking or blowing forcefully
• Colds, allergies and sinus infection
• Minor injury to the nose
• Blood thinning medicines
• High blood pressure contributing to prolonged bleeding
• Rarely a clotting disorder or nasal tumour

Symptoms

• Blood from one or both nostrils
• Blood trickling down the back of the throat
• Usually painless
• Light headedness with heavy or prolonged bleeding
• Nausea if blood has been swallowed

Risk factors

• Children aged 2 to 10 and adults over 50
• Anticoagulant or antiplatelet medicines
• Dry climates or winter heating
• Frequent nasal steroid spray use
• Bleeding disorders
• Alcohol excess

Diagnosis

• Usually clinical, based on history and examination
• Nasal examination to locate the bleeding point
• Blood tests including clotting if bleeding is recurrent or heavy
• Blood pressure measurement
• Nasendoscopy or imaging for persistent one sided bleeding

Treatment

• First aid pinching the soft part of the nose for 10 to 15 minutes
• Cautery of the bleeding vessel with silver nitrate
• Nasal packing for bleeding that will not settle
• Antiseptic or petroleum based ointment to prevent recurrence
• Reviewing anticoagulant medicines
• Specialist referral for recurrent or posterior bleeds

Self care

• Sit up and lean forward, never tilt the head back
• Pinch the soft part of the nose just below the bony bridge
• Hold firmly for 10 to 15 minutes without releasing to check
• Breathe through the mouth and spit out any blood
• Apply an ice pack to the bridge of the nose or suck ice
• Afterwards avoid blowing, picking or heavy lifting for 24 hours
• Use a humidifier and saline gel if the air is dry

When to see a doctor

Book an appointment if:

• Nosebleeds happening frequently
• Bleeding from one nostril persistently
• Nosebleeds while taking blood thinners
• Easy bruising or bleeding elsewhere
• Nosebleeds with a blocked nose that will not clear
• A child under 2 with a nosebleed

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Keep the nasal lining moist with saline or ointment
• Avoid picking or forceful blowing
• Humidify dry indoor air
• Aim nasal sprays away from the septum
• Treat allergies that cause rubbing and congestion
• Keep blood pressure controlled

Outlook

The great majority of nosebleeds stop with correct first aid and cause no lasting problem. Recurrent bleeds usually respond to cautery. Persistent one sided bleeding or blockage in an adult should be examined properly, since it can occasionally indicate a growth in the nose.

Related conditions

Common questions