Occur commonly, usually easy to treat
Nosebleeds are very common, particularly in children and in the elderly. They can affect both or just one nostril and usually stop after a few minutes. However, they can last for 15 minutes or more. Simple first aid measures usually stop the flow but if bleeding is very heavy or continues for 20-30 minutes, you need to attend an Emergency Department.
Most nosebleeds are at the front of the nose and come from the network of fine blood vessels lying just under the skin on the septum (the cartilaginous wall between the nostrils). The vessels are easily inflamed and damaged, such as when you have a cold or if the nose is picked. Other situations that often cause nosebleeds include:
- Falls onto the face or a punch to the nose.
- Blowing your nose hard
- Blocked, stuffy noses or sinusitis
- Dry air, particularly at altitude
- Hayfever and overuse of decongestants
These types of nosebleed are more common in children and usually stop on their own. They are not usually a sign of anything serious.
The nose can also bleed from arteries further back and higher up in the nose. This type of bleed is more common in adults and can be more difficult to treat. The bleeding can be very unpleasant as it is often much heavier than an anterior bleed and blood can run down the back of the throat leading to coughing and vomiting blood. Posterior bleeds can be caused by many conditions including:
- Medicines that thin the blood such as aspirin and warfarin
- High blood pressure (hypertension) or clotting disorders such as haemophilia.
- Blows to the head, broken noses and recent nasal surgery
- Rarer conditions such as tumours in the sinuses and nasal cavity, leukaemia and genetic conditions that make the walls of blood vessels more fragile.
What to do
- Sit down and squeeze the soft part of your nostrils together for 20 to 30 minutes.
- Lean forward and breath through your mouth. This allows blood to drain from the nostril and not down the back of the throat.
- Put something cold (a bag of frozen peas or an icepack) over the bridge of the nose to help the blood vessels shrink down and stop bleeding.
If the nosebleed stops, you won’t usually need to see a doctor. Leave any blood that remains in the nostril and don’t pick or blow it out – removing the clot may start the nose bleeding again. Avoid hot drinks and hot baths as both will cause the blood vessels in the nose to dilate and may increase the chance of rebleeding.
If a nosebleed continues beyond 20-30 minutes and none of the above works, then you should contact Bluezone or go to A&E – GPs don’t usually have the right equipment to hand.
If the bleed is anterior and a bleeding point can be seen, it can often be cauterised with a small silver nitrate stick that shrinks down the blood vessels. After this is done you may be given some antiseptic ointment to rub on the area.
If bleeding continues, the nose may be packed with gauze or various devices including balloons to try to stem the bleeding. If a posterior bleed is suspected, these packs may be kept in place for at least 24 hours and blood tests are usually taken to check for blood loss and clotting disorders. Very occasionally, if you’ve lost a lot of blood, you may need a blood transfusion.
Contact Bluezone if:
- You have repeated nosebleeds
- You have fallen or taken a hit to the nose
- You take blood thinning tablets or regular aspirin
- A child under two years has a nosebleed
- The nosebleed continues for more than 20-30 minutes or is very heavy
- You are having difficulty breathing or have swallowed a lot of blood which makes you vomit