Nosebleed

Also known as epitaxis or a 'blood nose'

Nosebleeds can be alarming, but they can usually be managed easily at home.

They are fairly common, particularly in children. During a nosebleed, delicate blood vessels in the lining of the nose burst. This causes blood to flow out one or both of the nostrils. Blood flow may be heavy or light and usually stops within 10 minutes. Sometimes nosebleeds are more severe. If you have bleeding that lasts for more than 20 minutes go to your nearest Accident and Emergency (A&E) department as soon as possible.

Key points:

  1. Nosebleeds are common in children and are usually not serious.
  2. First aid treatment includes pinching the nostrils until the bleeding stops.
  3. See your doctor if you experience lots of nosebleeds or if they are heavy. This may be a sign of an underlying problem (such as haemophilia) and can lead to complications (such as anaemia).

Seek urgent medical help if you have a nosebleed accompanied by the following symptoms:

  • very heavy bleeding from the nose
  • irregular heartbeat (palpitations)
  • breathlessness
  • swallowing such large volumes of blood that it causes vomiting
  • profuse bleeding which does not stop after pressure has been applied for 20 minutes.

Causes

The lining of your nose is filled with many tiny blood vessels. These blood vessels are quite fragile and bleed easily if disturbed. A nosebleed can be caused by a range of factors. In children, bleeding may happen for no known reason. Common causes of nosebleeds include:

  • falling on the face or the nose being hit
  • fingers picking the nose
  • blowing the nose too hard or sneezing
  • cold and dry air (this causes the lining of the nose to dry out and crack)
  • an infection in the airway, including the lungs, throat and nose.

Other causes of nosebleeds include:

Sometimes, nosebleeds can be a symptom of another condition, for example:

  • A clotting disorder, such as haemophilia (an inherited condition which affects the blood’s ability to clot).
  • Blood disorders, such as Von Willebrands disease (when the blood lacks a protein, the Von Willebrand Factor).
  • Growth of cells cancerous in the nose (this is rare and you would likely have other symptoms).

Who is more at risk of nosebleeds?

You are most at risk of having nose bleeds if you:

  • are a young child
  • are above 60 years old
  • are pregnant
  • are a patient on aspirin or blood thinning medication such as Coumadin, Warfarin or Plavix
  • have a blood disorder, such as Von Willebrands disease.

Symptoms

Nosebleeds are easily recognised by large amounts of blood dripping from the nose. They may be felt as a sensation of fluid flowing at the back of the throat.

Diagnosis

Most nosebleeds aren't serious. However, if you experience frequent (more than one a week) or very heavy nosebleeds you should see your doctor. These nosebleeds could be a sign of an underlying problem (such as haemophilia) and may lead to complications (such as anaemia). If your doctor suspects a more serious problem, they may refer you to an ear, nose and throat (ENT) specialist.

In rare cases, more tests may be needed, such as:

  • Complete blood count – including red blood cells, white blood cells and haemoglobin (a protein in the blood that carries oxygen - this is to test for anaemia).
  • Nasal endoscopy – a special camera lens used to look closely at the inner nose.
  • Partial thromboplastin time (PTT) – a test that measures how fast your blood clots.
  • Prothrombin test – a test that records how fast the plasma (liquid in your blood) clots.
  • CT scan of the nose.

Treating nosebleeds

First aid

Most nosebleeds are mild and can be managed easily at home. The aim of treatment is to control blood loss and keep an open airway. If someone gets a nosebleed:

  • Reassure them – nosebleeds can be very alarming, especially to young children.
  • Ask them to sit upright and lean forward slightly – this will help the blood drain out the nose instead of down the throat.
  • Have them squeeze the soft part of the nostrils, just below the bony bridge for at least 10 minutes or until blood flow has stopped. Very young children may need you to do this for them.
  • Apply a covered icepack to the bridge of the nose –  cold helps blood vessels constrict (close).
  • After 10 minutes, check if bleeding has stopped – if bleeding continues after 20 minutes of pressure or if there is too much bleeding, seek medical help.
  • Advise the person to avoid sniffing or blowing their nose for at least 15 minutes and avoid strenuous activity for 12 hours after bleeding has stopped.

If you seek medical help for a nosebleed, your doctor may insert a special gauze or sponge into the nose to stop the bleeding (nasal packing). You will be told how long you need to keep the packing in. An appointment will be made for it to be removed. After the bleeding has stopped and the packing is removed, your doctor will examine your nose.

Treatment for recurring nosebleeds

  • Cautery – the use of heat, silver nitrate sticks or electric current to cauterise (burn) and seal the blood vessels causing the problem.
  • Septal surgery – if the septum (the wall between the nostrils) is crooked it can sometimes cause nosebleeds. If this is the case, your ENT surgeon may recommend having your septum surgically straightened.
  • Ligation – this involves very fine surgery to tie off burst blood vessels. It may be used if other methods don't work.

Preventing nosebleeds

Things you can do to help prevent nosebleeds:

  • If you need to blow your nose, do so as gently as possible.
  • Avoid picking your nose.
  • Try using vaporizers to keep the air humid or use saline (saltwater) nasal spray if your nose is crusty and dry.
  • Use a head guard while playing contact sports, such as boxing or rugby.
  • Talk to your doctor if you are taking blood-thinning medications and have recurring nosebleeds.
  • Avoid overuse of nasal decongestants – always follow packet instructions.
  • Avoid smoking, alcohol and hot drinks – these expand the blood vessels in the lining of your nose.

Learn more

Preventing nosebleeds WebMD, 2013
Nosebleed overview WebMD, 2014
Nosebleed Treatment NHS Choices UK, 2013

Credits: Health Navigator, latest review November 2014.