13464 Nosebleed Epistaxis

Overview

A nosebleed (epistaxis) is bleeding from the inside of the nose. It happens when tiny blood vessels in the lining of the nose break and leak blood. Most nosebleeds look more serious than they are and stop with simple first aid.

Very common. Around 1 in 7 people will have at least one nosebleed at some point in their life.

People of all ages can get nosebleeds, but they occur most often in children aged 2–10 and adults over 65. They also become slightly more common in winter when heated indoor air is dry.

Symptoms

Common symptoms

• Blood flowing from one or both nostrils
• A feeling of liquid dripping down the back of the throat
• Swallowing blood, which may cause nausea or an upset stomach
• No pain in most cases

Symptoms in children

• Most nosebleeds in children come from the front of the nose and stop quickly.
• They are often caused by nose picking, dry air, or a minor knock.
• Children may swallow blood, which can lead to dark, sticky vomit.

Symptoms in older adults

• Bleeding may come from deeper in the nose and can be heavier.
• It may be linked to high blood pressure or blood-thinning medicines.
• The bleeding may take longer to stop, so applying firm pressure for longer is often needed.

Causes

Main causes

• Dry air, especially from central heating or dry climates
• Nose picking or rubbing the nose
• Minor injury or trauma to the nose
• Colds, allergies, or sinus infections that irritate the nasal lining
• High blood pressure (less common, but can contribute)
• Medicines that thin the blood

Risk factors

• Being a child, especially between ages 2 and 10
• Being over 65 years old
• Frequent nose blowing or sneezing
• Spending time in dry or dusty environments
• Taking blood-thinning medicines
• Being pregnant, due to hormonal changes that increase blood flow to the nose

When to see a doctor

See a doctor urgently if:

• See a doctor or go to a same-day care clinic if a nosebleed lasts longer than 20 minutes despite correct pressure.
• You have frequent nosebleeds that are hard to control.
• You take blood-thinning medicines and notice heavier bleeding than usual.
• You feel lightheaded or short of breath with a nosebleed.

Book a routine appointment if:

• You want advice on how to prevent future nosebleeds.
• You suspect an underlying cause such as high blood pressure.
• Your child has frequent nosebleeds that are causing concern.

Diagnosis

A doctor will ask about your symptoms and look inside your nose using a small light instrument called a nasal speculum. This helps find the bleeding point. In most cases, no tests are needed.

Tests that may be done

• A blood pressure check
• A blood test, if bleeding is heavy or repeated
• A nasal endoscopy, which uses a thin, flexible tube with a camera, for difficult or recurrent nosebleeds

What to expect at your appointment

The doctor will explain what is likely causing your nosebleeds and show you the correct first-aid technique. If needed, they may offer a simple in-clinic treatment to seal the bleeding blood vessel. Most people go home the same day.

Treatment

The main treatment for a nosebleed is correct first aid to stop the bleeding. For persistent or repeated nosebleeds, a doctor can offer simple clinic-based treatments. Self-care and prevention are the most important parts of managing nosebleeds.

Self-care at home

• Sit forward and lean your head forward, not back.
• Pinch the soft part of your nose, just below the bony bridge, and hold for 10–20 minutes.
• Breathe through your mouth while you pinch.
• Apply a cold compress or ice pack to the bridge of the nose to help narrow blood vessels.
• Avoid blowing your nose or picking it for at least 24 hours after a nosebleed.

Medical treatments

A doctor may apply a chemical cautery stick to seal the bleeding vessel, or place a special dressing inside the nose to press against the bleeding area. Sometimes a small balloon is used to apply pressure from inside the nostril. These procedures are done in the clinic and do not usually require a hospital stay.

When is surgery considered?

Surgery is rarely needed. It may be considered if nosebleeds are severe, keep returning, and do not improve with other treatments. Surgical procedures aim to block or seal the specific blood vessel that is causing the bleeding.

Living with this condition

Most people can manage nosebleeds at home with the right technique. Keep the inside of your nose moist, avoid picking, and carry tissues so you can apply pressure quickly if a nosebleed starts.

Lifestyle tips

• Use a saline nasal spray or gel to keep your nostrils moist.
• Use a humidifier in dry rooms, especially the bedroom at night.
• Avoid picking your nose or rubbing it hard.
• Trim children's fingernails to reduce damage from nose picking.
• Avoid heavy lifting or strenuous exercise for a day or two after a nosebleed.

Diet and exercise

A balanced diet with plenty of fruits and vegetables helps keep tissues healthy. There is no special diet to prevent nosebleeds. After a nosebleed, avoid strenuous activity for a day or two so the delicate blood vessels can heal.

Mental health and emotional wellbeing

Frequent nosebleeds can be distressing, embarrassing, or anxiety-provoking, especially for children. It is normal to worry about when the next one might happen. Having a clear first-aid plan can help you feel more in control. If anxiety is affecting your daily life, talk to your doctor.

Prevention

Many nosebleeds can be prevented by keeping the inside of the nose moist and avoiding nose trauma, such as picking or rubbing. This is especially helpful for children and for people who get nosebleeds in dry weather.

Vaccines

There is no vaccine that prevents nosebleeds.

Screening programmes

There is no routine screening test for nosebleeds, but a doctor may check your blood pressure or blood count if you have frequent or heavy nosebleeds.

Complications

If left untreated

• Prolonged bleeding that leads to anaemia (a low number of red blood cells) in rare cases
• Swallowing large amounts of blood, which can cause vomiting or stomach irritation
• In rare cases, severe blood loss that requires hospital care
• Missing an underlying cause such as high blood pressure

Long-term outlook

The outlook is excellent. Most nosebleeds stop within 20 minutes and cause no lasting problems. With simple prevention and correct first aid, most people can manage nosebleeds successfully. Even recurrent or more serious nosebleeds are usually treatable.

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