Nosebleeds

Overview

A nosebleed is when blood flows from the tissue inside your nose. Most nosebleeds look worse than they are and stop within a few minutes.

Yes, nosebleeds are very common. Almost everyone will have at least one in their lifetime.

Nosebleeds can happen to anyone, but they are most common in children aged 2 to 10 and in older adults.

Symptoms

Common symptoms

• Blood dripping from one or both nostrils.
• Blood flowing down the back of the throat (especially if lying down).
• A feeling of liquid in the nose or throat.

Symptoms in children

• Same as adults, but children may be more frightened by the sight of blood.
• Bleeding is often from a single nostril and stops quickly.

Symptoms in older adults

• Bleeding can be heavier and last longer because blood vessels are more fragile.
• May be related to high blood pressure or medicines that thin the blood.

Causes

Main causes

• Dry air (from indoor heating or dry climate) that dries out the inside of the nose.
• Picking or rubbing the nose.
• Injuries to the nose or face.
• Colds, allergies, or sinus infections that irritate the lining of the nose.

Risk factors

• Living in a dry climate or using central heating.
• Frequent nose picking (especially in children).
• Taking medicines that prevent blood clotting (such as anticoagulants or antiplatelet drugs).
• Having high blood pressure, liver disease, or a bleeding disorder.

When to see a doctor

See a doctor urgently if:

• If the bleeding does not stop after 20 minutes of firm pressure.
• If you have a nosebleed after a head injury.
• If you feel faint, dizzy, or have chest pain with the nosebleed.

Book a routine appointment if:

• If you get nosebleeds often (several times a week).
• If the nosebleed is heavy or hard to stop, even if it eventually stops.
• If you are on blood-thinning medicine and have a nosebleed.

Diagnosis

Your doctor will ask about your symptoms, how often nosebleeds happen, and any medicines you take. They will look inside your nose using a small light.

Tests that may be done

• A simple exam of your nose and throat.
• Blood tests if your doctor suspects a bleeding problem or low blood count.
• In rare cases, a thin tube with a camera (endoscopy) to look deeper for the source of bleeding.

What to expect at your appointment

The doctor will usually be able to find the cause quickly. Most people do not need any special tests. If the bleeding is frequent, your doctor may refer you to an ear, nose, and throat specialist.

Treatment

Treatment depends on how severe the nosebleed is and how often it happens. Most can be managed at home or with a simple procedure in the doctor's office.

Self-care at home

• Sit up straight and lean your head slightly forward (not back).
• Pinch the soft part of your nose just below the bony bridge for 10-15 minutes without stopping.
• Apply a cold compress or ice pack wrapped in a cloth to the bridge of your nose.
• Avoid blowing your nose or bending over for several hours after the bleeding stops.

Medical treatments

If self-care does not work, a doctor may apply a chemical or electric current to seal the bleeding blood vessel (cautery). They may also place a special gauze or balloon inside the nose to put pressure on the bleeding area (nasal packing).

When is surgery considered?

Surgery is rarely needed. It may be considered if nosebleeds are very severe and do not respond to other treatments. A specialist can tie off or block the artery that supplies the bleeding area.

Living with this condition

Most people with occasional nosebleeds can carry on as normal. Keep a stash of tissues and a cold pack handy. Children may need extra reassurance.

Lifestyle tips

• Use a humidifier in your bedroom, especially in winter.
• Avoid picking your nose or blowing it too hard.
• Apply a little petroleum jelly or saline gel inside your nostrils to keep them moist.

Diet and exercise

No special diet is needed. If you take blood-thinning medicines, talk to your doctor before changing your diet. Exercise is fine as long as you are not actively bleeding.

Mental health and emotional wellbeing

Frequent or heavy nosebleeds can cause worry or fear. If you feel anxious, talk to your doctor. Knowing what to do when a nosebleed starts can help you feel more in control.

Prevention

Many nosebleeds can be prevented by keeping the inside of your nose moist and avoiding picking or blowing too hard.

Complications

If left untreated

• Blood loss leading to anaemia (low blood count) if nosebleeds are frequent or heavy.
• Swallowing a large amount of blood can cause vomiting or nausea.
• Very rarely, severe bleeding that requires emergency treatment.

Long-term outlook

The outlook is excellent. Most nosebleeds stop on their own or with simple home care. Even recurrent nosebleeds are usually manageable with medical help and lifestyle changes.

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