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Nosebleeds: Causes, First Aid and Treatment

Nosebleed (also known as epistaxis) is extremely common and almost everyone gets it occasionally. The bleeding usually stops by itself. Pinching nostrils together for a few minutes helps to stop it sooner. It is extremely rare to lose a lot of blood from a nosebleed.

If the nosebleeds are frequent or heavy, a person should see a doctor. There are simple treatments to prevent them recurring. However, a doctor will need to rule out a more serious cause, though it is very unusual for a nosebleed to be caused by a serious disease. Occasionally, patients with stubborn nosebleeds will need specialist medical treatment.

Health Risks Associated with Nosebleeds

Nosebleeds are usually no more than a minor inconvenience. The bleeding tends to stop by itself, or with simple first-aid that patients can do themselves. Nosebleeds are rarely the result of a serious medical condition and there are normally no serious consequences.

However, when the back of the nose is bleeding, the blood may pass backwards into the throat. In such case people may tend to swallow the blood. Swallowing a lot of blood upsets the stomach and can make a person feel sick, while some people may feel faint.

Frequent nosebleeds may occasionally result in anemia. Anemia can make a person look pale and feel tired and dizzy. Another less common consequence of frequent nosebleeds, when an individual swallows a lot of blood, is black feces. This is because the digested blood turns the feces black. However, such symptoms are much more commonly the result of internal bleeding from the stomach or intestines.

Causes of Nosebleeds

One of the most common causes of a nosebleed is trauma such as caused by nose-picking. The bleeding usually comes from the fragile small blood vessels at front of the nose on the wall that separates the two nostrils, called the septum. In addition, allergic rhinitis, high blood pressure, use of blood thinning medications (e.g., warfarin, aspirin) or isotretinoin, a lack of vitamin C and dry air may contribute to nosebleeds.

Occasionally, nosebleeds are the result of a more serious condition, such as:

  • Hemophilia, an inherited blood disorder where the body lacks one of the factors that cause blood to clot
  • Hereditary hemorrhagic telangiectasia, a very rare inherited disease, where certain delicate blood vessels in the nose, mouth, intestines, stomach and lungs have a tendency to bleed.
  • Hormonal changes during pregnancy
  • Leukemia, a type of cancer that affects the bone marrow. Leukemia also interferes with the blood-clotting process.
  • Tumours in the nose or paranasal sinuses

First Aid for a Nosebleed

Anyone who has a nosebleed should sit down and try to relax. They should pinch the soft parts of their nostrils together with a finger and thumb, but take care not to press on the bone of the bridge of the nose, as this will not help. The pressure should be firm but not painful. It is necessary to keep the nostrils together for at least five minutes, preferably ten minutes. It also helps to lean forwards slightly and if any blood runs from the back of the nose into the throat it is better to spit it out rather than to swallow it. Sucking on an ice cube or putting an ice pack over the nose can also help to reduce bleeding. Once the nosebleed has stopped, people should avoid straining, hot drinks and hot baths, dry air and be gentle with their nose for the next few days.

When to See a Doctor

Most nosebleeds will stop within a few minutes by themselves or with some simple intervention. If the bleeding does not stop within 20 minutes, a person should contact their physician or an emergency department for advice.

People who get minor nosebleeds frequently should also seek professional help, both for treatment to prevent them recurring and to rule out possible serious causes. They may be referred to an ear, nose and throat specialist.

Treatment of Nosebleeds

Nosebleeds are usually not serious and easy to stop. Occasionally, they do not stop, or they keep happening, and a patient may need treatment by an ear, nose and throat specialist. Treatment may include any of the following:

Cautery

Cautery is usually the first step the specialist will take if the nosebleed is persistent or recurring. It involves sealing the broken blood vessel. In order to do that the doctor first needs to identify the broken blood vessel inside the nose using a headlight or telescope. This procedure can be slightly painful and a local anesthetic, such as an anesthetic spray, may be used. The doctor then touches the area around the bleeding point with a chemically coated stick called cautery stick, which causes a small burn and seals off the blood vessel.

Nasal Packing

Sometimes it is not possible to stop a heavy nosebleed with cautery. In these cases, a dressing called a nasal pack may be applied to fill the area at the back of the nostrils. The pack is usually a sponge. A local anesthetic will be sprayed into the nose when the pack is inserted, but the procedure can still be uncomfortable. The pack is usually left in for 24 to 48 hours, and the patient will probably have to stay in hospital during this time for monitoring. If the pack is left in for more than two days, the patient may be given antibiotics to prevent infection.

Surgery

Very occasionally a persistent nosebleed may require a surgery. This may involve any of the following procedures:

  • Electrocautery. It is a procedure used to electrically cauterise or clip a blood vessel to prevent future bleeding.
  • Ligation. This type of microsurgery may be necessary to tie off the blood vessels that supply blood to the nose. One of these blood vessels can be reached by making a small cut at the corner of the eye next to the bridge of the nose. Another can be reached through the cheek by making a cut inside the mouth through the gum just below the cheek.
  • Septoplasty. Some people have a crooked septum (the wall that separates the two nostrils), causing a blocked nose and interrupting the passage of air. This makes the septum dry out, and the area becomes more likely to bleed spontaneously. Surgery to straighten the septum can help unblock the nose and lower the risk of nosebleeds.
  • Embolization. This minimally invasive surgical procedure is used only in very serious cases of recurring nosebleeds. A tube is inserted into a large artery in the groin and passed up to the blood vessels supplying the nose. Embolization involves blocking the blood vessels with microparticles to stop them from bleeding. This method is rarely used because of the risk of the microparticles moving to other areas and blocking a nearby blood vessel supplying the brain.

Where to Get More Information: American Academy of Otolaryngology-Head and Neck Surgery