Nose Bleed (Epistaxis)

A nosebleed, medically called epistaxis, is when blood flows from one or both of your nostrils. It's very common and, in most cases, mild and easy to treat at home.

What causes a nosebleed?

Most nosebleeds happen because the delicate blood vessels just inside your nostrils become damaged and bleed easily. Common everyday causes include:

• picking or blowing your nose, especially if it's already irritated
• very dry or cold air, which dries out the inside of your nose
• colds, sinus problems or allergies that make you sneeze or blow your nose more
• a blow or injury to your nose
• a nasal infection.

Nosebleeds that come from deeper inside your nose are less common and tend to affect adults. These can be linked to a broken nose, recent nasal or sinus surgery, high blood pressure, a condition that affects blood clotting, or medicines that thin your blood, such as warfarin, aspirin, rivaroxaban or edoxaban. You're also more likely to get nosebleeds if you're pregnant or over 45.

Are there different types of nosebleed?

Nosebleeds are generally grouped by where the bleeding starts:

• From the front of the nose (the septum, which separates your nostrils): By far the most common type, and usually straightforward for a healthcare professional to stop
• From deeper inside the nose: Less common, harder to control, and more likely to need hospital treatment.

How is a nosebleed diagnosed?

If your nosebleed is frequent, severe, or has no obvious cause, a healthcare professional will examine the inside of your nose to try to find where the bleeding is coming from and how severe it is, as well as check your blood pressure.

If needed, further tests can include a blood test to check your blood count and how well your blood clots, a nasal endoscopy (examining inside your nose with a small camera), or a CT scan of your nose and sinuses if a broken nose or another structural cause is suspected.

How is a nosebleed treated?

To stop a nosebleed yourself:

1. Sit down and lean forward with your head tilted forward and your mouth open – never tilt your head back, as this can make you swallow blood and feel sick
2. Firmly pinch the soft part of your nose, just above your nostrils, for 10 to 15 minutes without letting go
3. Breathe through your mouth, and spit out rather than swallow any blood that reaches your throat
4. Holding an ice pack, or a bag of frozen peas wrapped in a tea towel, against the bridge of your nose may also help.

If the bleeding doesn't stop, or if it's severe or frequent, a healthcare professional may seal the bleeding point with a stick coated in a chemical called silver nitrate, or pack your nose with gauze or a special sponge to apply pressure from the inside.

Afterwards, you might be prescribed an antiseptic cream to use inside your nose for a while, to help prevent scabs from forming and reduce the chance of it happening again.

When should you see a doctor?

See a GP if you or your child keep getting nosebleeds, if a child under 2 has had one, if you have symptoms of anaemia such as a faster heartbeat, shortness of breath or unusually pale skin, or if you take a blood-thinning medicine such as warfarin, aspirin, rivaroxaban or edoxaban.

Call 999 or go to A&E if the bleeding lasts longer than 10 to 15 minutes, seems excessive, follows a blow to the head, or comes with feeling weak, dizzy, or having difficulty breathing. Do not drive yourself to A&E; ask someone to drive you or call 999 for an ambulance.