Nosebleeds: first aid and treatment

Summary

Most nosebleeds are not serious. Dry nasal lining, irritation, a cold, nose picking or forceful blowing are common triggers. Correct first aid usually stops the bleeding. Seek medical help if it is heavy, follows a significant injury, does not stop after sustained pressure, recurs frequently or occurs while taking blood-thinning medication.

Causes

A nosebleed, or epistaxis, can look alarming because even a small amount of blood spreads easily. It starts when a blood vessel in the nasal lining breaks. Nosebleeds are more common in dry winter air and may occur more readily in people using anticoagulants or antiplatelet medicines. High blood pressure does not usually cause a nosebleed by itself, but very high pressure can make bleeding harder to control.

Bleeding from the front of the septum is most common, especially in children and younger adults. Bleeding from farther back in the nose is less common, occurs more often in older adults and may run mainly down the throat.

First aid

1. Sit upright and lean slightly forward. Breathe through your mouth and spit out blood rather than swallowing it.
2. Pinch the soft part of the nose firmly, just below the hard bridge, so both nostrils are closed.
3. Hold continuous pressure for 10 to 15 minutes without releasing to check. Use a clock.
4. If bleeding continues, repeat once for another 10 to 15 minutes.

Do not lie flat, tilt the head back, pack the nose with tissue or repeatedly blow the nose. A clinician may sometimes recommend a topical decongestant such as xylometazoline, but it is not suitable for everyone and should be used only according to medical or pharmacy advice.

After bleeding stops, avoid nose picking or blowing, heavy exertion, hot showers or baths, very hot food and alcohol for about 24 hours or as advised. Saline spray or a prescribed nasal ointment can help a dry, crusted lining.

Medical treatment

If pressure does not work, a doctor can identify the bleeding point and may cauterise it chemically or electrically. Nasal packing or a balloon device may be required. Significant posterior bleeding can require hospital treatment and, occasionally, a procedure to seal the responsible vessel.

Seek urgent care if bleeding remains active after two full cycles of pressure, is very heavy, causes weakness or breathing difficulty, follows facial or head injury, or if you use blood thinners or have a bleeding disorder. Do not stop prescribed blood-thinning medication unless the treating clinician tells you to do so.