• Most nose bleeds are associated with minor injuries to the nose or with common colds
  • Simple first aid steps should stop the bleeding in 5–15 minutes
  • Sometimes a nosebleed has a serious underlying cause
  • Most nosebleeds occur more frequently in winter
  • The common nosebleed is easy to stop without medical attention

Alternative names

epistaxis; bleeding from the nose

What is a nosebleed?

A nosebleed is usually due to the rupture of small vessels overlying the anterior (front) part of the nasal septum - the cartilage that separates the two sides of the nose - (nasal chambers), which contains many fragile blood vessels that are easily damaged.

What causes a nosebleed?

A minor nosebleed is often caused by a blow to the nose or from vigorous nose blowing, nose picking, irritation from a foreign body lodged in the nose (common in small children), hay fever; repeated sneezing, upper respiratory infection or facial and nasal surgery.

Sometimes nosebleeds have serious underlying causes. Arteriosclerosis is a possible cause in the elderly. Polyps and other fleshy growths in the nose, food allergies, hypertension, vitamin deficiencies or any disease producing a bleeding tendency may cause a nosebleed.

Bleeding from the nose that does not originate in the nose itself is a serious indication that some damage has been done internally, either by injury or disease. Medical attention is necessary to trace the bleeding to its source. The blood probably originates in the stomach, the lungs, within the skull, or in passages related to these parts.

Who gets nosebleeds and who is at risk?

Nosebleeds occur more frequently in winter when viruses are common and heated indoor air dries out the nostrils.

Symptoms and signs of nosebleed

Sudden bleeding from one or both nostrils.

How is nosebleed diagnosed?

In most cases a nosebleed is easily stopped and there is no need for further investigation. However, if the bleeding is difficult to stop or occurs frequently, a visit to your doctor is necessary. Your doctor will obtain a history from you and perform a physical examination with a special instrument to look inside your nose to check exactly where the problem lies.

Medical history questions documenting nosebleeds may include:

  • How much bleeding is there?
  • When did the nosebleeds begin?
  • Do they occur frequently or repeatedly?
  • What other symptoms are present?
  • Is there blood in your faeces or are you vomiting blood?

Diagnostic tests that may be performed include:

  • Complete blood count
  • Partial thromboplastin time measurements
  • Prothrombin (PT)
  • X-rays of the skull

Can nosebleeds be prevented?

If you often have nosebleeds, there are certain measures you can take to decrease their frequency. Applying petroleum jelly to the inside of your nostrils once or twice a day can help. A cooler house and a humidifier or vaporizer (which returns humidity to the air) may also help to decrease nosebleeds. In addition, avoid picking your nose and do not blow your nose for several hours after a nosebleed.

How is a nosebleed treated?

The common nosebleed is easy to stop by using the following steps:

  • Sit up or stand. Do not lie down. An upright position slows the flow of blood.
  • Squeeze the soft portion of the nose between the thumb and index finger for 5-10 minutes, while breathing through your mouth. This should stop the flow of blood.

If a nosebleed persists your doctor may treat it by using several steps. First, excess blood is removed with a suction device. A medical cotton ball is then placed in the nose. The medication anaesthetises and shrinks the nasal membrane. If the bleeding still persists, your doctor may recommend chemical or electrical cautery. If the bleeding persists after cautery, your doctor may gently pack your nose with medicated gauze.

Nosebleeds caused by an underlying disease such as hypertension or arteriosclerosis, or that occur far back in the nose, are more difficult to stop. Your doctor will probably seek the help of a specialist who will place a special pack in your nasal cavity. This procedure will be performed in hospital. A 2-3 day stay will be necessary for observation.

When to call the doctor

  • When a nosebleed occurs after an injury to the head, which may indicate a skull fracture (X-rays should be taken no matter how trivial the blow seems at the time.)
  • When there are repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.

Reviewed by Prof Don du Toit (M.B.Ch.B) (D.Phil.) (Ph.D) (FCS) (FRCS).

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