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What are nosebleeds?

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What are nosebleeds?

Nosebleeds (medically known as epistaxis) can be frightening. However, they are fairly common, particularly in children, and can often be treated at home.

During a nosebleed, blood flows from 1 nostril, or sometimes both. It can be heavy or light, and can last from a few seconds to more than 10 minutes.

You may feel liquid in the back of your throat before blood runs from your nose. This usually happens while you're lying down. Nosebleeds can also occur while you're asleep.

When to seek medical assistance

Most nosebleeds are minor and usually stop with some self-care.

However, the bleeding may be heavier or last longer if you have high blood pressure a condition where your blood doesn't clot (thicken) properly or if you're taking medication that thins your blood (anticoagulants), such as warfarin or aspirin.

Go to the emergency department if:

  • your nosebleed lasts longer than 10 to 15 minutes
  • it seems like you are losing a lot of blood
  • you feel like you are struggling to breathe normally
  • you feel dizzy or weak
  • you are swallowing a lot of blood from the nosebleed and this is making you vomit
  • the nosebleed started after you hit your head

Visit your doctor if you have had a nosebleed and:

  • they happen often (more than once a week)
  • you have an irregular or fast heartbeat (palpitations), shortness of breath or you look paler than normal (symptoms of anaemia)
  • you are taking medicines that thin the blood eg warfarin
  • your blood does not clot properly because of a medical condition, such as haemophilia

What causes nosebleeds?

The inside of your nose is full of tiny blood vessels which can bleed if they're disturbed by injury, such as picking or blowing your nose.

Nosebleeds can also happen if the moist lining (mucous membrane) inside your nose dries out and becomes crusty.

This can be caused by an infection, cold weather or the drying effect of central heating. If the lining becomes inflamed or cracked, it's more likely to bleed if it is then disturbed.

Nosebleeds can start just inside your nostrils (anterior) or at the back of your nose (posterior). They have many different causes, including:

  • picking your nose or blowing it very hard
  • an injury to your nose - seek medical attention if your nosebleed started after a blow to your head or nose
  • a crooked nose - either present from birth (congenital) or caused by an injury (a deviated septum)
  • a cold, flu (influenza) or sinusitis
  • a blocked, stuffy or dry nose (caused by dry air in a hot climate or heated indoor air)
  • hay fever or other allergies
  • high altitude
  • excessive use of nasal decongestants or exposure to irritating chemicals
  • use of illegal drugs that are snorted, such as cocaine
  • recent nasal surgery
  • high blood pressure (hypertension), hardened arteries or a tumour in the nasal cavity
  • certain medicines, such as aspirin, medicines for arthritis and blood-thinning medicines (anticoagulants), such as warfarin and heparin

In some cases, nosebleeds can be a symptom of another condition. This could be a blood clotting abnormality, e.g. haemophilia (an inherited condition that affects the blood’s ability to clot), von Willebrand disease (an inherited disorder that causes bleeding and bruising) or leukaemia (although this is rare and you are likely to have other symptoms as well).

Who gets nosebleeds?

Anyone can get a nosebleed, but they are most common in:

  • young children
  • the elderly
  • pregnant women
  • people who regularly take aspirin and blood-thinning medication, such as warfarin
  • people with blood disorders

Are nosebleeds serious?

Nosebleeds aren't usually serious. However, a nosebleed can be more serious for older people whose blood takes longer to clot because they are at risk of losing more blood.

If your doctor suspects a more serious problem, they may refer you to an ear, nose and throat (ENT) specialist for further tests.

Excessive bleeding over a prolonged period of time can lead to anaemia.

Frequent nosebleeds (more than once a week) or heavy nosebleeds can make anaemia worse if you're losing a lot of blood.

Treating nosebleeds

You can usually stop a nosebleed yourself by pinching your nose just above your nostrils for 10 to 15 minutes.

Leaning forward and breathing through your mouth will drain blood down your nose instead of down the back of your throat. You should also:

  • stay upright rather than lying down as this reduces the blood pressure in the veins of your nose and will discourage further bleeding
  • place a covered ice pack on the bridge of your nose
  • avoid tipping your head backwards
  • avoid blowing your nose, lifting heavy objects and strenuous activity for at least 24 hours after a nosebleed; try to keep your head above the level of your heart during this time

Go to the nearest hospital's accident and emergency department as soon as possible if the bleeding doesn't stop after you've maintained pressure for 10 to 15 minutes.

If you seek medical help because your nosebleed hasn’t stopped after 10 to 15 minutes you may be given additional treatment, including:

  • a numbing (anaesthetic) and/or decongestant spray - this may help to slow the bleeding and allow the doctor to see inside your nose more easily
  • nasal packing - your nose may be packed with ribbon gauze or a nasal sponge until the bleeding has stopped
  • nasal cautery - a minor procedure that burns (cauterises) the blood vessel where the bleeding is coming from. It is done either using an electric current running through a wire (electrocautery) or a chemical, such as silver nitrate, on the end of a wool swab (chemical cautery)

You may be given additional tests to check for the cause of your nosebleed. These include measuring your blood pressure and pulse rate, as well as blood tests to check whether your blood is clotting properly.

If your nosebleeds are found to be caused by medication that you are taking, such as blood-thinning medicines (anticoagulants) like aspirin, warfarin or heparin, or an anti-inflammatory medicine, your doctor may need to change or adjust the dose.

In severe cases, you may need surgery to prevent the nosebleeds happening again. In this case, your doctor will refer you to an ENT specialist.

What should I do after a nosebleed?

After a nosebleed, avoid doing the following things for 24 hours:

  • blowing or picking your nose
  • drinking alcohol or hot drinks
  • bending over
  • heavy lifting
  • picking any scabs that may have formed
  • lying flat
  • strenuous exercise

Preventing nosebleeds

In general, you can help to prevent nosebleeds by not picking your nose or blowing your nose hard if it is blocked due to a cold or hay fever.

If you are taking nasal decongestants, take care to follow the instructions carefully and talk to your doctor if you have been prescribed blood-thinning medicines (anticoagulants) and you have a history of nosebleeds.

Taking extra precautions when playing contact sports may reduce your risk of nose injury and bleeding.

Date of last review: 17 July 2020

References

Nosebleed. [Internet]. NHS.uk. 2020 [cited 19 June 2020]. Available here.

Epistaxis (nosebleeds) - NICE CKS [Internet]. Cks.nice.org.uk. 2020 [cited 19 June 2020]. Available here.

Epistaxis [Internet]. Dynamed.com. 2020 [cited 19 June 2020]. Available here.

Epistaxis - Symptoms, diagnosis and treatment | BMJ Best Practice [Internet]. Bestpractice.bmj.com. 2020 [cited 19 June 2020]. Available here.

Content supplied byNHS Logonhs.uk

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