Nosebleeds (Epistaxis)

What causes nosebleeds?

Nosebleeds usually start just inside the entrance of the nostril, on the nasal septum (which divides the nasal cavity into two). At this site, the blood vessels are quite fragile and can rupture easily for no apparent reason. Bleeding can also occur further back in the nose. In most cases there is no specific cause for the bleed but rarely, nosebleeds can indicate an underlying problem. Contact your doctor if they persist despite the measures below or recur frequently.

Nosebleeds are more likely to occur:

• If you pick your nose
• If you have a cold or blocked stuffy nose from something like hayfever
• When you blow your nose

In most cases, the bleeding tends to last only a short time and is usually easy to control. The bleeding may be more prolonged and harder to stop if you have: high blood pressure; heart failure; a blood clotting disorder; or are taking 'blood thinning' drugs (anticoagulants) such as Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel, Ticagrelor.

How do I stop a nosebleed?

The following may help to stop your nosebleed:

Sitting forward with your mouth open and spit out any blood – try not to swallow blood as it will irritate your stomach and make you feel sick.

1. Pinch hard the fleshy/flexible part of your nose. It is useless to put pressure over the root of your nose or nose bones.
2. Apply an ice pack over the bony bridge part of your nose (a pack of frozen peas may be used) and suck an ice cube. The cold helps the blood vessels to constrict (become narrow) and stop bleeding.
3. Try to remain calm and rest quietly.
4. If after 20 minutes it has not stopped seek medical advice.

Having stopped the nosebleed, try to avoid:

1. Blowing your nose (for up to one week).
2. Sneezing through your nose – keep your mouth open.
3. Hot and spicy food and drinks, including alcohol for two days.
4. Heavy lifting, straining or bending over – for example: tying shoe laces.
5. Vigorous activities – rest quietly.
6. Picking your nose – you can put the tip of a tube of antiseptic cream up your nostril.
7. Sleep propped up for the first night with the windows open.

Recurring nosebleeds

Some people suffer from recurring nosebleeds. They may not be heavy, but they can become distressing. In this situation you may be referred to the Ear, Nose and Throat department. It is possible to cauterise ('seal') the bleeding point using an endoscope. This is a minor procedure which is usually successful in stopping recurrent bleeds.