Nosebleed

The lining of your nose is filled with many tiny blood vessels. These blood vessels are fragile and bleed easily if they're disturbed. When this occurs, blood comes out of one or both of your nostrils. Blood flow may be heavy (trickling out in a stream or fast drips) or light (slowly dripping) and usually stops within 10 minutes.

Common causes of nosebleeds include:

• an injury to your face or a broken nose
• picking your nose using your fingers
• blowing your nose too hard or sneezing
• cold and dry air – this causes the lining of your nose to dry out and crack, such as during winter
• flying at high altitude
• scuba diving
• an infection in your airway such as a cold or sinusitis
• bacteria such as Staphylococcus aureus living in your nostrils (known as colonisation) – this is a common cause of recurrent nose bleeds in children.

Other causes of nosebleeds include:

• blood-thinning medicines such as aspirin, warfarin, dabigatran or rivaroxaban (which slow down your blood clotting)
• cocaine use
• overuse of nose sprays
• recent nose surgery
• pregnancy (which causes the blood vessels in your nose to expand)
• a foreign object in your nose – this is more common in children
• a blood disorder such as haemophilia or Von Willebrand disease
• cancer or a tumour in your nose – this is rare.

High blood pressure can make a nosebleed worse but it is unlikely to be the cause. 

You're most at risk of having nose bleeds if you:

• are a young child
• are over 60 years of age
• are pregnant
• are on blood-thinning medicines such as aspirin, warfarin, dabigatran or rivaroxaban 
• have a blood disorder such as haemophilia or Von Willebrand disease.

Nosebleeds are easily recognised by blood coming from your nose. Blood flow may be heavy (trickling out in a stream or fast drips) or light (slowly dripping) and usually stops within 10 minutes.
 
Nosebleeds may also be felt as a sensation of fluid flowing at the back of your throat, particularly if they're from the posterior part of your nose. 

Most nosebleeds aren't serious and can be usually be treated with first aid (see the treatment section below). However, if you have frequent nosebleeds (eg, more than once a week) or very heavy nosebleeds, you should see your healthcare provider. These nosebleeds could be a sign of an underlying bleeding disorder and may lead to complications such as anaemia. If your healthcare provider thinks there may be a more serious problem, they may refer you to an ear, nose and throat (ENT) specialist.

Your healthcare provider will ask you questions about your nosebleed, including whether you have had any injury to your nose, any previous episodes of nosebleeds and whether you're taking any blood-thinning medicines. Your healthcare provider will also examine your nose and look inside your nostrils.

Rarely, more tests may be needed, such as:

• blood tests such as a complete blood count to check your red blood cells, white blood cells and haemoglobin, or a coagulation screen to find out how fast your blood clots
• nasal endoscopy, where a tiny camera on a flexible thin tube used to look closely at the inside of your nose
• a CT scan of your nose.

Most nosebleeds are mild and can be managed easily with first aid. The aim of treatment is to stop the bleeding and keep your airway open.

Nosebleed first aid 

If you or someone with you gets a nosebleed:

1. Reassure them – nosebleeds can be very alarming, especially to young children.
2. Sit upright and lean forward slightly – this will help the blood drain out of your nose instead of down your throat.
3. Using your thumb and finger, squeeze the soft part of your nostrils firmly together below the bony bridge for at least 10 minutes or until blood flow has stopped. Young children may need you to do this for them.
4. Breathe through your mouth.
5. Apply a covered icepack to the bridge of your nose – cold helps blood vessels to become narrower which slows bleeding.
6. After 10 minutes, check if the bleeding has stopped. If bleeding continues after 20 minutes of pressure, or if there's too much bleeding, continue the pressure and see your healthcare provider or call 111 for an ambulance immediately.
   
   

Image credit: Healthify He Puna Waiora

Tips for nosebleed first aid

• Make sure you're squeezing the soft part of the nose – it won’t do anything if you're pressing on the hard bony bridge or top part of your nose (see the image below).
  
• Don't keep releasing the pressure to see if the bleeding has stopped. Stay sitting comfortably and watch the clock for a full 10 minutes before you check.
• If a child has a nosebleed, check if anything is stuck in their nose. It there is, don’t remove it, see a healthcare provider. 
  
  

Image credit: Healthify He Puna Waiora

After a nosebleed 

Avoid these things for at least 24 hours, as they may start the bleeding again:

• picking, sniffing or blowing your nose
• having very hot food or drinks
• having a hot shower
• strenuous physical activity
• sneezing through your nose (if you have to sneeze, let it go out of your mouth and into your elbow). 

Apps reviewed by Healthify

You may find it useful to look at some first aid and emergency apps.

A nosebleed may need to be treated by your healthcare provider or in a hospital if it's serious or if you get repeated bleeds. An antibiotic cream or ointment may be prescribed for you to apply to the inside of your nose, or they may recommend using Vaseline or petroleum jelly in your nostrils. Sometimes your nose may need to be packed with soft dressing material. 

The following procedures can be done:

• Nasal cautery – this is the use of heat, silver nitrate sticks or electric current to cauterise (burn) and seal the blood vessels causing the nosebleeds. This can be done in your GP clinic or a hospital.
• Septal surgery – if the septum (the wall between the nostrils) is crooked it can sometimes cause nosebleeds. If this is the case, your ENT surgeon may recommend having your septum surgically straightened.
• Ligation – this involves very fine surgery to tie off the burst blood vessels. It may be used if other methods don't work.

Do these things to help prevent a nosebleed:

• If you need to blow your nose, do so as gently as possible.
• Don't pick your nose.
• Keep children's fingernails short and clean.
• Try vaporisers to keep the air humid or use saline (saltwater) nasal spray, or apply Vaseline twice daily, if your nose is crusty and dry. These products are available at pharmacies.
• Use a head guard while playing contact sports, such as boxing or rugby.
• Control your blood pressure if you have high blood pressure.
• Talk to your healthcare provider if you're taking blood-thinning medicines and have recurring nosebleeds.
• Avoid overuse of nasal decongestants – always follow packet instructions. Ask your pharmacist if you're not sure about using them.