Nosebleeds

Nosebleeds (also known as epistaxis) are a common problem. The amount of bleeding can vary from slight to profuse.

What causes nosebleeds?

Most nosebleeds come from the front part of the nasal septum (the tissue that separates the nostrils), which has many blood vessels. If this area just inside the nose becomes irritated by infection, nose picking, or simply drying out, nosebleeds can result. Nosebleeds that are caused by the nasal membranes drying out are often seen in the drier areas of Australia or in winter months when the air is drier and we use heating in our homes.

Less commonly, nosebleeds may originate from further back in the nose. These types of nosebleeds usually affect older people, and often the bleeding is more difficult to control.

There are also a number of medicines that can make people more susceptible to nosebleeds. These include:

  • medicines such as warfarin;
  • some types of aspirin; and
  • several types of anti-inflammatory medicines.

Colds and flu can often increase the incidence of nosebleeds and in the colder months the fluctuations in hot and cold temperatures — particularly from being outside and then going inside heated buildings — can trigger nosebleeds in many people.

Known causes of nosebleeds

  • Infection in the nasal membranes.
  • Nose picking.
  • Respiratory infections.
  • Trauma.
  • Allergies and hay fever.
  • Foreign objects in the nose (usually seen in children).
  • High blood pressure.
  • Constipation causing straining.
  • Medicines such as the ‘blood thinners’ (e.g. warfarin).
  • Excessive alcohol intake.
  • Some types of tumours.
  • Inherited bleeding disorders.

First aid for nosebleeds

Most nosebleeds cause only minor discomfort and inconvenience and can be handled at home. However, if the bleeding is severe and/or the nosebleeds happen regularly, you should speak to your doctor to make sure that there is no underlying serious cause.

To stop nosebleeds

  • Squeeze or pinch the soft parts of the nose together gently with your thumb and index finger.
  • Firmly press the pinched parts of the nose towards the bones of the face.
  • If possible, hold the nose in this position for about 10 to 15 minutes. You may have to repeat this technique until the bleeding ceases.
  • Sit up, keeping the head elevated — do not lie down or put your head between your legs. Lean with the head slightly forward to avoid blood flowing down the throat.
  • Apply crushed ice to the nose and cheek areas.
  • After a nosebleed, rest with the head elevated.

Preventing nosebleeds

If you have had a nosebleed you should try to minimise the likelihood of it happening again. Here are some guidelines that may be of help.

  • Try not to blow or pick your nose. If you need to sneeze, open your mouth so that the air escapes from the mouth and not the nose.
  • Avoid bending over for several hours — it’s important to keep your head higher than the level of your heart.
  • Constipation can be a cause of nosebleeds, so you may need a stool softener to prevent straining.
  • Avoid straining or bending to lift anything heavy.
  • Avoid smoking.
  • Avoid hot liquids for at least 24 hours after a nosebleed.
  • Avoid aspirin if possible. If your doctor has prescribed aspirin for a specific condition, ask what can be done for the nosebleeds.
  • A lubricating ointment may be of benefit. Check with your pharmacist for the best one for you.
  • Some people may benefit from the use of a nasal decongestant spray, but these should be used only for a short period (1–2 days).

When to see a doctor

Always remember that if the bleeding is profuse and persists you should contact your doctor or hospital emergency department. You should get immediate medical attention if your nosebleed lasts longer than 20 minutes, or if it occurs after a head injury or accident that may have broken your nose. You should also see your doctor if you have recurrent nosebleeds (which may be a sign of an underlying medical problem).

While most nosebleeds settle easily with simple first aid measures, some can be serious. Severe nosebleeds, especially those coming from the area at the back of the nose, may require nasal packing with gauze or a special type of inflatable latex balloon. Alternatively, nasal cautery (where the bleeding vessel in the nose is sealed by applying a special solution or an electrical or heating device) may be performed.

Last Reviewed: 15 August 2012
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References

1. Australian Resuscitation Council Guideline 9.1.1 – Principles for the control of bleeding for first aiders (November 2008). http://www.resus.org.au/policy/guidelines/section_9/guideline-9-1-1nov08.pdf (accessed Aug 2012).
2. Epistaxis (revised February 2008). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2012 Jul. http://online.tg.org.au/complete/ (accessed Aug 2012).
3. MayoClinic.com. Nosebleeds (updated 10 Aug 2012). http://www.mayoclinic.com/health/nosebleeds/MY01201 (accessed Aug 2012).
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