Discharge information following a nosebleed (epistaxis)

What causes nosebleeds?

During a nosebleed, blood flows from one or both nostrils and can last from a few seconds to over 10 minutes.

Nosebleeds can be caused by a number of different factors which are not always easy to identify.

Nosebleeds can start just inside your nostrils (anterior) or at the back of your nostrils (posterior). Anterior and posterior nosebleeds usually have different causes.

Anterior nosebleeds

The most common place for a nosebleed to start is just inside the nostrils by the septum (middle of the nostrils).

This is due to the delicate blood vessels inside your nose becoming damaged.

This can happen easily. The most common causes for anterior nosebleeds include:

• picking your nose.
• blowing your nose very hard.
• a minor injury to your nose.
• colds and stuffy noses, such as when you have hay fever.
• changes in humidity or temperature causing the inside of your nose to become dry and cracked.
• cocaine use.

Posterior nosebleeds

Sometimes, bleeding can come from the blood vessels deeper inside the nose.

Bleeding can be caused by a number of things including:

• medication such as aspirin and other blood thinners.
• medical conditions such as haemophilia or Von Willebrand disease.
• a blow to the head.
• recent nasal surgery.
• high blood pressure and atherosclerosis (hardened arteries).

Posterior nosebleeds are much less common and usually affect older adults. They can be serious because the blood flow is heavy. If the bleeding continues for over 20 minutes, please seek advice from NHS 111.

What to do if you have a nosebleed?

When you have a nosebleed there are some simple steps you can take to help it stop:

1. Sit down and firmly pinch the soft part of your nose, just above your nostril openings, for 10 to 15 minutes.
2. Lean forward and breathe through your mouth – this will drain the blood down your nose instead of it going down the back of your throat.
3. Place an ice pack or bag of frozen vegetables covered with a towel on the bridge of your nose.

Steps that may prevent further bleeding

• Avoid hot drinks, hot baths, alcohol, smoking, straining on the toilet, heavy lifting and exercise for a few days.
• Avoid both blowing your nose and picking the clot.
• Avoid nasal sprays if not prescribed by a healthcare professional.

When to seek medical advice

If after 20 minutes your nose is still bleeding heavily and there are no signs of it slowing down, contact NHS 111 for advice. If the person is unwell and has other health conditions, telephone 999.

Usually, the bleeding will stop if you have followed the advice on this page. No further treatment will be needed. However, please contact your GP or NHS 111 if:

• the patient is under 2 years old and has not injured their nose or face.
• you have had several nose bleeds over the last few days.
• you are taking blood thinning (anticoagulant) medication.

Further information

NHS111

Tel: 111

NHS UK

www.nhs.uk/Conditions/nosebleed/Pages/introduction.aspx

British Red Cross

Learn first aid for a child who has a nosebleed.

www.redcross.org.uk/first-aid/learn-first-aid-for-babies-and-children/nosebleed

Dealing with a nosebleed

www.patient.info/health/dealing-with-a-nosebleed