Nose Bleed (Epistaxis)

A nosebleed (also known as epistaxis) is bleeding from the nose due to burst blood vessels at the front or back of the nose

The bleeding is usually mild and easily treated. If the bleeding is more severe, it is usually in older people or in people with other medical problems.

We don’t always find a reason for why your nosebleed occurred.

The common site for a nosebleed to start is in Little’s area. This is just inside the entrance of the nostril, on the nasal septum (the middle harder part of the nostril). Here the blood vessels are quite fragile and can rupture easily for no apparent reason.  This delicate area is also more likely to bleed with the following:

• Picking the nose.
• Colds, and blocked stuffy noses such as hay fever.
• Blowing the nose.
• Minor injuries to the nose.
• Changes in temperature.

Bleeding sometimes comes from other areas further back in the nose. It is sometimes due to uncommon disorders of the nose, or to serious injuries to the nose. 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, clopidogrel, apixaban and aspirin.

A member of staff will take your observations (your pulse, blood pressure etc). If your observations suggest you are becoming unwell with the amount of the bleeding or your bleeding has been ongoing for some time, we may move you to a different area of the Emergency Department, where we can monitor you more closely.

A doctor or nurse will help treat you, using pressure on the soft part of your nose and using gauze to absorb blood.

Nasal cautery

• If the source of the bleeding can be identified by the doctor or nurse they may seal the blood vessel with a chemical called silver nitrate to reduce the chance of it bleeding again. This is called nasal cautery and normally takes around 20 seconds to do. It can sting a bit but most patients don’t find this troublesome. Occasionally it can cause some dark staining of the skin below the nostril which can take a few weeks to settle.

Nasal packing

• Your nose may require packing, with a sponge to stop the bleeding or if severe with an epistaxis balloon. The packing will completely block your nose and you will need to breathe through your mouth
• If your nose is packed with an epistaxis balloon, this will remain in place for 24 to 48 hours. Since your nostril will be blocked you may experience: a mild headache; dry mouth; reduced appetite; reduced taste sensation; difficulty swallowing; or watery eyes. It may be necessary to admit you to hospital but it may be possible to discharge you home with ENT (Ear Nose & Throat) specialist follow-up.

To avoid another nose bleed please follow the advice given below for at least three days:

• All food and drink should be cool
• Avoid strenuous activity, heavy lifting/pushing/pulling etc
• Avoid constipation and straining
• Do not take hot baths or showers
• Avoid alcohol and smoking
• Avoid scratching or blowing your nose. Sneeze with your mouth open if needed

If you have had nasal cautery, you may have been prescribed Naseptin cream which should be applied at least twice a day for one week.  If you have an allergy to peanuts, use Vaseline instead of Naseptin cream.

Apply the Naseptin or Vaseline with the tip of your little finger (please make sure the nail is short) - wiping the cream on the inner edge of the affected nostril then press the outer part of the nostril to spread the cream inside the nostril.  Avoid touching the inside of the nostril with your finger as this may cause further bleeding. 

• Try to avoid lifting, pushing/pulling/heavy lifting, strenuous exercise, constipation and stressful situations, as they can cause your blood pressure to rise and increase the chances of a nosebleed. For sleeping, try to lie propped up in bed to reduce the pressure in the nasal blood vessels.
• Do not blow, pick or attempt to clean the inside of your nose. The crusting discomfort you may feel is part of the healing process, and if you remove the crusts, you may infect the area or cause another nosebleed.
• You may have dark red or brown discharge from your nose. This is usual and is nature’s way of clearing the nose.

First Aid Advice

If you have a further nose bleed, sit upright and lean slightly forward. Firmly squeeze the soft lower half of the nose between the thumb and first finger for at least 10 minutes, without releasing. Spit out any blood as swallowing this may make you feel sick. A cold compress on the top of the nose or sucking ice may help

If your nose is bleeding is still bleeding after 20 minutes or you feel unwell, seek urgent medical advice or go to your local Emergency Department