Nosebleeds

What causes nosebleeds?

The common site for a nosebleed to start is from 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 happens most commonly in children. This delicate area is also more likely to bleed with the following.

• Picking the nose.
• Colds, and blocked stuffy noses such as hayfever.
• Blowing the nose.
• Minor injuries to the nose.

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.

What is the treatment for nosebleeds?

For most nosebleeds, simple first aid can usually stop the bleeding.

• If you are not feeling faint, sit up and lean slightly forward.
• With a finger and thumb, pinch the lower fleshy end of the nose completely blocking the nostrils. It is useless to put pressure over the root of the nose or nose bones. Usually, if you apply light pressure for 10-20 minutes, the bleeding will stop.
• If available, a cold flannel or compress around the nose and front of face will help. The cold helps the blood vessels to close down (constrict) and stop bleeding.
• Once the nosebleed has stopped, do not pick the nose or try and blow out any of the blood remaining in the nostrils. This may cause another nosebleed.
• If you feel faint it is best to lie flat on your side.

Get medical help quickly if bleeding is heavy, or it does not stop within 20-30 minutes. Sometimes the nose needs to be packed by a doctor to stop the bleeding. Rarely, a nosebleed is so heavy that a blood transfusion is needed, and surgery may be required to stop it.

Recurring nosebleeds

Some people have recurring nosebleeds. They may not be heavy, and soon stop, but can become distressing. In this situation you may be referred to an Ear Nose and Throat unit. It is often possible to cauterise ('burn') the bleeding point. This is usually a minor procedure which is usually successful in stopping recurrent bleeds.

References

1. J Evans and T Rothenhaus Epistaxis Emedicine Article dated July 19 2005
2. Epistaxis from Surgical Tutor. Site Accessed in February 2007
3. J Corry et al. Management of Epistaxis Am Fam Physician 2005;71:305-11, 312

© EMIS and PIP 2007   Updated: February 2007