When should you worry about nosebleeds?

Nosebleeds are fairly common and most people will experience them at some point in their life. However, they can be concerning and scary, especially if you’re bleeding a lot or if your child has a nosebleed. 

Although in most cases, nosebleeds are no cause for concern, it’s good to know how to deal with them and when you should see a doctor for treatment, if needed.

What is a nosebleed?

A nosebleed happens when the blood vessels inside the lining of your nose are injured or irritated, which triggers bleeding. They can happen when you have injured your nose or out of the blue.

Around 60% of people will have a nosebleed at some point in their lives but only 10% of these cases are serious enough to need medical attention.

What causes nosebleeds?

The inside of your nose is very delicate and the smallest irritation can lead to a nosebleed. In most cases, nosebleeds are caused by:

• Blowing your nose too hard
• Picking your nose
• The inside of your nose becoming too dry

In these instances, medical treatment isn’t usually needed and the nosebleed will subside on its own.

Sometimes, nosebleeds come from deeper inside the nose, which is usually a sign that they need medical attention. This type of nosebleed more often occurs in adults and can be caused by:

• A broken nose or nose injury
• Certain medications, including blood thinners eg heparin, warfarin
• Conditions that affect how your blood clots or your blood vessels
• High blood pressure

Who is at risk of nosebleeds?

Although some people are more at risk of nosebleeds, this isn’t usually a sign of a problem that needs medical attention. Those more likely to experience nosebleeds include:

• Children — children have more blood vessels in their noses than adults, so even a small irritation can cause bleeding; this risk reduces by around age 11
• Older adults
• Pregnant women
• Those with a history of bleeding disorders
• Those who take blood-thinning medications
• Those who take medications through the nose

What should you do if you have a nosebleed?

Nosebleeds are easily treated at home so the key is not to worry. If you have a nosebleed, you should follow these steps:

• Sit down and lean forward, tilting your head forward
• Pinch your nose just above the nostrils for 10–15 minutes
• Breathe through your mouth
• Hold a tissue under your nose to absorb any blood

Some decongestant sprays can also help to stop the bleeding if they contain oxymetazoline. However, these are only suitable for occasional, short-term use. 

Don’t tilt your head back to try and stop the bleeding as this can cause the blood to run down the back of your throat where you can swallow it. Swallowing blood can upset your stomach and cause you to vomit, which can also make your nosebleed worse or cause it to start again. 

Once your nosebleed has stopped, you should avoid doing any of these things for the next 24 hours:

• Blowing your nose
• Drinking alcohol or hot drinks
• Lifting anything heavy
• Picking your nose
• Picking any scabs inside your nose
• Strenuous exercise

When should you be concerned about a nosebleed?

Although most nosebleeds are not cause for concern, you should call your GP immediately or call 111 if:

• After 15–20 minutes of  following the instructions above to stop your nosebleed, you are still bleeding
• You have lost a lot of blood ie more than 230 ml (equivalent to about two-thirds of a can of coke)
• You are having difficulty breathing
• Your nosebleed came on after a blow to your head or injury, such as a broken nose
• You have vomited after swallowing a lot of blood as a result of your nosebleed

When should you see a doctor about nosebleeds?

While most nosebleeds resolve on their own, some may need treatment. You should therefore see your GP if you are having frequent nosebleeds, or:

• Your child under the age of two has a nosebleed
• You have symptoms of anaemia (feeling faint or weak, cold, tired, pale skin, breathless)
• Your nosebleed coincides with starting to take a new medication
• You are taking blood-thinning drugs and the bleeding won’t stop
• You have a blood clotting disorder and the bleeding won’t stop
• You are getting nosebleeds as well as unusual bruising over your body

What treatments are there for nosebleeds?

There are some treatments available for chronic (long-term) nosebleeds. The treatments depend on the cause of your nosebleeds and include:

• Cauterisation to seal the bleeding blood vessel — under local anaesthetic, heat or a chemical is applied to seal the blood vessel
• Foreign body removal — if something is inside your nose that shouldn’t be, removing it can stop the bleeding
• Nasal packing — if your nosebleed won’t stop, nasal sponges, gauze, foam or an inflatable latex balloon may be temporarily inserted into your nose to apply pressure to stop the bleeding
• Medication — this includes: 
• A change in your medication or dosage — if your nosebleed coincided with taking a new medication, you may be given a different prescription or a reduced dose
• High blood pressure medication — if high blood pressure is causing your nosebleeds 
• Ligation — if your nosebleeds are caused by one blood vessel, it can be tied off to stop the bleeding 
• Surgery to repair a broken nose or correct a deviated septum in your nose if either of these is causing your nosebleeds