Nosebleeds (Epistaxis)

Nosebleeds happen when a fragile blood vessel in your nose gets broken, due to infection, injury or other reasons. They’re very common and are usually nothing to worry about, but if you have them often, you should see a specialist who can diagnose the cause.

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What is a nosebleed (epistaxis)?

Having a nosebleed means you’ll see blood coming out of your nose. Epistaxis is the medical term for this.

Nosebleeds are caused when a fragile blood vessel in your nose breaks and leaks blood. Many things can cause a nosebleed, from a minor injury or an infection, to high blood pressure, hormone changes or too much nose blowing. They can happen anytime – usually unexpectedly – but are more likely to occur in the morning or late evening.

Anyone can have a nosebleed, but they’re slightly more common in men than women. They tend to affect the elderly and are also very common in children, with over half of children between the ages of 6 and 15 years old having regular nosebleeds.

At Welbeck, our consultants diagnose and treat patients with nosebleeds in our state-of-the-art Ear, Nose & Throat centre.

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Usually, the only symptom is blood coming from your nose. It might sting a bit or make your nose feel blocked.

If you don’t like the sight of blood, you might feel a bit dizzy or faint. You might swallow some blood if a larger vessel and the back of the nose breaks, which can make you feel a bit sick.

If you have any other symptoms, we recommend seeing one of our specialists. 

Seek emergency help for a nosebleed if:

  • the bleeding started after a blow to your head

  • you’re feeling weak, dizzy, or are struggling for breath

  • the nosebleed lasts longer than 15 minutes

  • the bleeding seems excessive

  • you're swallowing enough blood to make you vomit

A broken blood vessel in your nose causes a nose bleed. So what are the reasons a blood vessel breaks? Common reasons include:

  • colds and infections that cause repeated coughing, sneezing, and nose-blowing

  • rhinosinusitis and allergies inflaming the nasal lining

  • a dry nasal lining – from dry air, smoking, dehydration or a combination; or frequent use of nasal sprays containing decongestants and antihistamines, which can dry out the nasal membranes

  • use of recreational drugs, such as cocaine, that are inhaled through the nose

  • high altitudes and changes in temperature and humidity

Risk factors for nosebleeds include:

Blood clotting issues

Between the ages of 45 and 80, blood may take longer to clot, resulting in excessive bleeding when a blood vessel in the nose is damaged.

Anyone who uses anticoagulant medications for heart conditions (like aspirin and warfarin) is also at a greater risk of recurring nosebleeds (frequent epistaxis).

Pregnancy

Many women experience nosebleeds during pregnancy due to hormonal changes and increased blood flow, placing greater pressure on the delicate blood vessels in the lining of the nose.

A condition called pregnancy rhinitis usually affects women in the first trimester. This is where the mucous membranes in the nose swell and become inflamed, causing congestion, stuffiness, and sometimes nosebleeds.

Blood vessel disorders

Hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder that affects how blood vessels form. Adults with HHT have some blood vessels that haven’t developed properly, causing frequent nose bleeding or arteriovenous malformations (AVMs).

Excessive alcohol consumption

Alcohol is a natural blood thinner. Excessive amounts can cause dehydration and, in turn, dry the nasal passages out, increasing the risk of nosebleeds. People with high blood pressure who consume excessive amounts of alcohol are also more likely to suffer from nosebleeds. 

Nasal surgery

Patients who have recently undergone surgery on their nose (rhinoplasty, septoplasty, or septorhinoplasty, for example) may experience bleeding, usually as a result of the incisions made, use of blood thinners, or outside impacts.

Other possible nosebleed causes in adults include:

  • a deviated septum

  • colds and infections that cause repeated coughing, sneezing, and nose-blowing

  • rhinosinusitis and allergies cause the inflammation of the nasal lining

  • use of recreational drugs, such as cocaine, that are inhaled through the nose

  • high altitudes and changes in temperature and humidity

  • frequent use of nasal sprays containing decongestants and antihistamines, which can dry out the nasal membranes

In children, a minor skin infection called Staphylococcus Aureus can cause crusting inside the nose. This may be transferred to the inside of the nose by the child’s finger when they pick their nose, a common childhood habit, which can damage the nose lining and lead to nosebleeds.

Diagnosing the cause of regular nosebleeds usually involves an initial consultation where our ear, nose and throat specialist will: 

  1. Take a medical history to understand your health and any medications you’re on – for example, some medicines that thin the blood might make nosebleeds more likely, and drinking alcohol regularly may also contribute, as could sniffing substances such as snuff or illegal drugs.

  2. Get a full understanding of your symptoms and how they affect you – for example, how long does it last, how much blood you tend to lose, what makes them worse or better, how they affect your life.

  3. Examine your nose, check your pulse and blood pressure.

  4. Review any previous notes and explore family history to see if there are any conditions that might cause blood-clotting issues or a higher chance of nosebleeds.

  5. Talk through their initial findings and recommend treatment options.

  6. They may recommend tests such as blood tests or scans if you’re having frequent nosebleeds.

Some basic steps may help reduce the risk of a nosebleed, such as:

  • blowing your nose as little as possible and only very gently – try dabbing a runny nose

  • avoiding picking your nose, and keeping your fingernails short in case you do it without realising

  • keeping your nose lining moist with saline drops – your consultant can advise you on suitable products and how often to use them

  • avoiding dry air when you can – for example, putting plants or a bowl of water in an air-conditioned office space or centrally heated home can help, as can using a humidifier

  • quittin smoking – it dries out and irritates your airways, including your nose

  • managing allergies well to reduce sneezing and nose-blowing

  • using nasal decongestants as instructed – overusing them can cause nosebleeds

  • managing high blood pressure – this will also reduce your risk of cardiovascular events

protecting your head in sports or activities where your head or nose could get knocked

If you swallow blood during a nosebleed, you may feel sick and vomit. Heavy, regular nosebleeds may cause dizziness in the moment, and anaemia over the longer term.

You can treat many nosebleeds yourself with some simple steps. Your consultant will advise you to:

  • sit up: this will prevent the blood from running down the back of your throat, which can cause nausea, vomiting, and diarrhoea

  • lean forward: this allows you to spit out any blood in your mouth, to stop you swallowing it

  • pinch the soft part of your nose: using your thumb and index finger, firmly pinch either side of the nostrils for 10 to 15 minutes without releasing pressure to help stop the bleeding – don’t be tempted to let go and check before that time

  • apply a cold compress or ice pack: holding an ice pack against the bridge of the nose can help narrow blood vessels and slow the bleeding

  • avoid lying down: staying in an upright position will reduce the blood pressure in the blood vessels, helping to reduce further bleeding

  • measure the amount of blood loss: catch it in a bowl if you can, to give medical professionals an idea if you need to be examined

If you can’t stop the blood flow after 10 to 15 minutes, seek medical care. Your consultant may suggest treatments including:

  • antiseptic creams used regularly for a few weeks, if the cause of your nosebleeds is crusting and infection inside the nose

  •  inserting a nasal pack of gauze or foam in one or both nostrils to apply pressure to the septum and stem the bleeding – it will need to stay in place for at least 24 hours to ensure the bleeding vessel has stopped, and this may be in hospital if you’ve been taking blood thinners and need a prescription review

  • cauterisation to seal the blood vessel – with a chemical substance or heat energy, using a local anaesthetic

  • tying off or blocking the blood vessels with the surgical procedure that’s right for you – in cases of repeated or severe nosebleeds

    • using telescopes and diathermy to stop bleeding from deep within your nose

    • sphenopalatine artery ligation – sealing off the main blood vessel in your nose, which is located behind your cheek, using telescopes to avoid cutting the skin around your nose

    • embolisation – passing small guidewires along a blood vessel from your leg up into your nose and using fine mesh or glue to seal the blood vessel

At Welbeck, our ear, nose and throat specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.

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London

1 Welbeck Street
Marylebone
London
W1G 0AR

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Frequently asked questions

Although seeing blood coming out of your nose can be alarming, most nosebleeds aren’t serious. You can usually manage them at home. We highly recommend seeing your consultant to rule out any underlying medical conditions if:

  • you experience more than 3 to 4 nosebleeds a week (or 6 or more in a month)

  • you feel weak, faint, tired, cold, short of breath or have paler skin than usual – as these could be symptoms of anaemia due to blood loss

  • you get a nosebleed around the time you start a new medication

  • your nosebleeds come alongside unusual bruising all over your body — this combination may indicate a more serious condition, such as a blood-clotting disorder

  • your child is under age 2 and has a nosebleed

Frequent nosebleeds can be a symptom of cancer.

Leukaemia is a type of blood cancer that affects the bone marrow and its ability to produce normal blood cells. Symptoms often include fatigue, a pale complexion, shortness of breath, bruising, and bleeding from the nose, gums, and stools.

Nasopharyngeal cancer develops in the nasopharynx, which connects the back of the nose to the back of the mouth. Symptoms include a lump or growth in the neck area (lasting more than 3 weeks), hearing loss and ringing in the ears (tinnitus), headaches, difficulty swallowing, stuffy nose, double vision, facial numbness, and nosebleeds.

Nosebleeds are also common symptoms of nasal and sinus cancer, along with a persistent stuffy nose affecting 1 nostril, a lack of smell, bloody mucus running from the nose, and mucus draining to the back of the nose and throat.

Our consultants specialise in diagnosing any underlying causes of nosebleeds.

After a nosebleed, you should:

  • avoid hot drinks, and hot showers for 24 hours – heat can cause the blood vessels to widen (dilate), which can trigger the bleed again

  • avoid blowing your nose for a couple of days

  • don’t hold back sneezes, as it can increase pressure in your nose – cover your mouth and sneeze with your mouth open  

  • avoid constipation and straining to poo, as it increases the pressure inside your nose

  • don’t pick or try to clean away clots inside your nose, as you could dislodge them and restart the bleed

  • stay away from very smoky or dry places for a week

Nosebleeds can happen at night for exactly the same reasons as nosebleeds in the day.

This includes:

  • dry air – the blood vessels in the nose are sensitive to dryness. While you’re breathing through your mouth when you sleep, the membranes are more likely to crack, making the blood vessels bleed

  • allergies – if you suffer from allergies or hay fever, you might have spent most of the day sneezing, which irritated the nasal passages and makes them more prone to bleeding (especially when you lie down)

  • medications – anyone who takes blood thinners or aspirin is at a greater risk of nosebleeds, as these are designed to prevent blood clots, making you bleed more easily and take longer to stop

  • sleeping with your head to one side – this can also put pressure on the nasal cavity, much like a cold, allergies, and changes in pressure, humidity, and temperature, causing your nose to bleed

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