The initial treatment for a nosebleed is always the same, regardless of what has caused it. The first step is always to stop the bleeding. The next step will be to consider what has caused it and what, if any, further action needs to be taken.
Stopping the bleeding
If you are having a nosebleed you should:
- sit down and firmly pinch the soft part of your nasal cavity, just above your nostrils, for 10 minutes,
- lean forward and breathe through your mouth. Leaning forward drains the blood down your nose instead of down the back of your throat,
- stay upright, rather than lying down, as this reduces the blood pressure in the veins of your nose and will discourage further bleeding,
- maintain the pressure on your nose for up to 20 minutes (time this on the clock) so that the blood clots,
- place a covered ice pack on your cheek to help soothe the area,
- avoid blowing your nose, bending down and strenuous activity for at least 12 hours after a nosebleed. Try to keep your head above the level of your heart for this time.
Recurrent bleeding in children that arises from persistent crusting of the inside of the nostrils is best treated using a softening ointment such as petroleum jelly (Vaseline) to soften the inside of the nose.
See your GP if the bleeding is very heavy or if it does not stop after maintaining pressure for 20 minutes.
Also seek help if:
- you often have more than one nosebleed a week (it may be due to an undiagnosed underlying condition),
- you have had an injury to your head, such as a blow, or a fall (you may have broken your nose), or
- you are taking an anticoagulant (a blood-thinning medicine), such as warfarin, and the bleeding does not stop, or re-occurs.
If you seek medical help because your nosebleed has not stopped bleeding, your nose may be packed with ribbon gauze, or a special nasal sponge. The aim is to apply pressure to the source of the bleeding in order to cut off the flow of blood. This is done by packing the ribbon gauze inside your nose as far back as possible.
Your GP, or the healthcare professional who is treating you, will explain the process to you and tell you how long you will need to keep the pack in place. You should also be given an appointment to return to have it removed. After the bleeding has stopped, and your nose is unpacked, it will be thoroughly examined.
You should avoid any over-exertion while your nose is packed, and for 1-2 weeks afterwards.
Your GP may check your blood pressure and pulse rate to identify any underlying causes of your nosebleed. Frequent or heavy nosebleeds can be a symptom of some types of blood disorder, such as haemophilia, so your GP may order a blood test to see if your blood is clotting properly.
If your nosebleeds are found to be caused by medication that you are taking, such as blood-thinning medicines (anticoagulants) like aspirin, warfarin, or heparin, or an anti-inflammatory medicine, your GP may need to change, or adjust, these.
In severe cases, you may require surgery to your nose to prevent the nosebleeds happening again (see below). If necessary, your GP will refer you to an ENT (ear, nose and throat) specialist.
Nasal fractures (cracks or breaks in the bones of the nose) account for nearly 50% of all facial fractures. Most fractures are simple and will not require an X-ray. However, if it is a more serious injury, an X-ray may be taken of your entire face and skull.
Fractures can cause a lot of swelling around the nose. It may take between 5-7 days for this to go down enough to allow a full examination. Once the swelling has settled, there is often little change to the shape of your nose and it can be left to heal alone.
If there is a change in the appearance of your nose it can be manipulated under anaesthetic by an ENT specialist (they will move your nose back into place using their hands). Manipulation is most effective within two weeks of injuring your nose.
Surgery for recurring nosebleeds
Your ENT specialist may recommend surgery if you have frequent nosebleeds and the cause can be identified.
Your septum (the wall between the two nose channels) can be crooked from birth, or it can become crooked following an injury. If it causes nosebleeds, you can have septal surgery to straighten it. This will be carried out under local or general anaesthetic and should take less than an hour.
As septal surgery is surgery inside your nose, it should not leave any external scars. During the surgery, some of the bone and cartilage inside your nose is removed and the septum is moved back into the middle of your nose. Afterwards, you will have a dressing placed on your nose for a day or two to keep it in place and prevent bleeding. You will need to rest for a week, or for two weeks, if your job involves heavy lifting, or carrying.
After the operation, you may experience the following side effects:
- bleeding up to 10 days after the surgery,
- a blocked nose for two weeks after the surgery, though it can take up to three months for your breathing to clear completely, or
- an infection in your nose (although this is rare).
Your ENT specialist will explain the procedure to you in more detail.
A minor procedure to cauterise (burn) the place where the bleeding is coming from can be successful in stopping recurring nosebleeds. If a particular blood vessel is rupturing and causing your nosebleeds, it can be cauterised to prevent it happening again. This will be done with either:
- an electric current running through a wire, (electrocautery), or
- a chemical agent, on the end of a wool swab (chemical cautery).
The bleeding area will be touched for around 10 seconds with one of the above in order to burn and seal it.
Cautery does have some associated problems - for example:
- chemical cautery can be a painful experience, particularly for children, even with the use of a local anaesthetic,
- it is also not always effective as bleeding can occur from around the cauterised area , and
- it can only be used if a specific bleeding point can be identified.
If other treatments do not work, ligation may be recommended. This involves tying off the end of the relevant blood vessel that is bleeding. Endoscopic surgery (using very fine instruments) can be used to tie off the end of the blood vessel so that blood can no longer escape from it. In some, rare cases, the main artery, which the bleeding blood vessel branches off from, may need to be tied off.
If the bleeding blood vessel is very far back in the nose, or if it is difficult to compress, more major surgery may be required. Some possible side effects of ligation include:
- re-bleeding (the blood vessel still cause nosebleeds),
- swelling, numbing, or bruising of the face, or
- a dry, or runny, nose.
Glossary of Terms
Anti-inflammatory medicines reduce swelling and inflammation.
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.
A swab is a small piece of absorbent material, such as gauze or cotton, attached to the end of a stick or wire. Swabs are used to clean wounds, apply medicine, or to absorb samples of body fluids so that they can be tested.