Nosebleeds are common and usually stop with simple first aid. They happen when delicate blood vessels inside the nose break. This can be alarming, particularly if there seems to be a lot of blood, but most nosebleeds are not a sign of a serious problem.
Knowing what causes nosebleeds and how to respond calmly can make the situation easier to manage. It is also important to recognise when recurring nosebleeds, heavy bleeding or bleeding from one side of the nose should be assessed.
What causes nosebleeds?
The front part of the nasal septum, the wall that divides the two sides of the nose, contains many tiny blood vessels close to the surface. These vessels can break easily.
Common nose bleed causes in adults and children include:
- Dry air, particularly during colder weather or when central heating is on
- Picking the nose or rubbing it frequently
- Blowing the nose hard
- Colds, sinus symptoms and allergies
- Minor injury to the nose
- Nasal sprays, particularly if used incorrectly or more often than advised
- A blocked nose that leads to frequent blowing or irritation
Nosebleeds may also be more likely or harder to stop if you take medicines that affect blood clotting. These are often called blood thinners and include anticoagulants and antiplatelet medicines. Do not stop prescribed medication because of a nosebleed without speaking to the clinician responsible for your care.
High blood pressure does not explain every nosebleed, but it can be linked with bleeding that is more difficult to control. Other causes can include blood clotting problems or bleeding from further back in the nose, which is more common in older adults.
Sometimes there is no obvious reason why a nosebleed has happened.
How to stop a nosebleed
The most important step is to apply firm, continuous pressure to the soft part of your nose, just above the nostrils. Do not pinch the hard bridge of the nose.
Step-by-step first aid for a nosebleed
- Sit upright and lean forward slightly.
- Breathe through your mouth. Spit out any blood that reaches your mouth rather than swallowing it.
- Use your thumb and finger to pinch the soft, fleshy part of your nose firmly.
- Hold this pressure continuously for 10 to 15 minutes. Set a timer if helpful.
- If it is still bleeding, repeat the pressure for a further 10 minutes.
- Once the bleeding has stopped, avoid blowing, picking or rubbing your nose for at least 24 hours.
Leaning forward is important. Tilting your head back does not stop the bleeding. It can cause blood to run down the back of your throat, where it may make you cough, choke or feel sick.
A cool pack wrapped in a cloth can be placed on the bridge of the nose if it feels comfortable, but firm pressure remains the key part of first aid.
What not to do during a nosebleed
When you are trying to stop a nosebleed, avoid:
- Tilting your head backwards
- Lying flat
- Putting tissue, cotton wool or other objects inside the nose
- Repeatedly checking whether the bleeding has stopped before the full 10 to 15 minutes has passed
- Blowing your nose straight afterwards
Stuffing tissue into the nostril can disturb the clot when it is removed and start the bleeding again. Lying down or tilting your head back can also make it more likely that blood will run into your throat.
Why do I keep getting nosebleeds?
Frequent nosebleeds can happen when the lining of the nose remains dry, inflamed or irritated. This is common during autumn and winter, but can occur at any time of year.
Recurring nosebleeds may be linked to:
- Dryness and crusting inside the nose
- Allergies or repeated colds
- Regular nose-picking or forceful nose-blowing
- Ongoing use of some nasal sprays
- A fragile blood vessel near the front of the nose
- Blood-thinning medication
- A structural problem or inflammation inside the nose
If you have frequent nosebleeds, keeping the nasal lining moist may help. A pharmacist or clinician can advise on appropriate saline sprays, gels or ointments.
Recurrent one-sided nosebleeds warrant ENT assessment. Although there may be a straightforward cause, such as a visible fragile blood vessel, it is important to examine the inside of the nose and rule out other problems.
When a nosebleed needs medical attention
A single short-lived nosebleed that stops with pressure is usually not a cause for concern. However, you should seek urgent medical advice if bleeding continues after around 20 minutes of correct first aid, or sooner if it is very heavy.
Call 999 or attend A&E if you have a nosebleed and:
- The bleeding is heavy or you are losing a large amount of blood
- You feel weak, faint or dizzy
- You have difficulty breathing
- You are swallowing a large amount of blood or vomiting
- The nosebleed follows a significant injury to your head or face
- You have symptoms that may suggest a stroke, such as facial weakness, arm weakness or difficulty speaking
You should arrange a medical assessment if:
- You are having regular or frequent nosebleeds
- Nosebleeds repeatedly happen from one nostril
- You take blood-thinning medication
- You have a known bleeding or clotting condition
- You have symptoms such as unusual tiredness, breathlessness, palpitations or looking paler than usual
- A child under two has had a nosebleed
NHS guidance advises assessment for regular nosebleeds, nosebleeds in people taking medicines that prevent blood clots and symptoms that could suggest anaemia.
How recurring nosebleeds can be treated
An assessment can help identify where the bleeding is coming from and whether there is an underlying cause. This may involve looking inside the nose, reviewing your medicines and checking for signs of dryness, inflammation, infection or a visible blood vessel.
Where a fragile vessel is responsible for repeated bleeding, nasal cautery may be recommended. This is an outpatient procedure that seals the bleeding point using a chemical agent. It can be a quick option for suitable patients with recurrent bleeds from the front of the nose.
Other approaches may include advice on moisturising the nasal lining, treatment for allergies or infection, or further investigation where the cause is unclear.
When to speak to an ENT specialist
Most nose bleeds settle without specialist care. However, frequent, heavy or one-sided bleeding is worth investigating.
An ENT specialist can examine the nose carefully, identify possible triggers and discuss appropriate management. This can be particularly helpful if nosebleeds keep returning despite first aid and simple measures at home.
Nosebleeds FAQs
- What causes nosebleeds?
Nosebleeds are usually caused by delicate blood vessels inside the nose breaking. Dry air, nose-picking, hard nose-blowing, colds, allergies and minor injury are common triggers. Blood-thinning medicines can also make bleeding more likely or more difficult to stop.
- How do I stop a nosebleed in a child?
Ask the child to sit upright and lean forward. Pinch the soft part of their nose firmly for 10 to 15 minutes without releasing the pressure. Encourage them to breathe through their mouth and spit out any blood. Seek medical advice if the bleeding is heavy, does not stop or the child is under two years old.
- Are frequent nosebleeds a sign of something serious?
Frequent nosebleeds are often caused by irritation, dryness or a fragile blood vessel. However, they should be assessed, especially if they are one-sided, becoming more frequent or happening alongside other symptoms.
- Can I take my blood-thinning medication after a nosebleed?
Do not stop or change prescribed blood-thinning medication without medical advice. If you have a nosebleed while taking these medicines, particularly if it is heavy, prolonged or recurrent, speak to a clinician promptly.
- When should I worry about a nosebleed?
Seek urgent help if the bleeding is heavy, continues after around 20 minutes of firm pressure, follows a significant injury or leaves you weak, dizzy or short of breath. Recurrent one-sided nosebleeds should also be assessed by an ENT specialist.
