Nosebleed

What causes a nosebleed?

The common site for a nosebleed (epistaxis) to start is from just inside the entrance of the nostril, on the middle harder part of the nostril (the nasal septum). 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 with קדחת השחת.

• Blowing the nose.

• Minor injuries to the nose.

• Cocaine use.

Some people with high blood pressure (hypertension) have a higher risk of having a nosebleed. Much rarer causes of nosebleeds include tumours and blood clotting disorders.

Most often, the bleeding tends to last only a short time and is usually easy to control. The bleeding may last longer and be harder to stop if you have heart failure, a blood clotting disorder, or are taking 'blood-thinning' medicines such as warfarin or aspirin.

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.

For most nosebleeds (epistaxes), 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 nasal 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 to 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.

The reasons to see a GP about nosebleeds include:

• A child under 2 years old.

• Recurrent nosebleeds.

When to go to A&E for a nosebleed

You should go to the nearest hospital A&E if:

• Bleeding does not stop after 10–15 minutes despite the measures outlined above.

• You have lost a lot of blood, including if you're swallowing a large amount of blood that makes you vomit.

• You feel unwell and weak, dizzy, lightheaded or breathless with a nosebleed (call an ambulance; call 999 in the UK).

• You have a condition that prevents your blood from clotting properly, or you are taking a medicine that prevents blood clots (anticoagulant).

• You are otherwise frail because of other health problems.

Some people have recurring nosebleeds (epistaxes). These may not be heavy and they soon stop; however, they can become distressing.

Chlorhexidine with neomycin cream (Naseptin®) is equally as effective as nasal cautery, so is usually the first-line treatment. However, if Naseptin® is ineffective, you may be referred to an Ear Nose and Throat unit to 'burn' (cauterise) the bleeding point. This is normally a minor procedure which is usually successful in stopping recurrent bleeds. Alternatively, your GP may be able to perform cauterisation in your local surgery.