Where does the blood come from in a nosebleed

Nosebleed | NHS inform

About nosebleeds

Nosebleeds can be frightening, but they aren't usually a sign of anything serious and can often be treated at home.

The medical name for a nosebleed is epistaxis.

During a nosebleed, blood flows from one or both nostrils. It can be heavy or light and last from a few seconds to 15 minutes or more.

What to do

To stop a nosebleed:

• sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10 to 15 minutes
• lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat
• place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose
• stay upright, rather than lying down, as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding

If the bleeding eventually stops, you won't usually need to seek medical advice. However, in some cases you may need further treatment from your GP or in hospital.

Read more about treating nosebleeds

When to seek medical advice

Non-urgent advice: Contact your GP practice if:

• you're taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn't stop
• you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
• a child under 2 years of age has a nosebleed
• you have nosebleeds that come and go regularly

If your GP practice is closed, phone 111.

Immediate action required: Go to your nearest accident and emergency (A&E) or phone 999 if:

• the bleeding continues for longer than 20 minutes
• the bleeding is heavy and you've lost a lot of blood
• you're having difficulty breathing
• you swallow a large amount of blood that makes you vomit
• the nosebleed developed after a serious injury, such as a car crash

What causes nosebleeds?

The inside of your nose is full of tiny, delicate blood vessels that can become damaged and bleed relatively easily.

Common causes of nosebleeds include:

• picking your nose
• blowing your nose very hard
• a minor injury to your nose
• changes in humidity or temperature causing the inside of the nose to become dry and cracked

Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery and hardened arteries (atherosclerosis).

Read more about the causes of nosebleeds

Who gets nosebleeds?

Nosebleeds are fairly common and most people will experience them every now and again. Anyone can get a nosebleed, but they most often affect:

• children between 2 and 10 years of age
• elderly people
• pregnant women
• people who take blood thinning medication such as aspirin or anticoagulants, such as warfarin
• people with blood clotting disorders, such as haemophilia

Bleeding may also be heavier or last longer if you take anticoagulants, have a blood clotting disorder, or have high blood pressure (hypertension).

Are nosebleeds serious?

Nosebleeds aren't usually serious. However, frequent or heavy nosebleeds may indicate more serious health problems, such as high blood pressure or a blood clotting disorder, and should be checked.

Excessive bleeding over a prolonged period of time can also lead to further problems such as anaemia.

If your GP suspects a more serious problem is causing your nosebleeds, they may refer you to an ear, nose and throat (ENT) specialist for further tests.

Preventing nosebleeds

There are things you can do to prevent nosebleeds.

Do

• avoid picking your nose and keep your fingernails short
• blow your nose as little as possible and only very gently
• keep your home humidified
• wear a head guard during activities in which your nose or head could get injured
• always follow the instructions that come with nasal decongestants – overusing these can cause nosebleeds

Talk to your GP if you experience nosebleeds frequently and aren't able to prevent them. They may refer you to an ENT specialist for an assessment.

Causes of nosebleeds

Nosebleeds can be caused by a number of different things. It's not always possible to identify the exact reason why one occurs.

Nosebleeds can start just inside your nostrils (anterior) or at the back of your nose (posterior). These different types of nosebleeds tend to have different causes.

Anterior nosebleeds

The vast majority of nosebleeds are anterior nosebleeds, which means the bleeding comes from the wall between the two nose channels (the lower septum), just inside your nose. This part of the nose, known as Little's area, contains many delicate blood vessels that can be easily damaged.

The cause of anterior nosebleeds is sometimes unknown, but they can be caused by a number of things, including:

• picking your nose, particularly if you scratch the inside of your nose with a sharp fingernail
• blowing your nose very hard
• a minor injury to your nose
• a blocked or stuffy nose often caused by an infection such as a cold or flu
• sinusitis – an infection of the small, air-filled cavities inside your cheekbones and forehead
• dry air or an increase in temperature drying out the inside of your nose
• hay fever or other allergies
• high altitude
• excessive use of nasal decongestants
• a crooked nasal septum that's either present from birth (congenital) or the result of an injury (a deviated septum)

Anterior nosebleeds are more common in children and are not usually a sign of anything serious. They can often be treated easily at home.

Read more about treating nosebleeds

Posterior nosebleeds

A small number of nosebleeds are posterior nosebleeds, which means the bleeding originates from branches of arteries that supply blood to the space inside your nose between the roof of your mouth and your brain (nasal cavity).

These nosebleeds are more common in adults than children. They can be more serious than anterior nosebleeds and bleed more heavily. Medical attention may be required.

Causes of posterior nosebleeds include:

• a blow to your head, or a fall
• a broken nose
• recent nasal surgery
• hardened arteries (atherosclerosis)
• medicines that cause you to bleed more easily, including aspirin and anticoagulants such as warfarin and heparin
• a tumour in the nasal cavity
• a blood clotting abnormality – such as haemophilia or von Willebrand disease
• hereditary haemorrhagic telangiectasia (HHT) – an inherited genetic condition that affects the blood vessels
• leukaemia (although this is rare and you're likely to have other symptoms as well)

High blood pressure (hypertension) is also more common in people with nosebleeds and may make it harder to stop the bleeding, but it's not clear whether this directly causes nosebleeds.

Treating nosebleeds

Most nosebleeds can be stopped without the need for medical attention, but occasionally further treatment may be required.

What to do

To stop a nosebleed:

• sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 minutes
• lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat
• place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose
• stay upright, rather than lying down as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding

If the bleeding eventually stops, you won't usually need to seek medical advice. However, you should still follow our recovery advice.

Non-urgent advice: Contact your GP practice if:

• you're taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn't stop
• you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
• a child under 2 years of age has a nosebleed
• you have nosebleeds that come and go regularly

If your GP practice is closed, phone 111.

Immediate action required: Go to your nearest accident and emergency (A&E) or phone 999 if:

• the bleeding continues for longer than 20 minutes
• the bleeding is heavy and you've lost a lot of blood
• you're having difficulty breathing
• you swallow a large amount of blood that makes you vomit
• the nosebleed developed after a serious injury, such as a car crash

Find your nearest A&E department

Medical treatment

If you see your GP or go to hospital with a nosebleed, you will be assessed to determine how serious your condition is and what's likely to have caused it. This may involve looking inside your nose, measuring your pulse and blood pressure, carrying out blood tests and asking about any other symptoms you have.

These are the main treatments that your GP or hospital doctor may use to stop your nose bleeding.

Antibiotic ointment

Your doctor may prescribe an antibiotic ointment. This should be applied by squeezing a pea-sized amount onto the front of the nasal septum (wall between the nostrils).

This can reduce the inflammation and crusting in the nose and reduce the severity and frequency of nosebleeds.

Antibiotic ointment is particularly effective in children.

Cautery

If your doctor is able to identify exactly where the bleeding is coming from, they may carry out a minor procedure to seal the bleeding blood vessel by cauterising (burning) it.

This is normally done using a stick of a chemical called silver nitrate. A local anaesthetic will be sprayed into your nose to numb it and the silver nitrate stick will be held against the bleeding point for up to 10 seconds.

Nasal packing

If cautery is ineffective or your doctor is unable to identify a specific bleeding point, they may recommend packing your nose with gauze or special nasal sponges to stop the flow of blood by applying pressure to the source of the bleeding.

Packing will usually be carried out after local anaesthetic has been sprayed into your nose. The gauze or sponges often need to be left in place for 24-48 hours before being removed by a health professional. You'll usually need to be admitted to hospital to be monitored during this time.

Further treatment

If the treatments above don't help, you may be referred to a hospital specialist such as an ear, nose and throat (ENT) doctor for further treatment.

Additional treatments that may be used in hospital include:

• electrocautery – an electric current running through a wire is used to cauterise the blood vessel where the bleeding is coming from
• blood transfusions – a procedure to replace the blood you've lost
• tranexamic acid – medication that can reduce bleeding by helping your blood to clot
• packing under anaesthetic – your nose is carefully packed with gauze while you are unconscious from general anaesthetic
• ligation – an operation using small instruments to tie off bleeding blood vessels in the back of your nose

Recovery

Once your nose has stopped bleeding, you should follow the advice below to reduce the risk of your nose bleeding again and to stop you picking up an infection:

• avoid blowing or picking your nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours
• don't remove any crusts that form inside your nose – these may be unpleasant, but they're a useful part of the healing process
• if you need to sneeze, try to sneeze with your mouth open to reduce the pressure in your nose
• avoid people with coughs and colds

If you see a GP or a hospital doctor about your nosebleed, they may give you a prescription for an antiseptic nasal cream once the bleeding stops. This should be applied to the inside of your nostrils several times a day for up to two weeks to help prevent further bleeding.

If your nose does start to bleed again, follow the first aid advice above and seek medical advice if the bleeding doesn't stop.

Nosebleeds - Better Health Channel

Summary

• Bleeding from the nose is common in children and is usually not a sign of any underlying problem.
• First aid treatment includes pinching the nostrils until the bleeding stops.
• If the nosebleed won’t stop, see a doctor or go to a hospital emergency department.

A nosebleed happens when one of the blood vessels in the lining of the nose bursts. Nosebleeds may be caused by infection, injury, allergic reaction, nose picking or an object being pushed into the nostril. Another name for nosebleed is epistaxis.

Bleeding from the nose is common in children and is usually not serious. Seek medical attention if nosebleeds are severe, frequent or prolonged.

Blood vessels in the nose are fragile

The small blood vessels in the septum (the firm tissue between the nostrils, which divides the nose into two halves) are fragile and can burst fairly easily, causing a nose bleed.

In children, the nose tends to bleed from only one side (unilateral).

Children usually grow out of the condition. If the bleeding is very heavy, prolonged or does not stop with first aid measures, take your child to a doctor or a hospital emergency department.

Symptoms of nosebleeds

The signs and symptoms of a nosebleed include:

• bleeding from either or both nostrils
• a sensation of flowing liquid at the back of the throat
• the urge to swallow frequently.

Causes of nosebleeds

A nosebleed can be caused by a range of factors, including:

• fragile blood vessels that bleed easily, perhaps in warm dry air or after exercise
• an infection of the nose lining, sinuses or adenoids
• an allergy that causes hay fever or coughing
• bumps or falls
• an object that has been pushed up the nostril
• nose picking
• occasionally, a bleeding or clotting problem.

First aid management for nosebleeds

To manage a nosebleed include:

• Reassure the person, especially children, as crying increases blood flow.
• Sit the person up straight and drop their head slightly forward.
• Apply finger and thumb pressure on the soft part of nostrils below the bridge of the nose for at least 10 minutes.
• Encourage the person to breathe through their mouth while their nostrils are pinched.
• Loosen tight clothing around the neck.
• Place a cold cloth or cold pack over the person’s forehead and one around the neck, especially around the sides of the neck.
• After 10 minutes, release the pressure on the nostrils and check to see if the bleeding has stopped.
• If bleeding persist, seek medical aid.
• Tell the person not to sniff or blow their nose for at least 15 minutes and not to pick their nose for the rest of the day. (Having a nose full of clotted blood is unpleasant and children in particular may find it difficult to avoid sniffing or nose blowing for a few hours. Fifteen minutes will at least give some time for the clot to stabilise.)

You should go to the doctor or a hospital emergency department if the bleeding does not stop after simple first aid management. It is important to find and treat the cause of ongoing bleeding.

Frequent nosebleeds

If your child keeps having nosebleeds, see your doctor as the cause needs to be understood and treatment commenced. For example, if the cause is an ongoing infection, your doctor may prescribe an antibiotic ointment or medicine. Very occasionally, a child loses so much blood that this causes other health problems, such as anaemia.

Where to get help

• Your doctor
• NURSE-ON-CALL Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• The nearest hospital emergency department

Things to remember

• Bleeding from the nose is common in children and is usually not a sign of any underlying problem.
• First aid treatment includes pinching the nostrils until the bleeding stops.
• If the nosebleed won’t stop, see a doctor or go to a hospital emergency department.

• Australian First Aid, 2012, 4^th Edition, St John Ambulance Australia.

This page has been produced in consultation with and approved by:

Why does the nose bleed? — GAUZ OZP City Clinical Hospital No. 8

• Post author: Press Secretary
• The entry was published: 07/24/2019
• Post category: Prevention