Treating a nosebleed

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 down 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 the recovery advice outlined below.

When to seek medical advice

Contact your GP or call NHS 111 if:

• you're taking a blood-thinning medicine ( Anticoagulant medicines ) 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 anda pale complexion
• a child under two years of age has a nosebleed (this is rare and there's a chance it's caused by something serious)
• you have nosebleeds that come and go regularly

Ask someone to drive youtoyour nearestaccident and emergency (A&E) department or call 999 for an ambulanceif:

• 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 nosebleeddeveloped after a seriousinjury, 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.

The two main treatments that your GP or hospital doctor may use to stop your nose bleeding are cautery and nasal packing. These are described below.

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 bycauterising (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 afterlocal anaesthetic has been sprayed into your nose. Thegauze or spongesoften 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 toa 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 toreplace the blood you've lost
• tranexamic acid medication that can reduce bleeding by helping your blood to clot
• packing under anaesthetic your nose is carefullypacked with gauze while you are unconscious from general anaesthetic
• ligation an operationusingsmall instruments to tie offbleeding 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:

• avoidblowing 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 seeaGP or ahospital doctor about your nosebleed, theymay give you a prescription for an antiseptic nasal cream once the bleeding stops. This should be applied totheinside of yournostrils 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.