Patient information from BMJ

Nosebleeds (epistaxis) in adults

Last published:Sep 29, 2021

Bleeding from the nose is more common in children than in adults, but it happens to people of all ages.

You can usually stop a nosebleed by yourself, but some people need medical treatment. If you have problems with nosebleeds, you can use our information to talk with your doctor about the best treatments for you.

What is epistaxis?

Epistaxis is the medical name for bleeding from the nose or from the area between the nostrils and the back of the throat, called the nasopharynx.

Many things can cause this type of bleeding. They include:

• dry weather, or dry air in a building, which can cause the skin inside the nose to dry out and crack

• an injury to the nose, or a broken nose

• some medicines, such as those that thin your blood

• inflammation (swelling) inside the nose

• picking your nose, and

• blowing your nose hard.

Symptoms and diagnosis

Most people will have a nosebleed at some point in their life. But if you have severe bleeding, or if you have regular nosebleeds, you may need medical treatment.

If you need to see a doctor about severe or repeated nosebleeds, he or she will ask you questions to try to find out why it might be happening. For example, your doctor will probably ask about:

• how often you have nosebleeds and how bad they are

• what medicines or supplements you are taking

• any other medical conditions you have

• whether anyone else in your family has nosebleeds

• how much alcohol you drink. Alcohol can thin your blood so that it doesn’t clot as easily. This can make a nosebleed last longer.

Your doctor will also want to examine you. For example, he or she may shine a light into your nose, and clean out your nose in order to see any problems more clearly.

Your doctor may also suggest a blood test, or a test of how quickly your blood is able to clot.

What treatments are available?

Stopping a nosebleed yourself

You can usually stop a nosebleed within 10 or 15 minutes, like this:

• sit down and lean forward, with your head tilted slightly forward

• pinch your nose closed just above your nostrils and below the bone

• breathe through your mouth while you do this.

You can also try holding an ice pack wrapped in cloth to the top of your nose. This may help to make the blood vessels close up (constrict).

Medical treatment for a nosebleed

If you have medical treatment for a nosebleed, it will probably involve cautery. This means applying a chemical to the broken skin in your nose to stop it bleeding.

If your doctor thinks that the bleeding can be stopped without cautery, he or she may just pack your nose with cotton to block up the wound.

Your doctor might also apply a cream to the inside of your nose that helps to make the blood vessels tighten up so that you bleed less.

If you are in pain your doctor may prescribe a painkiller. But the medicine you can have will depend on what has caused your nosebleed, and on any other medical conditions you may have.

For example, you should not take aspirin if you are having severe bleeding, as aspirin slows down blood clotting and can make bleeding worse.

Your doctor might also advise you not to take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, as these can have the same effect.

After stopping your bleeding, your doctor will want to find out what has caused it, to help prevent it happening again.

For example, if your bleeding is linked to another medical condition, your doctor may take steps to help treat that condition, if it’s not being treated already.

If your bleeding is linked to any medication you are taking, your doctor may be able to suggest changes to your medication or to the dose, to help you stop having problems with bleeding.

Your doctor might also refer you to an ENT (ear, nose, and throat) specialist.

Preventing more nosebleeds

There are things you can do to prevent more nosebleeds.

In the short term, for a few days after a severe nosebleed you should take care not to:

• pick or blow your nose

• take aspirin or ibuprofen

• drink hot drinks or alcohol, and

• do anything strenuous.

In the longer term, if you have regular nosebleeds, it might help to do things like:

• use a humidifier in your home, to stop the air from becoming too dry

• avoid taking aspirin if possible

• using petroleum jelly or a similar nasal moisturiser, to stop the skin on the inside of your nose from drying and cracking.

What to expect in the future

Most people who need medical treatment for nosebleeds or injuries to the nose don’t have long-term problems that need more treatment.

Some people have complications linked to very severe bleeding or to other medical conditions. If this applies to you, your doctor will discuss any actions that might help, and he or she might refer you to a specialist.