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Health condition · Clinically reviewed

Nosebleeds (epistaxis), first aid, cautery — and when to worry.

Very common and usually anterior. Simple first aid stops most; recurrent or heavy bleeding needs ENT review and sometimes cautery, packing or embolisation.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against NICE CKS, ENT UK and specialist society sources you can see at the end.

  • 03

    Current for 2026

    Reflects current ENT UK guidance on first-aid, cautery, packing and interventional radiology.

Key facts

Nosebleeds at a glance.

The essentials, in plain English — anterior versus posterior bleeds, what first aid looks like, and when a nosebleed needs more than a tissue.

  • What it is

    Nasal bleeding — from the anterior (front) or posterior (back) part of the nose.

  • Anterior (~90%)

    Most bleeds arise from Little’s area on the nasal septum and are easy to control with first aid.

  • Posterior (~10%)

    Heavier bleeds from deeper vessels usually need ENT assessment, packing or intervention.

  • First aid

    Pinch the soft part of the nose for 10–15 minutes, sitting up and leaning forward — most bleeds stop this way.

  • Anticoagulants

    Warfarin, DOACs and antiplatelets are common contributors — always take a medication history.

  • Recurrent bleeds

    Repeated nosebleeds warrant ENT review to identify a bleeding point and rule out other causes.

Why this guide matters

Usually simple — but occasionally serious.

Most nosebleeds stop with correct first aid. The three points below shape everything else on this page.

  • First aid stops most bleeds

    Pinching the soft part of the nose for 10–15 minutes, sitting up and leaning forward — this is the single most useful skill.

  • Anterior versus posterior matters

    Anterior bleeds are usually easy to control; posterior bleeds are heavier and often need ENT intervention.

  • Recurrent bleeds deserve a proper look

    Repeated one-sided bleeding, especially with obstruction, must be checked to rule out a sinonasal cause.

How the diagnosis is made

From an active bleed to a settled plan.

The steps a UK GP and ENT team will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    First aid + duration of bleed

    Assess how long the bleeding has continued and whether simple first aid has been tried correctly.

  2. 02

    Recognising

    Medication history

    Ask about anticoagulants, antiplatelets, nasal sprays, cocaine and over-the-counter remedies.

  3. 03

    Recognising

    Blood pressure measurement

    Severe hypertension can drive and prolong epistaxis — record BP at presentation.

  4. 04

    Confirming

    ENT examination + nasendoscopy

    Direct inspection of the nasal cavity to identify a bleeding point, clot or mucosal lesion.

  5. 05

    Confirming

    FBC and clotting if recurrent

    Blood tests for anaemia, thrombocytopenia and coagulopathy in heavy or repeated bleeds.

  6. 06

    Managing

    Rule out sinonasal cancer

    Unilateral recurrent bleeding, especially with obstruction, needs imaging and biopsy to exclude tumour.

  7. 07

    Managing

    Nasal cautery

    Silver-nitrate or electrical cautery of an identifiable bleeding point in Little’s area.

Typical timeline: same-day to 2 weeks from bleed to a settled plan.

Symptoms

What a nosebleed actually looks like.

The patterns worth recognising — from a small dribble in a child to a heavy posterior bleed that needs urgent care.

  • Anterior bleed

    Blood dripping from the front of one nostril — usually Little’s area, controllable with first aid.

  • Posterior bleed

    Heavier bleeding from deeper vessels, often running down the back of the throat — needs ENT.

  • Recurrent bleeds

    Repeated episodes across weeks or months — always warrant ENT review to identify a source.

  • Heavy bleeding

    High-volume or ongoing bleeding despite first aid — needs urgent assessment.

  • Anticoagulant-related

    Bleeding on warfarin, DOACs or antiplatelets — often more prolonged and needs clotting review.

  • Dry environment / picking (children)

    Common in children — dry air, nose-picking and mild trauma to Little’s area.

  • Bilateral bleeding

    Blood from both nostrils suggests a posterior source or a systemic bleeding tendency.

  • Red flag

    Massive posterior bleed with airway compromise or shock — call 999 immediately.

Treatment

How nosebleeds are treated in the UK.

A ladder from first aid through cautery and packing to interventional radiology or surgery — what each option does, and where it belongs in the plan.

  • First-aid pinching + head-forward

    Pinch the soft part of the nose firmly for 10–15 minutes, sitting up and leaning forward to keep blood out of the airway.

  • Ice pack to nose

    A cold pack applied over the bridge of the nose helps constrict vessels and speed clotting alongside pinching.

  • Nasal decongestant spray (specific first aid)

    A short burst of xylometazoline or oxymetazoline before pinching can help by vasoconstricting the bleeding vessel.

  • Silver-nitrate chemical cautery

    Applied to a visible bleeding point in Little’s area under direct vision — quick, effective and outpatient.

  • Electrical cautery

    Used when chemical cautery fails or the bleeding point is deeper — performed by ENT with topical anaesthesia.

  • Nasal packing (anterior + posterior)

    Absorbable or inflatable packs applied to tamponade persistent bleeding — often the next step after failed cautery.

  • Embolisation (interventional radiology)

    Selective embolisation of the sphenopalatine artery for refractory posterior bleeds not controlled by packing.

  • Sphenopalatine artery ligation (surgery)

    Endoscopic surgical ligation of the sphenopalatine artery — a definitive option for severe posterior epistaxis.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your history and can tell you which parts apply to you.

  • NICE Clinical Knowledge Summary — Epistaxis (nosebleeds).

  • ENT UK. Epistaxis guidelines and patient information.

  • British Society for Haematology. Guidance on anticoagulation and bleeding.

  • NHS. Nosebleeds — patient information and self-care.

Red flags

When a nosebleed points to something else.

Most nosebleeds are simple. These are the situations that need urgent ENT input or emergency care.

  • Massive posterior bleed with shock

    Hypotension, tachycardia or collapse with heavy nasal bleeding is an emergency — call 999.

  • Airway compromise

    Choking, aspiration or difficulty breathing during a nosebleed needs immediate emergency care.

  • Anticoagulant-related uncontrolled

    Ongoing bleeding on warfarin or a DOAC despite first aid — urgent ENT and clotting review.

  • Post-surgical epistaxis

    New bleeding after sinus, nasal or skull-base surgery needs urgent contact with the surgical team.

  • Recurrent unilateral epistaxis

    Repeated bleeding from the same side, especially with obstruction, must exclude a sinonasal tumour.

  • HHT (hereditary haemorrhagic telangiectasia)

    Recurrent bleeds with telangiectasia or a family history — needs specialist HHT review.

  • Immunosuppression with epistaxis

    Bleeding in immunocompromised patients raises concern for invasive infection — urgent ENT.

  • Fungal / invasive sinusitis

    Bleeding with facial pain, numbness or necrotic mucosa suggests invasive fungal disease — emergency ENT.

  • Trauma with septal haematoma

    Nasal trauma with swelling of the septum needs urgent drainage to prevent cartilage necrosis.

Living with it

Simple habits, fewer nosebleeds.

Four things that make the biggest difference day to day — keeping the nose moist, avoiding trauma, reviewing medications, and getting a proper look when bleeds recur.

A quiet reminder

Correct first aid beats any home remedy.

Pinch the soft part of the nose for 10–15 minutes, sitting up and leaning forward — that alone stops most bleeds.

  1. 01 Prevention

    Keep the nose moist

    Saline sprays or a thin layer of petroleum jelly to the front of the nose reduces dryness and recurrent bleeds.

  2. 02 Habits

    Avoid picking and hard blowing

    Trim children’s nails, avoid vigorous nose-blowing, and treat any underlying itch or crusting.

  3. 03 Medication

    Review anticoagulants

    Discuss frequent bleeds with your GP — dose or drug adjustments may help without stopping treatment abruptly.

  4. 04 Follow-up

    ENT review for recurrent bleeds

    Repeated episodes deserve a proper look with nasendoscopy — don’t assume it’s always trivial.

Frequently asked

Everything we get asked about nosebleeds.

Quick answers on first aid, cautery, anticoagulants and recurrent bleeding.

  • How long should I pinch my nose for?

    Firmly for 10–15 minutes without releasing, sitting upright and leaning forward. Most anterior bleeds settle within this time. If bleeding continues, seek urgent care.

  • Should I tilt my head back?

    No. Tilt forward, not back. Leaning forward stops blood running into the throat and airway, and reduces swallowed blood which can cause nausea and vomiting.

  • When should I go to A&E?

    If bleeding continues after 20 minutes of correct first aid, if it is very heavy, if you feel faint, or if you are on anticoagulants and can’t control it, attend A&E or call 999.

  • What is nasal cautery?

    A quick outpatient procedure where a bleeding vessel — usually in Little’s area on the septum — is sealed with silver nitrate or electrical current under direct vision.

  • Do I need to stop my blood thinners?

    Not without medical advice. Anticoagulants are usually continued unless bleeding is severe — your ENT and GP will balance the bleeding risk against the reason you are on treatment.

  • When does recurrent epistaxis need investigation?

    Repeated one-sided bleeds, bleeds with nasal obstruction, or bleeding with a family history of HHT need ENT review with nasendoscopy — sometimes imaging or biopsy.

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