Nosebleed (epistaxis): how to stop it, causes and when to get help

A nosebleed, medically called epistaxis, is bleeding from one or both nostrils. NHS inform describes it as blood flowing from the nose that can be heavy or light and can last from a few seconds to 15 minutes or more. The inside of the nose has a rich supply of delicate blood vessels close to the surface, which is why the nose bleeds readily and why bleeds can look dramatic even when little blood has been lost.

Doctors distinguish front-of-nose bleeds from the less common bleeds from deeper inside the nose. The NHS says bleeds that need medical attention come from deeper in the nose and usually affect adults, while NHS inform says occasionally bleeding comes from vessels deeper within the nose after a blow to the head, nasal surgery or hardened arteries.

The NHS says the inside of the nose is easy to damage, and nosebleeds commonly follow nose picking, blowing the nose too hard, or the inside of the nose being too dry because of a change in air temperature. NHS inform adds recent alcohol, a minor injury to the nose and changes in humidity or temperature that make the inside of the nose dry and cracked. Overuse of nasal decongestants can also cause nosebleeds.

Some nosebleeds relate to injury or a condition. The NHS lists an injury or broken nose, conditions affecting the blood vessels or how the blood clots, and certain medicines such as warfarin. Sometimes the cause is unknown. NHS inform says nosebleeds affect most often children aged between 2 and 10, elderly people, pregnant women, people on blood-thinning medicine including aspirin or anticoagulants, and people with clotting disorders such as haemophilia.

The steps are consistent across the NHS and NHS inform. Sit down and lean forward, with the head tilted forwards and the mouth open. Firmly pinch the soft part of the nose, just above the nostrils, for at least 10 to 15 minutes without letting go to check. Breathe through the mouth. NHS inform adds to spit out any blood that collects in the throat or mouth into a bowl and not to swallow it, and to stay upright or seated rather than lying down to reduce the pressure in the nasal blood vessels.

A cold pack may help, though the NHS says the evidence that it works is not very strong. NHS inform suggests a bag of frozen vegetables covered with a towel on the forehead or back of the neck. Keep a child calm and seated, and show them how to breathe through the mouth.

• Sit upright and lean forward; do not tilt the head back.

• Pinch the soft part of the nose, just below the bony bridge, for 10 to 15 minutes.

• Breathe through the mouth and spit out blood rather than swallowing it.

• Keep seated or upright rather than lying flat.

• Avoid blowing or picking the nose for 24 hours afterwards.

The NHS lists reasons to see a GP: a child under 2 has had a nosebleed, you have regular nosebleeds, you have symptoms of anaemia such as a faster heartbeat, breathlessness and paler skin than normal, you have a nosebleed while taking a medicine that helps prevent blood clots such as warfarin, or you have a condition such as haemophilia that stops blood clotting properly. NHS inform gives a similar list and adds nosebleeds that come and go regularly.

The GP may test for conditions such as anaemia or haemophilia, according to the NHS. NHS inform says the assessment may include looking inside the nose, measuring pulse and blood pressure, blood tests and asking about other symptoms. If your GP practice is closed, NHS inform says to phone 111.

The NHS says to go to A&E if the nosebleed lasts longer than 10 to 15 minutes, the bleeding seems excessive, you are swallowing a large amount of blood that makes you vomit, the bleeding started after a blow to the head, you feel weak or dizzy, or you are having difficulty breathing. NHS inform says to phone 999 or go to A&E if the bleeding continues for longer than 20 minutes, is heavy and you have lost a lot of blood, you are having difficulty breathing, you feel weak or dizzy, you swallow a large amount of blood that makes you vomit, or the nosebleed followed a serious injury such as a car crash.

The two sources give slightly different time limits. In practice, if pressure has been applied properly and the bleeding is still going after the first 10 to 15 minutes, seeking help is reasonable, and anyone who is unwell or on anticoagulants should not wait. The NHS says not to drive to A&E; ask someone to drive you or call 999 and bring any medicines with you.

If bleeding continues, the NHS says a doctor who can see where the blood is coming from may use a stick with a chemical on it to seal the area, which is called cautery. If that is not possible they may pack the nose with ribbon gauze or sponge to stop the bleeding, and you may need to stay in hospital for a day or two. NHS inform also mentions ointments for the nose.

After a nosebleed stops the doctor may prescribe an antiseptic cream to use inside the nose to stop crusting and scabs. The NHS says to check the cream's ingredients first as it may not be suitable if you have a peanut or soya allergy. Follow the aftercare advice in the NHS list: avoid blowing, picking, hot drinks, alcohol, strenuous activity and lying flat for 24 hours.

NHS inform suggests avoiding nose picking and keeping fingernails short, blowing the nose as little as possible and only very gently, keeping the home humidified, wearing a head guard in activities where the nose or head could be injured, and following the instructions that come with nasal decongestants because overuse can cause nosebleeds.

It also advises speaking to a GP if you get frequent nosebleeds that you cannot prevent. Repeated bleeding from the same nostril, bleeding with easy bruising, or a family history of heavy nosebleeds are worth mentioning, as the NHS notes a GP may test for conditions such as anaemia or haemophilia.

Most nosebleeds never need care beyond first aid. For recurrent bleeds the NHS route is usually the GP, who may check blood pressure and blood tests, and an ENT referral if cautery or further examination is needed. Heavy or persistent bleeding is dealt with in A&E and by an ENT team in hospital.

Some people choose a private ENT consultation for repeated nosebleeds, usually for nasal examination with an endoscope and cautery in clinic. The assessment principles are the same: look for a source, check clotting-related causes and review medicines. If you take anticoagulants, do not stop them yourself; discuss with the prescriber, who can weigh bleeding against clot risk.