Most blood noses are minor and stop easily. If you have very frequent blood noses or severe blood noses, your GP may refer you to an ENT surgeon.

Preventing blood noses

Be gentle with the lining of the nose and don’t pick or scratch the inside of the nose. Avoid putting your fingers, cotton buds or tissues inside the nose.

If the nose feels dry or crusted, use a saline nasal rinse or an ointment.

Blood noses are more common when the nose is inflamed. Treating rhinitis reduces the risk of blood noses. Blood noses are more common when you need to take medication to prevent blood clots. You need to be very gentle with the lining of the nose when taking these medications.

First aid for blood noses

Most blood noses come from blood vessels on the nasal septum (the dividing wall between the two sides of the nose), close to the front of the nose.

First aid for epistaxis:

  • Sit up and lean forward.
  • Squeeze the whole soft part of the nose for ten minutes.
  • Breathe through your mouth and gently spit out any blood that comes into the mouth.
  • After ten minutes, stop squeezing.
  • If bleeding has stopped, avoid blowing the nose, lying down flat or exerting yourself for an hour or so.
  • If bleeding continues, squeeze again for ten minutes.
  • If bleeding hasn’t stopped after 20 minutes seek help from your GP or the emergency department.

Treatment for frequent blood noses

Your doctor will examine the nose, looking for the blood vessel that is causing the bleeding. This may involve nasal endoscopy.

For children and many adults, the first treatment is to use an ointment to heal the lining of the nose. The ointment is squirted into the nostril four times a day for a week. This works in more than 5 out of 10 people.

If ointment doesn’t stop blood noses happening, you may be referred to an ENT surgeon. The surgeon can treat the blood vessel by chemical cautery in the office after making the nose numb with a topical anaesthetic. There’s mild discomfort for a day or so afterward, you can return to work after the appointment and you should take 2 days off sport and vigorous activity. The help the cauterised vessel heal, you will use the same ointment again, four times a day for a week. Chemical cautery works for 9 out of 10 people. Sometimes is has to be repeated.

Once the blood vessel has healed, you can start using steroid nasal spray and saline rinses for rhinitis, if needed.

Treatment for severe blood noses

Older patients and patients taking medication to stop blood clots can have severe blood noses that need treatment in the emergency department. The nurse will do first aid for blood noses then spray medication into the nose to help stop bleeding. The doctor will examine the nose to look for the bleeding blood vessel. The vessel can be treated with chemical cautery.

If bleeding continues, you may have a sponge or pack inserted into the nose to put pressure on the blood vessel. Anaesthetic spray is used to make this easier for you to cope with; having a pack inserted can be painful. Once the pack is in place, you will rest sitting up for a few hours. Some people stay in hospital overnight and some people go home and come back in one or two days to have the pack removed. You should avoid blowing the nose and playing sport for a week after a severe blood nose.

If bleeding continues even with a pack inside the nose, you may be referred to an ENT surgeon for surgery to stop blood noses. Severe blood noses can come from the blood vessels near the front of the nose on the nasal septum or from the large blood vessel far back in the side wall of the nose. This is called the sphenopalatine artery. The surgery can be done while you are under a general anaesthetic or while you are awake with local anaesthetic to make the nose numb. The surgery is done through the nostrils with a camera. The surgeon examines the nose to find the bleeding vessel. The bleeding can be stopped with electrical cautery (diathermy) or by lifting up the lining of the nose and applying a metal clip to the artery. This surgery is effective in 9 out of 10 patients. You may go home the same day or the next day. The surgeon will let you know if you need to use sprays or rinses in the nose to help healing. You should avoid sport for a week after surgery for a severe blood nose.

If you need to take medication to prevent blood clots, your physician decides if it is safe to stop the medication for a few days to help the bleeding stop. Stopping your medication can increase the risk of heart attack and stroke. There needs to be a careful weighing up of the risk of stopping the medication versus the risk of severe blood nose.