Nosebleeds (Epistaxis)

What causes nosebleeds, how to stop them, and when to seek specialist help.

Treating Nose Bleeds

Epistaxis, more commonly known as nosebleeds, is a frequent occurrence affecting people of all ages. Studies indicate that around 60% of the population will experience at least one nosebleed in their lifetime, with a smaller percentage requiring medical intervention. Nosebleeds can be classified into two types: anterior, which originates from the front part of the nose and is more common, and posterior, which occurs deeper within the nasal cavity and is less frequent but often more severe.

Why Nosebleeds Happen
Several factors contribute to the occurrence of nosebleeds. One of the primary causes is dry air, which can lead to the drying out and cracking of the mucosa lining inside the nose. This lining is rich with blood vessels, particularly in an area known as Little’s area or Kiesselbach's plexus, where numerous small arteries converge. When the mucosa dries out and cracks, these delicate blood vessels become exposed and can easily rupture, leading to a nosebleed.

Nasal trauma is another common cause of nosebleeds. This can include anything from a minor bump to the nose to more significant injuries. Severe trauma often affects the anterior ethmoid artery, a major blood vessel that supplies the nasal cavity via the eyeball.

Additionally, tumours within the nasal cavity, although less common, can also cause nosebleeds. These growths can exert pressure on the surrounding tissues and blood vessels, leading to recurrent bleeding. While benign tumours are more common, it is essential to rule out malignancy in cases of persistent or unusual nosebleeds.

Impact of High Blood Pressure and Anticoagulants
It's a common misconception that high blood pressure directly causes nosebleeds. However, while high blood pressure does not initiate nosebleeds, it can certainly exacerbate them. Individuals with elevated blood pressure may experience more severe bleeding when a nosebleed occurs, making it harder to control. Similarly, anticoagulant medications, which are prescribed to prevent blood clots, do not cause nosebleeds. Nevertheless, they do impair the blood's ability to clot, resulting in prolonged and sometimes more intense bleeding episodes when a nosebleed does occur.

Treatment of Nosebleeds
Treating nosebleeds depends on their severity and underlying cause. For minor nosebleeds, applying direct pressure to the nostrils, leaning forward slightly to prevent swallowing blood, and sucking on ice (freezing the roof of the mouth and reducing the flow of blood to the nose there) may help stop the bleeding. For those who experience frequent or severe nosebleeds, more advanced treatments may be necessary.

One effective treatment is nasal cauterisation, which involves using a chemical or electric device to burn the bleeding blood vessel, thereby sealing it off. This procedure is often performed under local anaesthesia and is highly effective for recurrent nosebleeds originating from a specific site.

For individuals with more severe nose bleeds, surgical intervention may be required. In cases where medical treatment fails to control severe nosebleeds, arterial ligation or embolization may be considered. These procedures involve either tying off or blocking the blood vessels supplying the nasal cavity, thus reducing the risk of recurrent bleeding.

The National Institute for Health and Care Excellence (NICE) guidelines recommend a stepwise approach to the management of nosebleeds, starting with conservative measures and progressing to more invasive interventions if necessary. These guidelines emphasise the importance of identifying and addressing any underlying causes, such as nasal masses or tumours, to provide a comprehensive and effective treatment plan.

Professor Vik Veer, a leading ENT surgeon London, can provide personalised advice and treatment options for individuals experiencing frequent or severe nosebleeds. By understanding the causes and appropriate treatments for epistaxis, patients can make informed decisions about their care and improve their quality of life. Patients are seen at 150 Harley Street and other central London locations.



"I recently consulted Mr Veer due to chronic nose congestion. He was friendly and explained my treatment plan and follow-on actions in a very understandable and concise manner." Google Review, 5 stars — Gerald Yong

Frequently Asked Questions

Recurrent nosebleeds are most commonly caused by dry air drying out the mucosa lining of the nose, particularly at Little's area (Kiesselbach's plexus) where several small blood vessels converge. Other causes include nasal trauma, allergic rhinitis causing inflammation and fragility of the nasal lining, anticoagulant medications, high blood pressure (which worsens severity rather than causing bleeds directly), and less commonly, nasal polyps or tumours.

A nosebleed should be assessed by a specialist if it recurs frequently, is difficult to stop with simple first aid, is associated with blood thinning medication, is very heavy, occurs without obvious cause, or if there is any concern about a structural abnormality inside the nose. Any nosebleed associated with a lump in the nose or changes to the face or eye should be seen urgently.

Treatment depends on the severity and underlying cause. Conservative measures include regular moisturising of the nasal lining with saline or soft paraffin. Nasal cauterisation — using a chemical agent or electrical current to seal the bleeding vessel — is highly effective for recurrent bleeds from an identifiable site. For severe or persistent cases, surgical arterial ligation or endovascular embolisation may be required to reduce the blood supply to the nasal cavity.

Nasal cauterisation is typically performed under local anaesthesia in clinic and is generally well tolerated. There may be some discomfort during the procedure, and the nose can feel sore for a few days afterwards. Chemical cautery using silver nitrate is used for smaller, superficial vessels. Electrical cautery is used for more persistent bleeding points. Most patients find the procedure straightforward.

The vast majority of nosebleeds are benign and related to dry or fragile nasal lining. However, recurrent or unusual nosebleeds can occasionally indicate an underlying condition such as a blood clotting disorder, a nasal or nasopharyngeal tumour, or hereditary haemorrhagic telangiectasia (a condition causing abnormal blood vessel formation). A thorough assessment by an ENT specialist will exclude these causes.

You should see an ENT surgeon London if nosebleeds are occurring more than once a month, are difficult to stop, are associated with any other nasal symptoms, or if you have been prescribed anticoagulants and are experiencing prolonged bleeding. Professor Vik Veer at 150 Harley Street offers specialist assessment and a full range of treatments including cauterisation and surgical options for more complex cases.

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