How do you stop a severe nosebleed

Nosebleeds, also known as epistaxis, are common issues that usually resolve on their own or are easily treated in a medical environment. For some patients, nosebleeds can be severe enough that further treatments are needed. At Mount Sinai, we have experience handling these cases of epistaxis.

Table of Contents Show

Treatment Options
Topic Overview
Stopping a nosebleed
Preventing nosebleeds
How do doctors stop a severe nosebleed?
When should you go to the ER for a nose bleed?
How long is too long for a nosebleed?
What causes a nosebleed that won't stop bleeding?

Severe episodes of nosebleeds can be caused by:

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler Weber Rendu syndrome, is a genetically inherited condition. People with HHT have small blood vessel malformations, known as telangiectasias, which affect the skin and mucosal membranes. Nosebleeds are the most common symptom; between 50 percent and 80 percent have recurrent bleeds.
Spontaneous epistaxis usually occurs in the fifth decade of life, and may be associated with hypertension or liver insufficiency. This type of nosebleed resolves without medical treatment; however, in some patients, the intensity or repetition of hemorrhages in a short period of time may require more invasive nosebleed treatment such as embolization.
Trauma
Tumors Occasionally bleeding from the nasal or oral cavities may be related to the presence of a tumor. If there is concern for this, further imaging such as computer tomography scan or magnetic resonance imaging to evaluate what is happening.
Vascular Malformations

Treatment Options

The first step in managing a severe nosebleed involves "packing" the nose, which should be performed by an appropriately trained physician. If this does not stop the bleeding, a procedure called embolization is performed by which the blood vessel supplying the inner lining of the nose is blocked.

If you experience severe blood loss from a nosebleed, it can cause serious anemia or cardiac dysfunction and reduced quality of life. At Mount Sinai, we can use embolization to treat severe, recurring nosebleeds that cannot be controlled by traditional means.

We may investigate the source of the bleeding via angiography. After we identify the vessels responsible for the bleeding, we can go back in through a catheter and block the vessels to stop the bleeding (embolization). In some cases, this technique can be lifesaving.

Topic Overview

Most nosebleeds occur in the front of the nose and involve only one nostril. Some blood may drain down the back of the nose into the throat. These nosebleeds typically are not serious, and you can generally treat them yourself at home.

A less common but more serious type of nosebleed starts in the back of the nose and often involves both nostrils. Large amounts of blood may run down the back of the throat. This type of nosebleed may occur more frequently in older adults because of health conditions they may have. You will need treatment from a doctor to control bleeding from this type of nosebleed.

Stopping a nosebleed

Follow these steps to stop a nosebleed:

Sit up straight and tip your head slightly forward.
- Note: Do not tilt your head back. This may cause blood to run down the back of your throat, and you may swallow it. Swallowed blood can irritate your stomach and cause vomiting. And vomiting may make the bleeding worse or cause it to start again. Spit out any blood that gathers in your mouth and throat rather than swallowing it.
Use your thumb and forefinger to firmly pinch the soft part of your nose shut. The nose consists of a hard, bony part and a softer part made of cartilage. Nosebleeds usually occur in the soft part of the nose. Spraying the nose with a medicated nasal spray (such as Drixoral) before applying pressure may help stop a nosebleed. You will have to breathe through your mouth.
Keep pinching for a full 10 minutes. Use a clock to time the 10 minutes. It can seem like a long time. Resist the urge to peek after a few minutes to see if your nose has stopped bleeding.
Check to see if your nose is still bleeding after 10 minutes. If it is, hold it for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of direct pressure.
Put a thin layer of a saline- or water-based nasal gel, such as NasoGel, or an antiseptic nasal cream inside your nose. Do not blow your nose or put anything else inside your nose for at least 12 hours after the bleeding has stopped.
Rest quietly for a few hours.

Preventing nosebleeds

After you have stopped a nosebleed, the following tips may prevent a nosebleed from happening again:

Avoid forceful nose-blowing.
Do not pick your nose.
Avoid lifting or straining after a nosebleed.
Elevate your head on pillows while sleeping.
Put a thin layer of a saline- or water-based nasal gel, such as NasoGel, or an antiseptic nasal cream inside your nose.
Do not use aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 3 to 4 days. Acetaminophen, such as Tylenol, may be used to relieve pain. Be safe with medicines. Read and follow all instructions on the label. Talk to your doctor about stopping any medicines you are currently taking.
Do not use non-prescription antihistamines, decongestants, or medicated nasal sprays.

Nosebleeds may develop in people who have colds or chronic hay fever symptoms (post-nasal drip, sneezing, or a runny, stuffy, or itchy nose) because nasal tissues become inflamed and irritated. Using medicines may relieve the symptoms, leading to less inflammation and irritation and fewer nosebleeds. But overuse of allergy medicines may lead to nosebleeds because of their overdrying side effects. If you have a lot of nosebleeds, talk to your doctor about the proper use of cold and allergy medicines.

If you are helping someone else stop a nosebleed, avoid touching the other person's blood. Use gloves, if available, or layers of fabric or a plastic bag to protect yourself.

Credits

Current as of:
July 1, 2021

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
David Messenger MD

How do doctors stop a severe nosebleed?

Your doctor may pack your nose with special gauze or an inflatable latex balloon to put pressure on the blood vessel and stop the bleeding. You're experiencing nasal bleeding and taking blood thinners, such as aspirin or warfarin (Jantoven). Your doctor may advise adjusting your medication dosage.

When should you go to the ER for a nose bleed?

The good news is that most nosebleeds are not serious and can be managed at home. However, see your doctor or get emergency medical attention if you are losing a heavy amount of blood, if you cannot stop your nosebleed after 20 minutes of trying or have had an immediate injury to your head, face or nose.

How long is too long for a nosebleed?

Immediate action required: Go to A&E if: your nosebleed lasts longer than 10 to 15 minutes. the bleeding seems excessive. you're swallowing a large amount of blood that makes you vomit. the bleeding started after a blow to your head.

What causes a nosebleed that won't stop bleeding?

Severe episodes of nosebleeds can be caused by: Hereditary hemorrhagic telangiectasia (HHT), also known as Osler Weber Rendu syndrome, is a genetically inherited condition. People with HHT have small blood vessel malformations, known as telangiectasias, which affect the skin and mucosal membranes.