How do I stop a nosebleed, and when does one need medical help?
The position and the pinch that actually work, the ten to fifteen minutes people never wait, and the situations where a nosebleed stops being a nuisance.
- Difficulty
- beginner
- Time
- 6 min
- Read
- 4 min
- Safety
- caution
Short answer
Sit down and lean forward with the head tilted forward and the mouth open. Pinch the soft part of the nose just above the nostrils and hold it for 10 to 15 minutes without letting go to check. Breathe through the mouth. If it has not stopped after 10 to 15 minutes, go to A&E.
Almost everything people do instinctively for a nosebleed is wrong — the head goes back, the pinch is in the wrong place, and the whole thing is released after ninety seconds to see whether it has worked. The correct version is not complicated and it works on the great majority of nosebleeds.
Safety
Step by step
- Sit down and lean forward.Head tilted forward, mouth open. Leaning forward keeps blood coming out of the nose rather than running down the throat, where it is swallowed and causes nausea and vomiting.
- Pinch the soft part.Just above the nostrils, on the fleshy part rather than the bony bridge. Almost all nosebleeds come from a vessel near the front of the septum, and that is exactly what this pressure closes.
- Hold for a full 10 to 15 minutes.Without letting go to look. Releasing early disturbs the clot that is forming, which is the single commonest reason a nosebleed seems not to stop. Use a timer, because the time feels much longer than it is.
- Breathe through the mouth.Obvious once you are doing it, and worth saying to a child who is panicking about not being able to breathe.
- Consider a cold pack.A wrapped ice pack held on the nose or the back of the neck is commonly suggested and the evidence for it is limited. It is harmless and it gives a distressed child something to focus on.
- Afterwards, leave it alone.For the next few hours, avoid blowing the nose, picking it, bending over, heavy lifting and hot drinks. All of these disturb a clot that is only hours old, and a rebleed is usually caused by one of them.
- Know when to go to A&E.It has not stopped after 10 to 15 minutes. The bleeding is heavy. Blood is being swallowed and then vomited. It followed a head injury. The person feels weak or dizzy, or is having difficulty breathing.
- Know when to see a GP instead.Repeated nosebleeds, nosebleeds in a child under two, symptoms of anaemia such as breathlessness and pallor, or being on a blood-thinning medicine such as warfarin.
Tips
- Dry indoor air in winter is a genuine cause. A cooler bedroom, and not sleeping directly under a blast of warm air, both reduce recurrence.
- A child who gets frequent nosebleeds and picks their nose is a common and entirely fixable combination. Keeping nails short and treating any crusting helps more than anything else.
- Set a timer on your phone rather than counting. Everyone underestimates ten minutes with their fingers on their nose.
Common mistakes
- Tilting the head back — It sends blood down the throat, which gets swallowed, irritates the stomach and causes vomiting — and it hides how much bleeding there actually is.
- Pinching the bony bridge — There is nothing to compress there. The pressure has to be on the soft part just above the nostrils, where the bleeding vessel is.
- Letting go every minute to check — It breaks up the clot each time. Ten to fifteen minutes of uninterrupted pressure is the instruction, and interruption is why people conclude it is not working.
- Packing the nose with tissue — It disturbs the clot when it is removed, and it does not apply the pressure that stops the bleeding. Fingers on the soft part is what works.
If it doesn't work
It stops and then restarts a few hours later
Cause: The clot has been disturbed — by blowing the nose, bending, lifting or a hot drink — Fix: Repeat the pressure for a full 10 to 15 minutes, and then be stricter about the avoid list for the rest of the day.
Frequent nosebleeds with no obvious cause
Cause: Dry air, nose picking, a prominent vessel, an allergy or a medicine — or occasionally something that needs investigating — Fix: See a GP. Cauterising a prominent vessel is a straightforward outpatient procedure, and recurrent bleeds are worth assessing rather than tolerating.
A nosebleed after being hit on the nose
Cause: Trauma, potentially with a fracture — Fix: Apply pressure as normal, and get it assessed. If there is clear fluid mixed with the blood, or any of the head injury 999 signs, ring 999.
Questions people ask
Why do nosebleeds happen more in winter?
Dry, heated indoor air dries the lining of the nose, which cracks and bleeds more readily. It is the commonest seasonal explanation and it is why they cluster in cold months.
Are nosebleeds a sign of high blood pressure?
The relationship is much weaker than folklore suggests. If someone has frequent nosebleeds, having their blood pressure checked is sensible general practice, but a nosebleed is not a blood pressure test.
Should I go to hospital if I am on blood thinners?
Get advice. NHS guidance lists blood-thinning medication as a reason to see a GP about nosebleeds, and a bleed that will not stop with pressure needs A&E in the same way as for anyone else.