• Reference Number: HEY0230-2025
• Departments: ENT
• Last Updated: 30 September 2025

Introduction

This leaflet has been produced to give you general information nosebleeds, also called epistaxis. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your healthcare professional but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a nosebleed (epistaxis)?

Epistaxis is a medical term for a nosebleed. This is bleeding from either 1 or both nostrils, that can come from the front of your nose, go down the back of your throat, or both.

Epsitaxis can affect anyone but is generally more common in men than women and tend to affect the elderly, although are common in young children.

It is thought that nose bleeds occur because of a fragile blood vessel in the nose breaking, either spontaneously, or because of trauma or injury.

The risk of having a nosebleed is increased when you have high blood pressure, consume alcohol, take blood thinning medication, have problems with your blood clotting, have had a nasal infection or injury or have a dry/crusty nose. However, the cause of some nosebleeds is unknown.

It is important to note that if you take blood thinning medications and develop nose bleeds that you do not stop taking the medication until you have sought advice from a healthcare professional.

How to manage nosebleeds (epistaxis):

If you experience a nosebleed, it is important to pinch the fleshy part at the end of your nose firmly for at least 15 minutes without letting go. You should lean forwards and spit any blood out that is running down your throat, as swallowing it can make you feel sick. If you can, wrap some ice in a cloth and apply this to the bridge of your nose whilst you are pinching.

After 15 minutes if the bleeding has stopped, generally no further action is needed, however if this happens frequently, please seek medical review via your GP.

After 15 minutes if the bleeding continues despite your efforts or you are concerned about the severity of the bleed then you should attend your local A&E department.

How will a doctor manage a nosebleed (epistaxis)?

If you have frequent nose bleeds, which stop with pressure, and you have attended your GP for advice, they can prescribe an antiseptic cream. This can be an effective treatment for nosebleeds. It is important to make your GP aware if you are allergic to nuts, as one type of cream (Naseptin) contains nut oil. In this case the GP can prescribe an alternative.

If you have attended A&E due to an ongoing or severe nosebleed there are several options of interventions a healthcare professional may use to stop the bleeding:

• A healthcare professional will continue to apply pressure and provide ice therapy (if available). When ready, they will examine the inside of your nose and try to locate the vessel that is bleeding. If a bleeding vessel is located, they can use chemical cauterisation to seal off the blood vessel. This involves using a small amount of local anaesthetic solution to the area and then applying silver nitrate to the vessel. This is generally not painful and can be very effective. You will be monitored for a short time after this procedure, and if no further bleeding occurs, you can be discharged.
• If the above treatment is not appropriate, or it does not work, a solution called Floseal can be put into your nose. This solution is mixed at your bedside and is used to stop/control bleeding. It is instilled into the nostril and remains there. After this procedure, you will be monitored for a short time, if no further bleeding occurs you can be discharged. Having floseal instilled into your nostril will cause you to feel like you have a blocked nose, this solution will slowly dissolve over time as your body absorbs it, or you may experience granules dropping out of your nose, and your breathing through your nostril should gradually improve. This is nothing to be concerned about, but if you are worried you should seek medical advice. Please be aware Floseal contains bovine derived gelatin matrix and human-derived thrombin you may decline this product due to religious or personal circumstances; you can have further discussion regarding this with your healthcare provider.
• If necessary, a healthcare professional may need to pack the nose with a rapid rhino device. This pack is inserted into your nose and inflated to apply pressure to the bleeding point. After this procedure you may experience discomfort and require some painkillers. You will need to be admitted to hospital whilst this device is in place. You will have this in for approximately 24 hours, at which point, if no further bleeding has occurred, it can be removed and steps 1-2 followed. In some cases, the pack needs to stay in longer, and you may be started on antibiotics to prevent infection; however, this will be discussed with you at the time. You will likely have blood tests taken on your admission so that healthcare professionals can monitor your haemoglobin levels and ensure you haven’t lost too much blood.
• In rare cases, the above interventions do no stop bleeding, and posterior packing or an operation will be considered. If this is the case, an ENT surgeon will discuss this with you.

What should I do after a nosebleed?

Please read the information leaflet. Share the information it contains with your family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of your nosebleed.

Precautions can be taken after a nosebleed to reduce the likelihood of it re-occurring. Hot food/drinks/baths and showers should be avoided for at least 24hours. Avoid blowing your nose forcefully, putting any tissue in your nose, or prodding/poking the inside of your nose, this can disturb fragile blood vessels or scabbed areas where your nose is trying to heal. If you need to sneeze, do so with your mouth open, this reduced the force of pressure going through your nose. Avoid any strenuous exercise, heavy lifting, bending over with your head down, smoking, smoky atmospheres and drinking alcohol for a short time.

What happens afterwards?

Follow up with the ENT department is generally not needed after receiving treatment for a nosebleed. However, your healthcare professional should discuss this with you prior to your discharge from their care.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Ear, Nose and Throat (ENT) Department.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.