A heavy or persistent nosebleed can be an emergency
Seek Urgent Medical Care If
- Bleeding is heavy or does not stop after correctly pinching the soft part of the nose continuously for 10–15 minutes.
- Blood is pouring into the throat, causing choking, repeated swallowing or vomiting.
- You feel faint, very weak, confused, short of breath or close to collapse.
- The nosebleed followed a significant injury to the head or face.
- There is breathing difficulty, chest discomfort or a rapidly worsening overall condition.
- You have a known bleeding disorder or take prescribed treatment that affects bleeding and the nosebleed is difficult to control.
- A young child has a severe unexplained bleed or a possible object or battery in the nose.
Keep applying pressure while arranging help when it is safe to do so. Do not drive yourself if you feel faint or unwell.
What Should I Do During a Nosebleed?
1. Sit upright
Sit down and keep your head above the level of your heart.
2. Lean forward
Let blood come out through the nose rather than running into the throat.
3. Pinch the soft part
Use your thumb and finger below the hard bridge, pressing both nostrils firmly together.
4. Hold continuously
Keep steady pressure for 10–15 minutes without releasing it early to check.
5. Breathe through your mouth
Spit out blood that reaches the mouth rather than swallowing it.
6. Reassess safely
Seek urgent care if bleeding remains heavy, continues or you become unwell.
Do not tilt the head backwards
Tilting back does not stop the bleeding and can make blood run into the throat. Do not push tissue, cotton or another object into the nose.
What Is a Nosebleed?
A nosebleed, or epistaxis, happens when a blood vessel in the lining of the nose opens. The nasal lining has many delicate vessels, so dryness, rubbing, infection, forceful blowing, an injury or a recent procedure can trigger bleeding. Sometimes no single cause is found.
Repeated or unusually heavy bleeding may be influenced by local nasal disease, a blood-clotting problem or prescribed treatment that affects bleeding. A clinician must consider the whole picture rather than assuming one cause.
Anterior and Posterior Bleeding
Anterior nosebleed
Starts nearer the front of the nose and is often easier to see and control with pressure or targeted cautery.
Posterior nosebleed
Starts deeper in the nose, may be heavier or run into the throat, and more often needs packing, monitoring or hospital care.
These descriptions guide treatment, but patients cannot reliably identify the source from symptoms alone. A front bleed can still be heavy, and blood from any site may reach the throat.
How Is a Persistent Nosebleed Assessed?
Immediate condition
Pulse, blood pressure, breathing, alertness and the apparent amount of blood loss are checked first.
History
The clinician asks about side, duration, recurrence, injury, earlier nasal procedures and prescribed treatment.
Nasal examination
Clots may be cleared carefully so the front of the nose and a possible bleeding point can be inspected.
Camera examination
A nasal endoscope may help find deeper bleeding or investigate repeated one-sided episodes.
Selected blood tests
Significant, recurrent or unexplained bleeding may require tests for blood count or clotting.
Imaging only when indicated
A scan is not routine for every nosebleed but may be considered after major trauma or when a deeper cause is suspected.
How Do the Main Treatments Differ?
Direct pressure
Correct pinching is the first treatment for most active nosebleeds and may be all that is needed.
Targeted cauterisation
A visible bleeding point is sealed in a controlled way. It is not suitable when the source cannot be identified safely.
Anterior nasal packing
A dressing or purpose-made device provides steady pressure in the front part of the nasal cavity.
Posterior nasal packing
A deeper device controls bleeding farther back and usually requires closer observation because breathing and other risks need monitoring.
Endoscopic control
A camera helps the ENT specialist find and treat a deeper vessel more precisely, sometimes in an operating theatre.
Higher-centre treatment
Persistent severe bleeding may need a procedure to close or block a feeding vessel at a centre with the required facilities.
What Happens During Nasal Cauterisation?
Cautery is used only when the clinician can identify an appropriate bleeding point. The nose is examined, the area may be numbed, and a controlled chemical or electrical method seals the small vessel. A camera may be used when the source is deeper.
You may feel pressure, touching or brief stinging. Cautery does not mean every patient needs a general anaesthetic or a major operation. The setting depends on the bleeding site, severity and ability to remain still.
Cautery treats a target—not every possible cause
Recurrent bleeding may still need review for dryness, injury, inflammation, a structural problem, a clotting concern or another nasal condition.
What Happens During Nasal Packing?
Placement
The clinician places a soft dressing, sponge or balloon-type device into the correct part of the nasal cavity.
Pressure
The pack presses against the nasal lining to support clot formation and control the bleeding vessel.
Observation
Bleeding, breathing and overall condition are reassessed. Deeper packing more often requires admission or monitored care.
Removal plan
Some packing dissolves; other packing must be removed by the clinical team at the agreed time and place.
The pack may cause blockage, facial pressure, headache, watering eyes, reduced smell, dry mouth or mouth breathing. Tell the team about marked pain, breathing difficulty or continued bleeding.
How Long Does Packing Stay In?
The removal time is individual. It depends on the type of packing, bleeding site, severity, other health conditions and whether the material is designed to dissolve. The clinician should give you a specific follow-up and removal plan.
Do not pull, reposition or remove a nasal pack
Removing it early can restart bleeding. Leaving non-dissolving packing longer than instructed can also cause harm. Contact the hospital if the pack moves, feels loose or causes concern.
Are There Risks?
- Pain, pressure, headache, watering eyes, reduced smell and mouth dryness.
- Bleeding that continues despite treatment or restarts during or after pack removal.
- Crusting, irritation, infection or delayed healing of the nasal lining.
- Pressure injury to the nasal lining or skin at the nostril.
- Scarring or a hole in the nasal septum, which is uncommon.
- Movement of the pack or a sensation of material toward the throat.
- Worsened sleep-related breathing or oxygen concerns in vulnerable patients, particularly with deeper packing.
- A need for repeat packing, endoscopic treatment, admission or transfer if bleeding is not controlled.
The balance of benefit and risk depends on how serious the bleeding is. A pack used to control dangerous bleeding may be necessary even though it is uncomfortable.
What Should I Do After Treatment?
- Follow the written instructions for observation, pack care, removal and ENT review.
- Do not remove or adjust a pack and do not place anything else into the nose.
- Avoid blowing, picking or forcefully cleaning the nose while the treated area heals.
- Follow the clinician’s individual advice about work, exercise, bending, lifting, bathing and travel.
- If you need to sneeze, open your mouth rather than trying to suppress it.
- Do not stop, restart or change prescribed treatment that affects bleeding unless the responsible clinician gives you a clear plan.
- Attend follow-up even if the bleeding has stopped, particularly after packing or repeated episodes.
After packing or cautery
Return for Urgent Review If
- Fresh bleeding returns from the nose or mouth and does not settle with correctly applied pressure.
- You develop shortness of breath, noisy breathing, choking or a pack moves toward the throat.
- You feel faint, confused, increasingly weak or generally very unwell.
- Pain becomes severe, facial swelling develops or the skin around the nose changes colour.
- Fever, worsening discharge, vision change or a spreading rash develops.
- The pack falls out, shifts position or appears not to be controlling the bleed.
What If Bleeding Does Not Stop?
The team may repeat the examination, clear clots, change the packing position, use endoscopic vision to identify a deeper vessel or arrange treatment in an operating theatre. Severe or recurrent bleeding may require transfer for a procedure that closes or blocks a feeding blood vessel.
Escalation is based on active bleeding and safety, not simply on whether the first method “failed.” A deeper source often needs a different level of care.
Repeated One-Sided Bleeding Deserves Assessment
Most nosebleeds are not caused by a tumour. However, repeated bleeding from one side—especially with one-sided blockage, unusual discharge, facial symptoms or a visible mass—should be examined rather than repeatedly treated without looking for a cause.
Common Myths
Frequently Asked Questions
Is nasal packing painful?
It can be uncomfortable and cause pressure or headache. Tell the team if pain is severe or worsening so the pack and your condition can be reassessed.
Can I breathe with a nasal pack?
You may need to breathe mainly through your mouth. Any true breathing difficulty, choking or pack movement toward the throat needs urgent review.
Can I eat and drink with packing in place?
The plan depends on whether further treatment may be needed and your swallowing or breathing. Follow the clinical team’s instructions before eating or drinking.
How long will the pack stay in?
There is no single duration for every patient. The material, bleeding site, severity and other health conditions determine the agreed removal or review time.
Who removes a non-dissolving pack?
The responsible clinical team should tell you who will remove it, where this will happen and when. Do not remove it yourself.
Will I need admission?
Some patients can leave with a clear follow-up plan, while posterior packing, severe bleeding or important medical risks may require observation or admission.
Does nose cautery hurt?
You may feel brief stinging, warmth or pressure. The area may be numbed first, and the clinician should stop and reassess if pain is sharp or severe.
Can bleeding return after cautery or pack removal?
Yes. A treated area can bleed again, and a separate vessel or underlying cause may be present. Apply correct pressure and seek care if bleeding remains heavy or continues.
Can a child need nasal packing?
It may be required for significant bleeding, but age, cause, ability to cooperate and the possibility of an injury or foreign body all affect the pathway.
Is treatment different during pregnancy?
Pregnancy can influence nasal bleeding and clinical decisions. Tell the team you are pregnant so examination, monitoring and any procedure can be planned appropriately.
Should I stop prescribed treatment that affects bleeding?
Do not make the decision yourself. Contact the clinician responsible for that prescription or the emergency team for an individual interruption and restart plan.
Why does repeated bleeding from one side need review?
A local irritated vessel is common, but repeated one-sided bleeding can also accompany a structural problem, inflammation or a less common nasal condition that should be seen directly.
Does every nosebleed need a scan?
No. Examination controls and explains many nosebleeds. Imaging is reserved for selected concerns such as major trauma, a suspected mass or an unclear deeper cause.
Will I need a general anaesthetic?
Not usually for simple front-of-nose cautery or routine packing. Deeper endoscopic control or severe bleeding may require a procedure in theatre.
When is higher-centre referral appropriate?
Transfer may be needed when bleeding remains severe despite packing or cautery, a feeding vessel requires specialist closure, or monitoring and facilities exceed local capability.