Frequent nosebleeds – causes and treatment
Nosebleeds – also known medically as epistaxis – are very common and usually harmless. However, if they keep recurring, they can become troublesome, and in adults a sudden onset of nosebleeds should always be examined by a specialist. In many cases, the cause can be identified and treated during the same visit.
What is a nosebleed?
A nosebleed is bleeding from the lining inside the nose. In the vast majority of cases, the blood comes from a small network of blood vessels at the front of the nasal septum, known as Kiesselbach’s plexus. These blood vessels lie just beneath a thin mucous membrane and can rupture easily when the lining becomes irritated.
According to a review article in Ugeskrift for Læger, around 60% of people experience a nosebleed at least once in their lifetime, but only around 6% require medical treatment and 1–2% undergo surgery. Children and adults over the age of 35 have the highest risk.
There are two main types of nosebleeds: anterior and posterior. Anterior nosebleeds are by far the most common and can usually be treated with a short procedure. Posterior nosebleeds originate from larger blood vessels further back in the nose. They are less common and may require surgery.
Why do frequent nosebleeds occur?
The most common cause is irritation of the lining over the small blood vessels at the front of the nose. This can be caused by nose picking, allergies, tobacco smoke or nasal spray that is directed towards the nasal septum.
Some types of medication can make the nasal lining thinner. Blood-thinning medication can also make bleeding more likely to occur and more difficult to stop.
A nosebleed may occur suddenly and without any obvious cause – including during the night or in the morning. This does not necessarily mean that anything is wrong. However, if nosebleeds keep recurring, it is a good idea to have the nose examined so the cause can be identified.
If you also have a blocked nose, this can be investigated during the same appointment.
Nosebleeds in children – when should a child be examined?
Many young children go through periods of frequent nosebleeds, which often resolve on their own. In children, around 9 out of 10 nosebleeds originate from the front of the nose, typically from Kiesselbach’s plexus.
If your child has frequent nosebleeds or the bleeding affects everyday life, an ear, nose and throat specialist can assess whether the blood vessel should be cauterised.
At Charlottenlund Private Hospital, children can be treated from the age of 2. In our experience, local anaesthesia is rarely a good option for children under 15, so children are always given a short general anaesthetic and sleep while the blood vessel is sealed.
When should adults have nosebleeds examined?
When an adult suddenly starts experiencing nosebleeds, the nose should be examined by a specialist. The purpose is to make sure there is no underlying cause other than an irritated blood vessel and to determine the most appropriate treatment.
The same applies if nosebleeds occur repeatedly, are heavy or are difficult to stop.
Nosebleeds and blood-thinning medication
Patients taking blood-thinning medication can also have their nose examined and treated at Charlottenlund Private Hospital.
Blood-thinning medication should not be stopped without first consulting your own doctor.
What can you do yourself about frequent nosebleeds?
The first step is to identify what is triggering the bleeding. It can often help to avoid picking your nose, adjust your technique when using nasal spray or apply petroleum jelly inside the nostrils morning and evening for a period of time.
If the nosebleeds continue, the blood vessel can be sealed with a short procedure.
How is a blood vessel in the nose cauterised?
Cauterisation of a blood vessel in the nose – medically known as bipolar electrocoagulation – is the most common procedure used for frequent nosebleeds.
A separate initial assessment is often unnecessary: you can usually be examined and treated during the same appointment, and the procedure can be carried out at all of the hospital’s locations across Denmark.
If the doctor and patient choose local anaesthesia, a small piece of cotton wool containing local anaesthetic is placed inside the nose. After a few minutes, the lining around the blood vessel is numb.
The specialist then seals the blood vessel using a small electrical instrument that gently heats the area. Finally, a thin strip of gauze with ointment is placed in the nostril, and you can go home afterwards.
The procedure can also be carried out under a short general anaesthetic if you prefer to sleep during the treatment. After general anaesthesia, you will be observed for a short period and can then return home the same day.
Anterior nosebleeds
- Originate from the small blood vessels at the front of the nasal septum and are by far the most common type.
- Treated with bipolar cautery under local or general anaesthesia.
- Treatment can be performed at all hospital locations. Children from the age of 2 are treated under general anaesthesia.
Posterior nosebleeds
- Originate from larger blood vessels further back in the nose and are uncommon.
- Treated surgically under general anaesthesia by sealing the arteries supplying the bleeding area.
- Surgery is performed in the surgical department in Charlottenlund.
What if the bleeding originates further back in the nose?
Posterior nosebleeds originate from larger blood vessels deep inside the nose and cannot always be treated under local anaesthesia.
A Danish review article states that around one-third of patients admitted to hospital with nosebleeds have posterior bleeding.
In the rare cases where the bleeding continues, a nose and sinus surgeon seals one or more of the arteries supplying the affected area, such as the sphenopalatine artery or anterior ethmoidal artery.
The procedure is performed under general anaesthesia in the surgical department in Charlottenlund.
What is recovery like after treatment?
Most people experience only mild discomfort for the first few days, although minor bleeding may occur. Daily activities can usually be resumed after 4–7 days, while strenuous physical activity should be avoided for around 14 days. A short period of sick leave may be needed after surgery for a posterior nosebleed. Most people can return to work within a week, and heavy physical work can be resumed after 14 days.
For a few days after treatment, we recommend sleeping with your head raised and avoiding hot baths, sunbathing, alcohol, and spicy or hot food. The specialist will explain aftercare and pain relief on the day of treatment.
Treatment of nosebleeds at Charlottenlund Private Hospital
Nosebleeds are examined and treated by specialists in ear, nose and throat conditions at the main department in Charlottenlund and at the hospital’s clinics at several locations across Denmark.
Cauterisation of blood vessels in the nose can be performed at all locations under local or general anaesthesia, while surgery for posterior nosebleeds is carried out in Charlottenlund.
The hospital’s other ear, nose and throat procedures are listed on one page.
Referral and payment
Most patients come through health insurance. Insurance companies typically require a referral from your GP and prior approval.
Self-paying patients do not need a referral, and prices are available in the price list.
If you have waited more than 30 days for treatment in the public healthcare system, you may be entitled to treatment paid for by the region under the extended free choice of hospital.
Appointments can be booked online at any time.
Read also
Nosebleeds are often examined together with other nasal problems.
Frequently asked questions
Why does my nose bleed?
Most often, the lining over the small blood vessels at the front of the nasal septum is irritated—for example, by nose-picking, allergies, tobacco smoke, or nasal spray. Some medications can thin the lining. Young children often have periods of nosebleeds that go away on their own. Sudden nosebleeds in adults should be examined by a specialist.
What can I do myself?
First, the underlying cause needs to be identified. Often, it is enough to stop picking your nose, change how you use your nasal spray, or apply petroleum jelly inside your nostrils morning and evening for a period.
What can a specialist do?
The bleeding blood vessel is sealed using bipolar cautery. Adults can choose local anaesthesia or a brief general anaesthetic. Children aged 2 and over are treated under general anaesthesia so they sleep during the procedure. You go home the same day.
Are nosebleeds dangerous?
Nosebleeds are usually harmless. Around 60% of people experience a nosebleed during their lifetime, but only around 6% need medical treatment. If nosebleeds occur frequently or start suddenly in an adult, the nose should be examined by a specialist.
What is the medical term for a nosebleed?
Both terms are used and mean the same thing. The medical term is epistaxis.
Can nosebleeds be treated if I take blood-thinning medication?
Yes. Patients taking blood-thinning medication can be examined and treated at Charlottenlund Privathospital. Do not stop taking your medication without consulting your GP.