Nasal care

Recurrent Nosebleeds in Adults: First Aid, Causes and When ENT Assessment Helps

A practical guide to recurrent adult epistaxis, including first aid, common causes, anterior versus posterior bleeds, red flags and ENT treatment options.

Nasal care8 min readGeneral informationUpdated June 2026

Adult nosebleeds are often treatable, but the cause and site of bleeding matter.

Most bleeds are anterior

Many adult bleeds come from small vessels at the front of the septum and can be treated in clinic.

Medication and health context matter

Blood thinners, high blood pressure, nasal sprays, inflammation and bleeding disorders can change management.

Posterior bleeds are different

Bleeding running backwards into the throat, heavy bleeding or repeated uncontrolled bleeds may need urgent ENT care.

Before you readThis article is general information only. It is not a diagnosis or personalised medical advice. Use your usual healthcare route for personal symptoms and urgent services if symptoms are severe or feel unsafe.

First aid: what to do when a nosebleed starts

Most nosebleeds settle with correct pressure. Sit upright, lean forward and pinch the soft part of the nose just below the bony bridge. Hold steady pressure for 10 to 15 minutes, breathing through the mouth. Avoid repeatedly checking too early. Do not lie flat or tilt the head back, because blood can run into the throat and be swallowed.

If blood runs into the mouth, spit it out rather than swallowing it. After the bleed has stopped, avoid nose blowing, picking, heavy lifting, vigorous exercise, alcohol, hot baths and very hot drinks for a while, as these can restart bleeding.

Pinch the soft part, not the bony bridgePressure over the hard bridge of the nose usually misses the bleeding point. The soft lower part of the nose is the area to compress.

Common causes of recurrent adult nosebleeds

Recurrent adult nosebleeds are common and often come from fragile vessels at the front of the septum. They can still be disruptive and worrying, especially if they happen without warning, wake someone at night or affect travel, work or confidence.

Dryness and crustingCold weather, heating, dry air, irritants and crusting can make the lining crack.

Inflammation or infectionRhinitis, allergy, sinus inflammation and local infection can irritate the front of the nose.

MedicationBlood thinners, antiplatelet medicines and overuse of some nasal sprays can affect bleeding risk or nasal lining health.

Trauma or rubbingNose picking, forceful nose blowing, nasal injury or previous surgery can create recurrent fragile areas.

Blood pressure and general healthBlood pressure may make an active bleed harder to control. Anaemia or clotting problems may need checking if bleeding is heavy or frequent.

Less common causesOne-sided bleeding with obstruction, crusting or blood-stained discharge can occasionally need deeper assessment.

Watercolour illustration showing adult and child nasal care with a central nose diagram — Dryness, inflammation, fragile vessels, medication and deeper bleeding sources can all play a role.

What ENT assessment looks for

A useful assessment asks how often the bleeding happens, which side it comes from, whether blood runs forwards or backwards, how long it takes to stop, whether there is obstruction, crusting, discharge, smell change, pain or blood-thinning medication, and whether there are other bleeding symptoms.

Examination may identify a visible anterior bleeding point. If the pattern is deeper, one-sided, heavy or associated with other nasal symptoms, a finer endoscopic examination of the nose may be needed. Not everyone needs blood tests or scans, but they may be appropriate if there is frequent heavy bleeding, concern about anaemia or clotting, blood thinners, unusual crusting, or one-sided symptoms.

Watercolour diagram showing nose care, moisturising, nasal spray, allergy triggers and symptom tracking — Good nasal care and reviewing triggers can reduce recurrent anterior bleeds.

Treatment options: from simple measures to ENT procedures

For simple recurrent anterior bleeding, treatment may include moisturising the nasal lining, avoiding irritation, reviewing nasal sprays, treating allergy or crusting, and adjusting contributing factors where possible. Do not stop blood thinners unless a clinician responsible for them advises you to do so.

If a clear bleeding point is seen, silver nitrate cautery may seal the small vessel. ENT specialists may also use endoscopic examination and bipolar cautery for more targeted treatment. If bleeding is heavy or the source is deeper, nasal packing may be needed.

Posterior nosebleeds are more serious. They may run backwards into the throat, be heavier, recur despite front-of-nose cautery, or require admission. In selected cases, operations such as sphenopalatine artery ligation or interventional radiology embolisation may be discussed by the treating ENT team.

When to seek urgent help

Seek urgent help if a nosebleed is heavy, does not stop with correct pressure, causes dizziness or faintness, affects breathing, follows a significant injury, or blood runs backwards into the throat and is difficult to control. People on anticoagulants or with known bleeding disorders should have a lower threshold for medical advice.

Arrange routine review for recurrent patternsRecurring bleeds, one-sided bleeding with blockage or discharge, crusting, pain, blood-stained mucus or symptoms of anaemia should be assessed rather than repeatedly treated as simple dryness.

Sources and further reading

This article was written in patient-friendly language using UK and well-regarded US sources, alongside the linked articles supplied for this project.

NosebleedNHS inform
Epistaxis: management and referral guidanceNICE Clinical Knowledge Summaries
Nosebleeds (Epistaxis)ENT UK
Nosebleeds: first aidMayo Clinic
Nosebleeds: when to see a doctorMayo Clinic
Nosebleeds: causes, treatment and preventionCleveland Clinic
Recurrent nosebleeds in adultsDr Ayeshah Abdul-Hamid
Recurrent nosebleeds in childrenDr Ayeshah Abdul-Hamid