Nose Bleeds: When Should I be Concerned?

Nose Bleeds: When Should I be Concerned?

Epistaxis or more commonly known as nose bleeds can happen quite easily. While nosebleeds may appear out of the blue, most are not of serious concern and can be dealt with at home.

The ENT Clinic is a medical centre par excellence with highly qualified ENT doctors who practice evidence based medicine in Singapore. The centre handles both paediatric and adult ENT patients for a range of ENT disorders including epistaxis. The centre is conveniently located at Gleneagles Hospital and Mt. Elizabeth Novena Specialist Centre.

What exactly is a nose bleed?

The nose contains several blood vessels on its surface lining. A small injury, altitude changes, dry air are a few ways that can trigger bleeding

Is it serious to have a nose bleed?

While it is  quite alarming to see blood coming out of your nose, having a nosebleed once in a while may not be serious. However, if there are recurrent nosebleeds happening at very short intervals then investigating the cause is essential. Some nose bleeds can originate from the back of the nose where there are large blood vessels. If these are damaged then it can lead to heavy bleeding which is dangerous. If such bleeding has occurred following an injury, and the bleeding continues even after applying direct pressure for 20 minutes, then it is best to seek medical attention.

If you are worried about your nasal bleeding, then consult an ear, nose and throat clinic without delay.

What are the different kinds of nose bleeds?

There are different kinds of nose bleeds based on the location of the bleed. The two types are:

Anterior nosebleed:

This is the most common type of nose bleed and it is generally not serious. It initiates from the nasal septum, where small capillaries are present which can break easily and bleed. This is common in children and can be treated at home. 

Posterior nosebleed:

This requires medical attention and occurs deep inside the nose. It involves large blood vessels at the back of the nose close to the throat. Damage to these vessels can cause heavy bleeding which can flow back to the throat. Emergency attention might be needed and this is more common in adults.

In whom are nosebleeds more common?

While a nosebleed can happen in anyone, there are some individuals who are more likely to have a nose bleed than others. These include:

Children:

Kids who are between two and ten years have a higher chance of having a nosebleed. Dry air, respiratory tract infections, allergies as well as inserting foreign objects into the nose, makes them more prone to having a nose bleed.

Adults:

Individuals who are between 45 and 65 years old have a greater chance of having nose bleeds. This is because blood may take longer to clot in these adults. In addition, since most take blood thinning medications for hypertension or atherosclerosis, it makes it easier to have nose bleeds in adults.

Pregnant women:

During pregnancy blood vessels in the nose can expand which puts more pressure on the blood vessels lining the nasal cavity.

Individuals with certain disease conditions:

Anyone who is taking blood thinner medications or has a condition like haemophilia which involves a blood clotting disorder has a higher chance of having nose bleeds.

What causes a nosebleed?

Nose bleeds can occur due to many reasons. Dry air is the most common cause when one lives in a dry climate and there is a central heating system running. This causes the nasal membranes to dry out. This dryness can cause crusting in the nose which can itch and become irritated. When one picks or scratches the nose, it can lead to bleeding. Certain medications such as decongestants and antihistamines can lead to nasal membranes to dry out causing nosebleeds. In addition, frequent nose blowing is another cause of nose bleeds.

Upper respiratory tract infections:

Sinusitis and colds which bring about repeated blowing and sneezing can cause nose bleeds.

Allergies:

Both allergic and non-allergic rhinitis which causes an inflammation of the nasal passage can lead to nose bleeds.

Facial Injury:

Knocking your nose with force or inserting a foreign object to the nose can lead to nasal blood vessel injury.

Irritants:

Certain chemicals such as cleaning agents and toxic fumes can cause nose bleeds. In addition, inhaling illicit drugs like cocaine can irritate the lining of the nose.

High altitudes:

As the air is thinner and drier in high altitudes it can cause nasal bleeds.

Juvenile Nasopharyngeal Angiofibroma:

This is a rare benign tumour which occurs in the nasal passage and it is more common among adolescent males. This can spread aggressively and spread to the base of the skull. It can lead to nasal obstruction and nose bleeds.

Nasopharyngeal cancer:

While this cancer can occur at any age, it is most common among adults who are between 30 and 50 years. It is mostly caused by chemical inhalation and consuming salt cured foods. This cancer increases the risk of nasal bleeds.

Nasal polyps:

Polyps or tumours which occur in the nasal cavity can bring obstruction and irritate the nasal lining causing bleeds.

How to diagnose a nose bleed?

An otolaryngologist at a clinic such as ENT Dr Jeeve, Dr Hobbs or Dr Annabelle  will conduct a physical examination to find the cause. In addition, he  or she will do a thorough medical history and review the current medications you are on. It is important to let your doctor know of any recent injuries. The doctor will perform a full blood count to check if you have any blood disorders. In addition, a partial thromboplastin time test may be done to check the blood clotting rate. The doctor may do a nasal endoscopy, X-ray or nasal CT scan to diagnose the cause of nasal bleeding.

What are the treatments for nose bleeds?

The kind of treatment depends on the cause of the nasal bleed. It includes:

Nasal packing:

In order to create pressure at the nasal bleed, a special nasal sponge is usually inserted. This is left for a day or two and removed by a clinician.

Cauterization:

This procedure uses the application of silver nitrate or heat energy to seal bleeding blood vessels. Prior to procedure local anaesthesia is used.

Medication review:

The doctor may limit blood thinning medicines if possible and blood pressure medications will be optimised. Tranexamic is prescribed to help blood clotting.

Surgical repair:

If there is a broken nasal bone or a deviated septum it is usually corrected by the ENT surgeon.

What first-aid can I follow to stop a nose bleed?

Minimising on the loss of blood is advised during a nose bleed and these 5 quick steps can be practiced:

Sit upright:

It is important to sit upright and lean forward. Although it is tempting to lean back to prevent the drip on your face, leaning forward prevents blood travelling to the back of the throat which can cause vomiting or choking.

Resist packing the nose:

Avoid packing in cotton pads and tissues as this can worsen bleeding since it irritates the blood vessels further. Instead place a damp cloth to catch the blood as it comes out.

Spray a decongestant:

Use a spray like Afrin to tighten blood vessels in the nose. It can relieve inflammation and congestion to slow or stop bleeding.

Pinch the nose:

Pinching the fleshy part of the nose below the nasal bones for about 10 minutes can help to compress blood vessels and prevent bleeding.

Repeat these steps for up to 15 minutes:

If the nosebleed doesn’t stop even after 10 minutes of pressure then reapply pressure for 10 more minutes. Applying a decongestant again to the affected nostril may help at times.

However, if the bleeding continues even after 20 or more  minutes and you are losing a significant amount of blood then it is best to visit the emergency room.

How to prevent nosebleeds?

By following the below steps nosebleeds can be minimised:

  • Using a humidifier if the  house is too dry.
  • Avoiding  nose picking
  • Limiting aspirin usage if not needed. This should be discussed with the doctor
  • Decongestant and antihistamine use must be done in moderation to  prevent nasal dryness.
  • Saline spray application to dampen the nose to prevent drying.
John Norwood
John Norwood is best known as a technology journalist, currently at Ziddu where he focuses on tech startups, companies, and products.