What could be the cause of recurrent nose bleeds?

Doctor's Answers (2)

Thank you for your question. Nosebleed (medical term is epistaxis) is a common condition seen by Family Physicians, ENT Specialists and as pointed out by Dr Winston Lee,  Accident & Emergency Specialists too (when it is heavy or fails to stop with nose pinching for longer than 5-10 minutes).

The causes of nosebleed can be broadly divided into local and systemic causes. Some of the common causes are as follows:

Local:

  1. Large or prominent blood vessels on the front part of the nasal cavity (most commonly on the nasal septum – the wall that separates the nasal cavity into right and left sides. This accounts for more than 90% of the nosebleed that I see in my practice).
  2. Trauma (e.g nose-picking, blunt trauma to the nose etc)
  3. Deviated nasal septum (a crooked nasal septum)
  4. Sinusitis
  5. Tumours in the nose (this is a rare cause of nosebleed. Most tumours of the nose are more likely to cause blood-stained nose mucous or blood-stained phlegm rather than nosebleed)

Systemic:

  1. Uncontrolled high blood pressure
  2. Blood thinning medications (e.g aspirin, clopidogrel, warfarin etc)
  3. Blood clotting and bleeding disorders (rare)

The most important thing when you have an episode of nosebleed is to pinch the soft part of your nose (nostrils) together and tilt your head forward (not backward as commonly advised by our parents/teachers!). If you tilt your head backwards or lie down on your back during a nosebleed, the blood will continue to flow down your throat and you may end up spitting it out or swallowing it. Blood is an irritant to the stomach and you will end up vomiting the blood!

If your bleeding is frequent, e.g more than once a week, you should consult an ENT Specialist for a full clinical history and physical examination, which would likely include a nasoendoscopy (passage of a small lighted tube into your nose, back or nose and down to the level of your voicebox) which is done in the clinic under local anaesthesia.

If the cause of your nosebleed is due to a large or prominent blood vessel, it can be easily sealed off  by applying a chemical stick (called a Silver Nitrate stick) to it. This is done in the clinic under local anaesthesia.

Hope this helps.

Simply put. There are benign causes and worrisome ones. If the frequency is unusual and lasting longer than a minute or two, I would advise you to get it checked.

At the A&E, our practice would be to first examine where the bleeding occurs, if it’s at the front and easily seen it’s usually due to mucosal injury be it nose digging or blowing your nose very hard. Some medicines like acne medications can cause dry mucosa, as can cold weather and climates.

Some simple bloods to check for platelet levels and blood clotting ability are done to exclude that as a cause of frequent bleeds. If normal, we would then suggest referring to ENT for a evaluation.

Unfortunately, smoking and high processed foods intake does increase risk of nasopharyngeal and throats cancers. Any such risk factors should be minimised through healthy living.

Please see the ENT and allay your fears soon!

Heres the best

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