Just a Nosebleed or something more? Your ENT can help.

Anyone who’s seen a nosebleed will vouch for the fact that it can be a scary sight. Usually, there will be blood oozing from one or both nostrils, and the incident will be referred to as epistaxis medically speaking.

Although it looks alarming, most of the time the nosebleed will stop on its own. All it takes is a few minutes of self-care. The intensity and the time of the bleed could differ from person to person, but most nosebleed episodes last between a few seconds to a few minutes.

Medical attention will be required only in cases that are heavy and/or frequent require medical attention.

Most often, nosebleeds are caused by the mucus lining inside the nose drying up - which could happen if you live in a cold, dry place; spend lots of time in air-conditioned areas; or due to an infection. Nosebleeds could also be caused by deficiencies, inhalation of dangerous chemicals, sinusitis and substance abuse. The usual routine for stopping the bleed is to hold/pinch the area above your nostrils for ten minutes.

People whose blood takes longer time to clot, whether because of their body constitution, or due to some medication they are taking- also suffer from longer and heavier bleeds. In cases where ‘pinching of the nose’ routine does not work, and the episode lasts for more than twenty minutes, then the doctor will have to try other options to solve it. Cauterising the bleeding point is one option - the bleeding point is sealed with either chemicals like trichloroacetic acid or silver nitrate or with electrocautery. If the bleeding is very profuse, the nose is tightly packed with ribbon gauze soaked in antibiotic creams or with special hemosealent sponges.

For an episode that lasts more than twenty minutes, it is very important that you get professional help to check why this is happening. Your doctor is likely prescribe a few blood tests like a complete hemogram to see is the patient is anemic or whether he/she has an abnormal bleeding tendency due to blood cancers like leukemia, lymphoma , idiopathic thrombocytopenic purpura etc. Sometimes acute nosebleeds could be the sign of certain kidney ailments like acute nephritis, chronic renal failure etc and to check this out blood urea levels, creatinine levels and blood uric acid levels are checked. Liver failure or some variants of hepatitis also can cause a nose bleed, so a full liver function tests also, including a check of bleeding and clotting parameters.

People who suffer from hypertension or high blood pressure are likely to have heavier bleeds that are usually posterior in nature. This means that the bleeding is not happening from the front of the nose, but it is happening from the top. For BP patients, this can be a chronic and sometimes frequent experience. Chronic bleeds require medical attention, since this heavy blood loss can be serious and in some cases could even lead to anemia.

People who have nose bleeds due o high BP should monitor their blood pressure carefully and ensure that it stays within the healthy limits. This can be done by following a healthy food pattern that helps to regulate blood pressure, proper exercise, getting adequate sleep, and finding a good way to destress.

If the nose bleed is not profuse and only blood streaked mucous generally it could be due to simple causes like dryness, finger picking of the nose or acute rhinosinusitis. On the other hand, having persistent blood streaked mucous could be a symptom of something more serious like cancerous lesions of nose and nasopharynx or fungal infections. If these are not identified and treated early, it could become life threatening. It is very important that these be ruled out by an ENT specialist.

If you are generally prone to nosebleeds, try to avoid picking your nose, or blowing too hard through your nostrils. Be careful about the blood-thinning medicines that you use, and do discuss with your physician or specialist if you are on such medications. It is also advisable to avoid alcohol, smoking and hot drinks, especially when you are recovering from a nosebleed, since these will make the blood vessels inside your nose to expand.

Dr Anita Krishnan
Consultant ENT and Balloon Sinuplasty Surgeon

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