Nosebleeds are relatively common –almost everyone has had a few episodes of nosebleed in his or her lifetime. In most cases, they stop almost as fast as they start, and usually last no more than a few minutes. They are usually not serious and can be handled fairly easily at home. However, sometimes a nosebleed can be a serious indication of something more going on within the body. Knowing what type of nosebleed is occurring is very important-as some rare kinds can cause serious medical complications or even death.

1. What Is A Nosebleed?

A nosebleed, also called epistaxis, is bleeding from the nose. According to Dr Andrew Loy Heng Chian, Consultant ENT-Head & Neck Surgeon at Mount Elizabeth Hospital, nosebleeds are more common in young children between the age of 2 and 10 years old, and older adults from 50 years onwards; and they are divided into two types, depending on the source of bleeding- anterior (front of the nose) or posterior (back of the nose).

Anterior nosebleeds usually come out from tiny blood vessels at the very front part of the nose (the septum), and are easy to stop. Posterior nosebleeds which are less common begin deep and high in the nasal cavity and the blood will flow backwards into the back of the mouth and throat. Posterior nosebleeds are usually more severe and tend to occur in older people, those with high blood pressure or taking anti-clotting medicines, or after nasal trauma or injury. These nosebleeds are more complicated and harder to stop, and usually require management by an Ear, Nose and Throat (ENT) specialist.

2. What Causes Nosebleeds?

The blood vessels in the nose are very soft and any interference with them, however slight, can cause the nose to bleed. While it is true to say that most nosebleeds occur for no obvious reason, Dr Andrew Loy shares that there are some factors which can contribute to frequent nose bleed. Among them are:

  • Vigorous nose blowing or nose picking, which results in damage to nasal lining and rupture of the superficial blood vessels.
  • Nasal allergies, which are poorly controlled, resulting in frequent nose rubbing and picking
  • Nasal infections, such as rhinitis or sinusitis
  • Drugs which interfere with clotting (such as warfarin or aspirin)
  • Clotting disorders, for example, hemophilia, leukemia
  • Trauma or fractures to the nose
  • Tumors (both malignant and benign) arising from the nasal cavity, sinuses or nasopharynx

Dr Ralph Stanley, Senior Consultant ENT/head & Neck Surgeon at Gleneagles Hospital adds that although nosebleeds are common in the general population, anterior nosebleeds or blood stained sputum in the morning could signal something serious and may require immediate ENT consultation and a nasoendoscopy to rule out Nasopharyngeal Carcinoma (NPC) or nose cancer. He also cautions that if you have repeated episodes of nosebleeds, or if there is presence of blood in the urine or stool, or easy bruising, a general bleeding disorder would have ruled out and immediate medical attention is required to diagnose the condition. A full blood count, bleeding and clotting times would arrive at a diagnosis in most cases. Special tests are required if hemophilia is suspected. As Dengue Hemorrhagic Fever (DHF) is endemic in Singapore, this would have to be considered in a patient with fever and nose bleeds.

3. What Should You Do To Stop A Nosebleed?

Don’t panic! Stay calm as the bleeding may be more severe if you are agitated and restless, advises Dr Andrew Loy. If the bleeding occurs in a young child, help him to stay calm by reassuring and comforting him.

Sit up and lean forward: Many people mistakenly lie on their backs or point their noses to the sky. This tends to result in blood flowing back into the throat and the patient may end up choking and coughing. By remaining upright, you reduce blood pressure in the veins of your nose, discouraging further bleeding. Sitting forward will help you avoid swallowing blood. Applying a cool compress on the bridge of the nose may also help.

Pinch your nose: Using the thumb and index finger, apply direct pressure by pinching the soft part of the nose between the tip of the nose and the bony nasal bridge. Hold the nose tightly for 5 minutes and breathe through your mouth. If the bleeding persists, continue to hold on for another 10 minutes. Apply ice in a plastic bag or wrapped in a towel to the nasal bridge and forehead. This will cause the facial blood vessels to constrict and reduce the bleeding rate.

After the bleeding episode: To prevent a repeat nosebleed, don’t blow your nose too hard or too often, don’t bend over for several hours and don’t pick your nose.

4. How Is A Nosebleed Treated?

Most anterior nosebleeds stop on their own in a few minutes, and can be treated fairly easily at home with simple first aid measures. However, if the bleeding is profuse and lasts longer than 30 minutes, or it occurs after a head injury or accident, you should seek immediate medical attention with an ENT specialist. He will try to find out where the bleeding is coming from in your nose, and examine it with a headlight as well as a flexible nasoendoscope to visualize the entire nasal cavity.

If the bleeding fails to stop by external pressure, the nostrils may need to be packed with cotton gauze, says Dr Ralph Stanley. The gauze is usually impregnated with a small amount of adrenaline. The adrenaline reduces the diameter of the blood vessels in the nose, thereby reducing the amount of blood loss. Referral to an ENT specialist may be needed in order to undergo a nasal Cautery, where the bleeding vessel in the nose is sealed by applying a special solution or an electrical or heating device.

While most nosebleeds stop with Cautery and/or packing, severe or recurrent bleeding may require surgical treatment. In such a severe situation, you may need to be admitted to hospital for further tests, and may have to undergo endoscopic examination and ligation of particular blood vessels that are causing the nosebleed.

5. How Can You Prevent A Nosebleed?

If you have recurrent nosebleeds, Dr Andrew Loy offers the following precautions to help you prevent the problems and maintain a healthy nose:

  • Control and treat any underlying nasal allergies or infections.
  • Keep the nasal lining moist by applying a thin layer of petroleum jelly or Vaseline with a cotton bud three times a day and before bed.
  • Encourage the child not to pick or blow his nose vigorously.
  • Avoid prolonged periods of exposure to dry air. Sleeping with the air conditioner every night dries out the nose.
  • A saline nasal spray can be useful to keep the nasal lining moist.
  • Stop smoking! Inhaled smoke dries out the nasal membranes, irritates the nose and is associated with increased risk of cancer.

Stop the gush.

Don’t let a nosebleed ruin your day.

Nosebleeds may be frightening, but they are usually not serious and can be managed quickly with some simple first aid measures. If you have a history of nosebleeds, it may be the result of blowing your nose too hard or repeated rubbing and picking-this can all be remedied by changing your habits. However, if you have nosebleeds that last for more than 30 minutes, you may need to see an ENT specialist immediately. With proper treatment and precautions, you can recover from nosebleeds without any long- term effects.

As one of Asia’s leading private healthcare providers, ParkwayHealth is renowned for its high quality clinical outcomes, and service excellence in various multi-disciplinary specialties, including ENT (Ear, Nose and Throat) Surgery. We have more than 25 ENT surgeons under one roof who are specialized in treating ear, nose and throat conditions.