Don't ignore frequent nosebleeds

Most of us would have experienced a nosebleed at some point in our lives.

About 80 to 90 per cent of nosebleeds are spontaneous and occur in normal, healthy people, especially children, said Dr Yuen Heng Wai, consultant at Changi General Hospital's (CGH) Ear, Nose and Throat (ENT) Department.

While an occasional nosebleed is rarely cause for concern, frequent and severe nosebleeds may sometimes indicate underlying problems such as hypertension (high blood pressure), clotting problems or cancer, said ENT experts.

In extreme cases, frequent bloodstains in the nasal mucus or sputum may indicate advanced-stage nasopharynx carcinoma (NPC), which is cancer of the nose.

Dr Duncan Wong, associate consultant at Khoo Teck Puat (KTPH) Hospital's ENT Department, said he would perform a thorough nasal endoscopic examination, go through the patient's family history and do a blood test to exclude NPC. Patients suspected of having NPC are required to undergo a biopsy.

A person with high blood pressure may have nosebleeds more easily and find it harder to stop the bleeding, said Dr Wong.

According to Dr Yuen, studies have not proven that hypertension directly causes more frequent nosebleeds. What high blood pressure does, however, is that it could result in more severe bleeds.

"When the nose bleeds, the patient gets anxious and scared. His blood pressure goes up even more, and the bleeding continues. It is a vicious cycle," explained Dr Yuen.


When a nosebleed ends up as an emergency

An average nosebleed lasts five to 10 minutes. However, Dr Wong has seen instances where the severe loss of blood required emergency treatment and blood transfusions.

"Especially if the patient has cardiovascular problems and is on blood thinning medications such as aspirin and warfarin. Any trauma on the nose will cause them to bleed more severely," he said.

Dr Yuen advised: "As a rough guide, if you are having nosebleeds several times a week for consecutive weeks, and if it takes more than half an hour to stop despite taking measures, you should seek medical attention."

Stopping the bleeding

Tips from ENT specialists.

- Learn forward, not backward, to avoid swallowing the blood or choking.

- Pinch the lower, softer part of the nose. This exerts pressure on the most common area of bleeding.

- Put an ice pack on the forehead or back of the neck. Gurgling some iced water may also help contract the blood vessels.

- If the bleeding still does not stop after 30 minutes, seek medical attention.