What causes nosebleeds? When should you check for signs of cancer?
From sinus infection and ageing to simply picking your nose too hard, it’s a common occurrence among adults – but how do you tell if it’s something worse? Also: The explanation behind TCM alternatives.
Unless you're Eleven from Stranger Things, getting a nosebleed isn’t unusual. More often than not, these bloody episodes are caused by more mundane reasons: The lining of your nose has become too dry from the air-conditioning, you blew your nose too hard, you picked your nose too forcefully, or you were hit in the face.
Sometimes, the cause could be medical, like a sinus infection or an allergic reaction. It could also be the result of taking certain medication for age-related health issues. “This may be related to hypertension, anticoagulant medication and the thinning of the nasal lining with age,” explained Dr Vyas Prasad, Thomson Surgical Centre’s head and neck surgeon.
With such a range of causes, it is no wonder that nosebleeds in adults are rather common. According to Dr Leslie Koh, the head of Rhinology Services, Otorhinolaryngology at Changi General Hospital, he sees about five cases a week in his clinic.
HOW CAN YOU STOP A NOSEBLEED?
For the common nosebleed, Dr Koh advised to pinch the soft part of the nose hard and keep the pressure up for five to 10 minutes. “It may also help to gargle some ice water, or suck on an ice cube to reduce the amount of bleeding,” he said. “The bleeding usually continues for five to 10 minutes, until the formation of a clot stops the bleeding.”
To minimise a recurrence, Dr Koh suggested looking at the cause of your nosebleed:
- Dry air from the air-conditioner
Get a humidifier to counter the dryness in the room, especially during sleep. There are also moisturising ointments that can be applied to the areas in the nose that are prone to bleeding.
- Nasal allergy
Get the allergy treated so that you won’t be rubbing and blowing your nose forcefully.
- Nose picking
Use a damp cotton bud to clean your nose instead of jabbing your finger into your nostril.
“Seek medical advice if the nosebleed persists despite measures such as avoiding nose picking and vigorous nose blowing,” said Dr Prasad, who added that an endoscopy of the nose and assessing your blood profile to rule out clotting disorders may be in order. If suitable, nasal cautery and anti-bacterial creams may suffice, he said.
WHEN SHOULD YOU BE CONCERNED ABOUT THAT NOSEBLEED?
While the occasional nosebleed shouldn’t send alarm bells ringing, you might want to be aware if there are accompanying symptoms such as pain, visual issues and headaches with nosebleeds, said Dr Prasad.
He added that it is also worth having a doctor check you out if there’s no obvious trigger (such as the ones mentioned earlier) and the bleeding doesn’t seem to come from the front of the nasal partition or the cartilage separating your nostrils.
Dr Koh pointed out that, while uncommon, nosebleeds could be the first sign of nasopharyngeal cancer or cancer of the back of the nose. “According to the Singapore Cancer Registry, nasopharyngeal cancer is the ninth most-common form of cancer in males, accounting for close to four per cent of all cancer in males in Singapore,” he said.
Nasopharyngeal cancer is also more prevalent if you are of south Chinese heritage – particularly Hong Kong and Guangzhou – according to the American Cancer Society.
So how do you tell if the nosebleed is the result of over-enthusiastic nose picking or cancer? “If the bleeding recurs repeatedly, seeking specialist attention to exclude the presence of nasopharyngeal cancer is recommended,” said Dr Koh.
ALTERNATIVE VIEW: WHAT’S THE TCM TAKE ON NOSEBLEEDS?Meanwhile, there’s also the traditional Chinese medicine (TCM) explanation for nosebleed – and the reason your mother makes you drink liang teh or cooling Chinese herbal tea when your nose bleeds: Heatiness.
According to Thomson Chinese Medicine’s TCM physician Jun Negoro, “The common causes of nosebleeds include heat in the lungs, heat in the stomach and a yin deficiency.”
The variations in the bleeding’s duration, interval, as well as the quantity, colour and texture of the blood can tell the physician the root cause, she added.
For instance, dryness or a burning sensation in the nostrils accompanied by fever are likely signs of heat in the lungs. Heat in the stomach would present with symptoms such as bad breath, mouth dryness, swollen gums and constipation.
“A yin deficiency is a more chronic condition, where the body fluids are exhausted and there are symptoms such as a low-grade fever, and warm palms and soles,” said Negoro.
Interestingly, TCM physicians believe that nosebleed is likely to occur in women during menstruation, too. “This is seen as a reverse qi and blood flow in the chong meridians, where the blood is forced to flow out of its regular pathway,” said Negoro.
So what’s the treatment if you go by this route? TCM physicians may prescribe herbs to clear the heat in the respective organs, said Negoro. The treatment may also focus on cooling, astringing the blood and directing it to its correct pathway, she said.