When to Worry About Nosebleed

Reviewed by Dr Soh Hsiu Hsien, Lead Resident Physician, 24-hour Urgent Care Centre, Parkway East Hospital

Nosebleeds, or epistaxis, are common occurrences that most people experience at some point in their lives. While they are often benign and easily manageable, frequent or severe nosebleeds tell a different story. This is when you might want to seek professional advice to rule out underlying health issues.

Learning to distinguish between harmless nosebleeds and those that require attention can help ensure timely medical intervention and effective management of potential causes.

Why does my nose bleed?

Most nosebleeds tend to affect just one nostril, but it is also possible to experience bleeding from both. There are several factors that can contribute to nosebleeds, including:

• Nasal irritation: Frequent nose blowing, allergies, or exposure to irritants like smoke or strong chemicals may trigger nosebleeds. Nose picking can also irritate or damage the delicate blood vessels in the nasal lining, an occurrence that is particularly common in children.
• Humidity changes: While Singapore generally has high humidity, variations can occur, especially in air-conditioned environments. Extended exposure to dry indoor air can irritate and dry out the nasal membranes, making them more susceptible to bleeding.
• Nasal infections: Conditions like sinusitis and colds can inflame the nasal passages, with constant sneezing, coughing and nose blowing contributing to nosebleeds.
• Injury: Trauma to the nose, like a fall, an impact, or surgery, can result in bleeding. Depending on the severity, it is advisable to have the injury assessed by a doctor, especially after a significant trauma, to rule out any serious damage, such as a fracture.
• Medication: Certain medications, particularly nasal sprays or anticoagulants, can increase the risk of nosebleeds.
• Nasal structure changes: Altering the shape or structure of the nose such as through rhinoplasty, can sometimes affect airflow or nasal moisture, potentially drying out the nasal lining and making it more fragile.
• Underlying health conditions: Conditions like high blood pressure, bleeding disorders, or liver disease can affect the blood vessels or the body’s ability to clot, making nosebleeds more likely.

How to stop a nosebleed?

To stop a nosebleed, try following the below steps.

• Sit upright: Keep your head above your heart by sitting upright. This reduces the blood pressure in the veins of your nose, helping to slow the bleeding.
• Lean slightly forward: Lean forward slightly to prevent blood from flowing down the back of your throat, which could lead to choking or an upset stomach.
• Pinch your nose: Pinch both nostrils shut using your thumb and index finger. Breathe through your mouth and maintain the pressure for 10–15 minutes without releasing it.
• Apply a cold compress: If available, while pinching your nose, place a cold compress or ice pack wrapped in a cloth on the bridge of your nose. This can help constrict the blood vessels and slow the bleeding.

After the bleeding stops, avoid picking or blowing your nose, lowering your head below the heart level, or lifting heavy objects to prevent another nosebleed. If the bleeding persists for more than 20 minutes or you experience frequent nosebleeds, please visit your nearest Urgent Care Centre for medical attention.

What can I do to prevent nosebleeds?

To reduce the risk of nosebleeds, you should:

• Keep your nasal passages moist: Use a humidifier in dry environments and apply saline nasal sprays.
• Avoid irritants: Minimise exposure to smoke, chemicals, and allergens.
• Practice gentle nasal care: Avoid aggressive nose blowing and handle your nose carefully if you have a cold or allergies.
• Keep fingernails short, especially for children: This helps prevent accidental scratching or injury to the delicate nasal lining.

When to be concerned about nosebleeds

While occasional nosebleeds are usually not a cause for alarm, frequent and unexplained bleeding may require medical attention. Watch for additional symptoms like dizziness, fatigue, fainting, severe headaches, vision changes, or facial swelling, which could indicate underlying conditions such as sinus infections, benign tumours, or even cancers like nasopharyngeal cancer.

If you have concerns about the severity or frequency of your nosebleeds, consulting a healthcare provider is advisable. Your doctor can perform a thorough examination, review your medical history, and run tests if needed to determine the cause.

Recognising when nosebleeds might signal a more serious issue and seeking timely care are essential for maintaining your health and prevent complications. Regular check-ups with your healthcare provider can also help catch potential issues early, so stay proactive in managing your health.