I am 24-years-old and at university. For years now, I have suffered with random nose bleeds. When I was a child, I used to nose bleed every time we stood at assembly for too long, which wasn’t the case for other kids. As I grew, I would nose bleed on very hot days and once at a friend’s wedding, it got really bad, I had to be taken home. It never lasts longer than a couple of minutes but my issue is why it happens so often. For weeks now, instead of blood dripping, I sneeze and notice blood clots. What is happening to me? I talked to a friend about it and she told me it was dehydration. But I drink a lot of water and eat right - at least fairly well. I just want to know what is causing these nose bleeds and how can I get it to stop.

Rebecca K

Dear Rebecca K

The most common cause for nose bleed (epistaxis) to occur at an early age is dryness of the nasal mucosa. A dry nasal mucosa causes itching and people often scratch inside the nose due to this.  It damages the delicate inner lining over the nostrils. Even if one does not scratch, the capillaries present there can rupture and bleed spontaneously due to excess dryness. This happens because the nasal mucosa is very thin and fragile. 

The tendency to nose bleed can run in families, making some people more prone to it than others. Those who suffer from allergic rhinitis, i.e. running of the nose or sneezing due to cold are also more vulnerable to epistaxis because recurrent inflammation makes the nasal mucosa more friable and prone to bleed spontaneously.

Another common cause for epistaxis is high blood pressure, where the blood vessels rupture due to high pressure of the blood flowing inside. But at your age one is unlikely to get hypertension.

Disorders of blood clotting or bleeding can also cause frequent and uncontrollable bleeding from any part of the body including the nose.  Deficiency of platelets, secondary to infections or bone marrow dysfunction due to any cause   makes one prone to bleeding from one or more body parts because platelets are vital for blood clotting. Drugs like aspirin and coumadin which are used to prevent clotting can cause bleeding as a secondary effect. Liver diseases result in deficiency of clotting factors inside the body and can manifest as bleeding from any part including the nose. It may be the first sign of liver disease.

There is nothing to worry about the nose bleeds at a young age. First thing one ought to do is to prevent dryness of the nasal mucosa. It is advisable to use any lubricant like oil, ghee, petroleum jelly or glycerin. With a dry clean finger, it should be applied gently inside the nose at least two to three times every day. While moving about, particularly in a dusty environment, it is useful to keep the nose covered. Those suffering from allergic rhinitis can also benefit if they protect themselves from exposure to dust.

Corticoid containing nasal sprays are available for providing relief at the earliest in people who have a repeated cold due to allergy. Their use also helps in preventing recurrent inflammation of the nasal mucosa and subsequent nose bleed.

Fingering the nose should be totally avoided. If in spite of these measures one bleeds from the nose, the individual should be vigilant enough. At the first drop of blood coming out, the nose can be pinched tightly, to stop or minimise bleeding. Clean cotton can be pushed inside the nose gently to press on the bleeding vessels to stop bleeding.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hopsital