Dear Doctor,

My cousin is living with me but I noticed she nose bleeds a lot. She says it has always been like this. Is this normal? Rita

Dear Rita,

Nose bleed is common for some people, due to excess dryness. The inner lining of the nose (nasal mucosa) is very fragile. Due to excess dryness, the minor blood vessels present in this mucosa can break down, causing bleeding. It can occur in dry weather or in a dusty environment. Underlying genetic component is also present.

Those suffering from recurrent cold are also vulnerable to nose bleed. Trauma to the nose as caused by picking of the nose or something else, leads to nose bleed.

High blood pressure causes rupture of blood vessels and can have nose bleed as one of the manifestations. It can be due to bleeding or clotting disorders, alcohol use, liver and or kidney disorders. Tumours and fungal infections of the nose present nose bleed as one of the manifestations. But in these conditions, there would be other associated features of underlying medical disorders. Drugs used for thinning blood, like aspirin and warfarin, can cause nose bleed as a side effect. Hormonal changes during pregnancy can lead to nose bleeding.

Recurrent nose bleed, even if minor, can potentially lead to anaemia due to chronic blood loss. Massive nose bleed if unchecked can be fatal.

Dryness within the nose can be prevented by applying some moisturising substance two to three times every day inside the nostrils. Avoid nose picking, avoid alcohol. Those suffering from high blood pressure should keep it well controlled by medicines and dietary restrictions. If any underlying medical disorder is suspected, it can be investigated and treated.

When nose bleed occurs, bending the head forwards and pinch the nose tight as first aid to stop bleeding. Apply an ice pack to the front of the nose, or insert a nasal pack. Medicines are also available to stop the bleeding.