DEAR DOCTOR,

Over the last couple of months, I have been getting occasional nose bleeding. It usually happens on very hot days. It is not heavy, but is it something I should be concerned about? What could be the cause of this? ALBERT

DEAR ALBERT,

How frequently you are having nose bleeds and what is the quantity of blood being passed? The most common cause for nose bleed, or epistaxis as called in medical terminology, is dryness of inner lining of nose. In dry and or hot weather, this lining becomes dry and the small blood vessels can rupture causing nose bleed. Same thing occurs while moving out in hot sun or use of room heaters, inside the house. Due to dryness, one feels itchy inside the nose and tends to scratch with fingers. Picking of nose increases risk of nose bleed.

The blood vessels of interior of the nose can also rupture due to high blood pressure. Anti-clotting drugs like aspirin can cause nose bleed as adverse effect.

Nose bleed can also be due to small tumours called papilloma inside the mouth. Papillomas can be benign or malignant, which can be determined only by biopsy. 

Nose bleed can be mild, where one loses only few drops of blood whereas in moderate nose bleed, a person can pass much blood, depending on whether few or more very small blood vessels or bigger vessels are affected. If nose bleed is persistent or recurrent, it can result in anaemia. Body’s immunity is also reduced due to anaemia, making a person more vulnerable to infections.

Generalised weakness occurs as result of weakness. Certain preventive measures can help prevent epistaxis or reducing the quantity of blood loss. The most important thing in this regard is to prevent dryness. One should apply some lubricating cream or oil inside the mouth two to three times every day. Anybody having high blood pressure, should keep it well controlled by regular medicines and dietary restrictions as prescribed. Individuals on anti-clotting drugs should immediately inform their caretaker about it and the drug can be skipped or its dose reduced.

Once epistaxis starts, one should pinch the nose tightly to stop the flow of blood and flex neck forwards, for few minutes till bleeding stops. Avoid use of room heaters inside rooms, as they cause dryness of inner nose. However if nose bleed is heavy or persistent, or if there is associated fever one should consult a doctor physically.  

Among sinister medical causes, tumours are cause for epistaxis.

 Dr. Rachna Pande,Specialist in internal medicine rachna212002@yahoo.co.uk