Why does my nose bleed when I blow it?

I’VE been nursing a terrible mucousy cold for the past week. Now when I blow my nose, there’s a considerable amount of blood in the tissue. Should I be worried?

NOSEBLEEDS are quite common – 60 per cent of the population has one at some point in their lives. There is a large increase in the winter months because of the correlation with common infections affecting the sinuses, throat, airways or lungs.

You are much more likely to have nosebleeds with a cold because of the inflammation of the nasal passages, which causes the tiny blood vessels in the nose to swell. The blood vessels at the front of the nose, on the septum, are fragile and can be broken quite easily.

It is also more typical in hot, dry indoor environments such as a centrally heated homes in winter. This causes the lining of the nose to be even more fragile because the moisture dries out.

Nosebleeds are more likely in smokers and if patients are taking certain medications such as aspirin, decongestants and anti-inflammatories such as ibuprofen. Recurrent or significant nosebleeds may be investigated, but only usually if there are other worrying features. If nosebleeds persist after the cold has subsided, blood tests may be necessary.

The recommendation from NICE is that people with nosebleeds do not need further investigation unless they fall into very specific categories: children under two or those who start having nosebleeds over 50. This is because of the higher rates of nasal and sinus cancer in this age group.

Rarely nosebleeds are associated with bleeding disorders including leukaemia, but most are self-resolving and do not require any treatment.

I AM 72 and have had an ultrasound which confirmed that a lump on my neck called a ‘lipoma’ was ‘benign’ and so not cancerous. But I read an article online that said ultrasounds are not able to tell whether a lump is cancerous. What should I do next?

LUMPS understandably cause a great deal of worry because of their association with tumours. It is always important to get a persistent lump examined by a doctor. Often the diagnosis is clear on examination but imaging is used to clarify the diagnosis.

Doctors have specific criteria for examining lumps, ranging from the obvious such as shape and size to the less obvious like if it appears transluscent when a light is shined on it.

A benign lump, otherwise known as a lipoma, is very common. They are lumps of fat, usually soft and painless, and can be any size. The back of the neck and the limbs are common sites for a lipoma.

On ultrasound, a lipoma has very clear signs that a radiologist would look for and such a diagnosis is considered definitive. Other lumps may be more complicated. In breast lumps, for example, there can be many features to determine if a cancer is present and at least two scans are used to confirm a lump or if a biopsy is required.