NOSE BLEEDS - WHEN IS THIS A PROBLEM?
When is This a Problem?
Causes of nose bleeds in children & adults & when to be concerned
Nose bleeds can occur at different times during your life. It is worth discussing this topic by using age ranges as reference points, as different problems can cause nose bleeds.
NOSE BLEEDS IN CHILDREN:
Every child has a nose bleed from time to time. Since young children do not blow their noses, nasal material builds up in the nostrils. This is uncomfortable and blocks the nose to some degree. Often there is an accompanying low-grade nasal infection. This infection leads to the skin on the inner aspect of the nose developing cracks and this results in bleeding. The other thing that can affect children is hot weather, where there is an increase in the volume of blood that is pumped around the body by the heart. This in turn, can put pressure on the blood vessels within the nose such that they burst and bleed. So, in children, if the bleeding is just every now and then, with such a small volume that it is easily controlled, then usually there is not too much to worry about. However, if the bleeding is quite persistent, recurs often, or is hard to stop then it is time to visit the doctor to see what is going on. One special case in children to be mindful of, is the nose bleeds that occur when they are asleep at night. This could be a sign that their blood pressure is going up at night and if this is the case, then it may be a sign of them having a breathing problem at night. So, if your child has nose bleeds at night, check on them for mouth breathing, snoring and sleep apnoea. If this is the case, then definitely see a GP to get a referral to see an Ear Nose and Throat Specialist (ENT).
NOSE BLEEDS IN ADOLESCENTS:
This is uncommon but there is one special cause that warrants noting. This condition is pretty unusual in that in generally only affects teenage boys. It is called juvenile nasal angiofibroma. This condition results in nose bleeds from just one side of the nose and that side of the nose ends up getting quite blocked and difficult to breathe through. Most GPs will never see a case and an ENT Specialist may only see less than 5 in their whole career. So, don’t over react to learning about this condition, but likewise don’t always assume that nose bleeds are due to nonserious conditions.
NOSE BLEEDS IN ADULTS:
Probably the most common cause these days is the use of blood thinning medication resulting in a free flow of blood from the nose. Usually there is an underlying preexisting condition that becomes evident once the blood becomes too thin. The most common would be a deviated septum, where the middle part of the nose is crooked. Another common scenario is a small benign blood vessel tumour called an angioma is in the nose. These have very thin walls and burst easily. When the blood is thin, these blood vessels can bleed easily. Apart from stop taking the blood thinners (which is not always possible), the next option may be surgery to fix the underlying issues in the nostrils. In adults we also need to be mindful of tumours and sometimes these can actually be cancers. Whilst it can happen in both genders at any time, this is unusual but if the bleeding is persistent, it is not worth risking missing such a problem.
One special scenario in adult women when they are pregnant, is that during pregnancy there is an increased risk of developing a lesion called a pyogenic granuloma. These are thought to develop from an episode of minor trauma to the skin lining of the nose. They bleed prolifically and may need to be surgically removed, which is tricky when it comes to making that decision when a woman is pregnant.
NOSE BLEEDS CAUSED BY SPECIAL CONDITIONS:
Noses bleeds can be a sign of blood thinning due to an underlying issue with the blood clotting system. This could be an inherited condition, such as haemophilia, or it could be an issue that develops due to a problem such as leukaemia or lymphoma. The clues that there is a general blood clotting problem includes a tendency to easily bruising and also significant bleeding from minor cuts and scratches. In these cases, your GP can order a blood test to check for these conditions.
Dr David McIntosh is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development and its relationship to ENT airway problems and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr McIntosh can be contacted via this website.