Nosebleeds: Causes, Treatments, and Expert Advice

Q: Nosebleeds: Causes, Treatments, and Expert Advice

Hello： The common causes of frequent nosebleeds are primarily related to the rupture of microvessels in the nasal septum. <br>If bleeding occurs frequently, it is advisable to seek local treatment from an otolaryngologist at a hospital or clinic. <br>If there is still no improvem

Nosebleeds are common!

Hello Dr.
Zheng,
1.
The last time I experienced a nosebleed was in January 2014, which took nearly two days to completely stop! It was like a malfunctioning faucet.
At that time, I went to the emergency room and was referred to an ENT specialist.
After examination, the doctor suggested that it might have been caused by taking Ticagrelor, and recommended that I consult with my cardiologist to change or discontinue it (I eventually stopped taking Ticagrelor and continued with aspirin).
2.
Today (August 2020), after a gap of six years and five months, I experienced another nosebleed.
Although the bleeding was less severe compared to the previous incident, it still lasted for three hours.
I managed to stop it by tightly packing cotton balls into my nose and applying ice.
3.
Both incidents occurred while I was in a semi-conscious state during sleep, and I felt that the bleeding was coming from the junction of the soft and hard parts of the nasal septum.
4.
Given that the two incidents are over six years apart and I have not taken Ticagrelor for over six years, it should not be related to any other medications prescribed by my cardiologist, right?
5.
By the way, I am currently taking medications including Xyntha (anxiolytic) and Zhennao Qing (a brain health supplement) that have been prescribed by my neurologist for the past two years.
My question is, aside from consulting with the relevant specialists again, do you have any other suggestions or reminders?
Thank you for your time and assistance.

Lao Zhang, 50~59 year old female. Ask Date: 2020/08/07

Dr. Zheng Jueyi reply Otolaryngology

Hello: The common causes of frequent nosebleeds are primarily related to the rupture of microvessels in the nasal septum.
If bleeding occurs frequently, it is advisable to seek local treatment from an otolaryngologist at a hospital or clinic.
If there is still no improvement, electrocautery may be considered.
Regarding medication, since the two episodes of bleeding were spaced out over a long period and you have been taking medication for some time, the correlation is likely minimal.
However, if you are taking aspirin, it can make bleeding more difficult to control, resulting in a larger volume of blood loss.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/08/07

More Info

Nosebleeds, medically known as epistaxis, can be a common occurrence and may arise from various causes. Understanding the underlying factors, potential treatments, and expert advice can help manage and prevent future episodes effectively.

Causes of Nosebleeds
1. Environmental Factors: Dry air, especially during winter months or in arid climates, can dry out the nasal membranes, making them more susceptible to bleeding.
2. Trauma: Any injury to the nose, whether from picking, blowing, or an external impact, can lead to bleeding.
3. Medications: Certain medications, particularly anticoagulants like Ticagrelor, can increase the risk of bleeding. While you mentioned stopping Ticagrelor and only using aspirin, it's essential to consider that aspirin also has blood-thinning properties, which could contribute to bleeding tendencies.

4. Underlying Health Conditions: Conditions such as hypertension, liver disease, or blood disorders can predispose individuals to nosebleeds. Given your history of chronic liver disease and hypertension, these could be contributing factors.

5. Anatomical Issues: Structural abnormalities in the nasal passages, such as a deviated septum or the presence of nasal polyps, can lead to recurrent nosebleeds.

Treatments for Nosebleeds
1. Immediate Management: When a nosebleed occurs, the first step is to remain calm. Pinching the nostrils together and leaning forward can help minimize blood flow down the throat. Applying a cold compress to the nose can also constrict blood vessels and reduce bleeding.

2. Nasal Moisturizers: Using saline nasal sprays or gels can help keep the nasal passages moist, especially in dry environments.

3. Cauterization: If nosebleeds are frequent and originate from a specific site, a healthcare provider may recommend cauterization, a procedure that seals off the bleeding vessel.

4. Medication Review: Since you have a history of using anticoagulants, it’s crucial to have a thorough review of all medications with your healthcare provider. They may suggest alternatives or adjustments to minimize bleeding risks.

5. Blood Pressure Management: If hypertension is a contributing factor, effective management of blood pressure through lifestyle changes and medication can help reduce the frequency of nosebleeds.

Expert Advice
Given your history of recurrent nosebleeds, especially during sleep, it would be wise to consult with an Ear, Nose, and Throat (ENT) specialist. They can perform a thorough examination of your nasal passages and may recommend imaging studies if necessary to rule out any anatomical issues.

Additionally, maintaining a humid environment, especially while sleeping, can help prevent dryness in the nasal passages. Using a humidifier in your bedroom may be beneficial.

Lastly, keep a record of when the nosebleeds occur, their duration, and any associated symptoms. This information can be invaluable for your healthcare provider in determining the underlying cause and appropriate treatment.

In summary, while occasional nosebleeds can be benign, recurrent episodes warrant further investigation, especially considering your medical history. Collaborating with your healthcare team to address potential contributing factors and exploring preventive measures can significantly improve your quality of life and reduce the incidence of nosebleeds.

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