Persistent Nosebleeds: Causes, Concerns, and When to Seek Help

Recent occurrences of nosebleeds?

Hello Dr.
Cheng,
Recently, I have noticed blood in my nasal mucus.
Although I have experienced nosebleeds in the past, I have never encountered a situation like this where it does not heal.
Each time I blow my nose, there are streaks of blood rather than a large amount.
Three weeks ago, I accidentally scratched the inside of my nasal membrane with my finger, and a few days later, I caught a cold.
During the cold, I often blew my nose forcefully, which resulted in nosebleeds.
However, even after recovering from the cold, the nosebleeds have persisted.
I have tried using cotton swabs or tissue to reach deep into one side of my nasal cavity to stop the bleeding.
I found a bleeding point approximately 2-3 centimeters inside the nasal cavity, but the bleeding point is small.
Therefore, while it does not bleed profusely, whenever I exert a little force to blow my nose, I can see clots of blood or streaks of blood from the wound.
This situation has been recurring daily for about three weeks.
Currently, I suspect it may be a symptom of nasopharyngeal cancer, but I underwent a nasopharyngoscopy, X-ray, CT scan, and blood EB test, along with a physician's neck examination a year ago.
Although polyps were found in the nasal cavity, they were benign upon biopsy, and the polyps were located in the other side of the nasal cavity, which does not have nosebleeds.
The other examinations did not show any abnormalities.

I would like to ask the doctor the following questions:
1.
My nasal bleeding point is at the front, but if there were bleeding from nasopharyngeal cancer, would it be from deeper in the nasal cavity that cannot be reached with a regular cotton swab or finger?
2.
Is the daily occurrence of nosebleeds related to the weather or blood pressure? Although the wound clots, does blowing my nose forcefully remove the clots and prevent the wound from healing?
3.
Aside from the above conditions, although I do not have headaches, neck lumps, double vision, facial numbness, or unilateral headaches, I am still concerned because I have never experienced such prolonged bleeding before.

Thank you, doctor, for taking the time to respond.

Nick, 20~29 year old female. Ask Date: 2011/01/19

Dr. Zheng Jueyi reply Otolaryngology

Dear Nick,
Regarding nasal bleeding, most of the bleeding occurs at the anterior part of the nasal septum, as this area is a convergence point for blood vessels.
It can be caused by dry weather, trauma, or hypertension, leading to the rupture of blood vessels.
Nasopharyngeal carcinoma typically presents with blood-streaked sputum in the morning; unless the tumor is large, it is rare for it to manifest as a nosebleed initially.
Additionally, the nasopharynx is generally inaccessible by finger examination, and cotton swabs are also difficult to reach without the expertise of a medical professional.

If nosebleeds persist, it is advisable to seek medical attention at a hospital.
Through direct examination or endoscopy, the source of the bleeding can usually be identified.
Localized treatment can be applied to stop the bleeding, and subsequent treatment with ointments and oral medications often leads to a cure.
Wishing you safety and health.
Sincerely,
Dr.
Jue-Yi Cheng
Attending Physician, Department of Otolaryngology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2011/01/19

More Info

Persistent nosebleeds can be concerning, especially when they last for an extended period. Based on your description, it seems that you have been experiencing recurrent nasal bleeding for about three weeks, primarily after a recent cold and some trauma to the nasal mucosa. Let's address your questions and concerns systematically.

1. Location of Bleeding and Cancer Concerns: You mentioned that the bleeding point is located in the front part of your nasal cavity. Generally, nosebleeds (epistaxis) can originate from the anterior (front) or posterior (back) parts of the nasal cavity. Most common nosebleeds arise from the anterior part, particularly from the Kiesselbach's plexus, which is a network of blood vessels located in the front part of the nasal septum. In contrast, bleeding associated with nasal cancers, such as nasopharyngeal carcinoma, typically occurs deeper in the nasal cavity or nasopharynx and may not be easily accessible or visible with a cotton swab. Given that you have had a thorough examination a year ago, including a nasal endoscopy and imaging studies that did not indicate malignancy, it is less likely that your current symptoms are due to cancer. However, if you have persistent concerns, a follow-up with an ENT specialist may provide peace of mind.

2. Weather, Blood Pressure, and Healing: Environmental factors such as dry air, especially in winter, can contribute to nasal bleeding. Additionally, high blood pressure can exacerbate bleeding tendencies, but it is not typically the primary cause of recurrent nosebleeds. The fact that you are experiencing bleeding after blowing your nose suggests that the trauma from the forceful action is preventing the healing of the mucosal injury. Each time you blow your nose, you may be dislodging clotted blood and reopening the wound, which can perpetuate the cycle of bleeding. It is advisable to avoid forceful nose blowing and to use saline nasal sprays or humidifiers to keep the nasal passages moist.

3. Other Symptoms and Concerns: You noted the absence of other concerning symptoms such as headaches, neck swelling, or visual disturbances, which is reassuring. However, the persistence of your symptoms warrants attention. If the bleeding continues despite conservative measures, such as avoiding trauma to the nose and using saline sprays, it may be beneficial to consult with a healthcare professional. They may recommend cauterization of the bleeding site or other interventions to promote healing.

In summary, while your symptoms are likely related to trauma and irritation of the nasal mucosa, it is essential to monitor the situation closely. If the bleeding persists or worsens, or if you develop new symptoms, seeking medical advice is crucial. Maintaining nasal moisture and avoiding trauma can help facilitate healing. If you have ongoing concerns about the possibility of more serious conditions, do not hesitate to reach out to a specialist for further evaluation. Your health and peace of mind are important, and addressing these issues proactively is the best approach.

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