DR NG’ANG’A: I nosebleed often, is it a cancer sign?

Q: I am a middle-aged lady and for the past 10 years, I have been nosebleeding regularly. The frequency increased during pregnancy but it did not disappear altogether after I got my children. I nosebleed three or four times a month. I have had to go to hospital because the bleeding does not stop on its own. What could be wrong with me? Is nose bleeding one of those subtle symptoms of cancer?

Nose bleeding is one of the most common causes of visits to emergency units in hospitals. An occasional nosebleed should not be a cause of concern. However, recurrent unexplained nosebleeds require further investigation.

Nose bleeding occurs when there is blood loss from the vessels at the top and back of the nose. Although blood can come out of both nostrils, it is more common to get nose bleeding from one nostril. Common causes of nosebleeds include:

Nose picking: Although it is more common in children, there are adults with a habit of picking their noses. This destroys the lining of the nose, and its blood vessels, leading to frequent nosebleeds.

Dry air: Air in the environment can become dry during extreme weather. Moisture-less air dries out the lining of the nose leading to nosebleeds. Use of saline sprays or drops during harsh weather to help reduce nasal dryness. While indoors, use room humidifiers to keep the air moist.

Allergies and regular blowing of the nose: These can lead to drying of the nasal lining, causing nose bleeding. In addition, some of the medication used to treat allergies dries out the nose. If you have allergies, avoid routine usage of these drugs. Speak to your doctor/pharmacist about changing the type of antihistamine you are using (some cause worse drying than others). Antihistamine nasal sprays can have similar complications if used too frequently.

Infections: Sinusitis, the common cold and flu can all lead to nosebleeds. These are, however, are short-lived and stop once the infection is over.

Smoking: This dries out the mucus membranes of the nose making one more susceptible to nosebleeds. Second hand smoke has the same effect (This is when you inhale cigarette smoke from someone else).

Aspirin use: Many people in Kenya take aspirin regularly. In most cases, the low doses prescribed do not have significant complications. However, regular aspirin use has been associated with nose bleeding.

Blood thinners: These are prescribed to people who have a history of blood clots forming in limbs or chest. In addition, they may also be prescribed for people with abnormal heart rhythms. A common side effect of these drugs is nose bleeding and easy bruising.

Nose abnormalities: Tumours (both cancerous and non-cancerous) in the nose can lead to nose bleeding. Non-cancerous growths include polyps. Nasal septum deviation can be associated with bleeding from one nostril. Also, people with nasal septum deviation snore and experience difficulty in breathing.

Cancer: Leukaemia can present with a wide variety of symptoms, including nose bleeding. Contrary to popular belief, leukaemia is not exclusively a childhood cancer. It can affect adults.

Bleeding disorders: These are conditions in which blood does not clot appropriately. Usually, it is associated with easy bruising, nosebleeds and abnormally long durations of bleeding after an injury.

Drug abuse: Alcoholism and use of recreational drugs like cocaine can lead to nosebleeds. Alcohol leads to clotting problems whereas cocaine destroys the lining of the nose.

Occupational hazards: Working in an environment in which you are constantly exposed to nasal chemical irritants such as ammonia can lead to frequent nosebleeds.

Organ dysfunction: Long-term liver and kidney malfunction has been associated with nose bleeding. The liver is vital in producing various proteins and chemicals needed for blood clotting.

Abnormal blood vessels: These are rare, often hereditary health problems in which the blood vessels are unusually fragile and bleed easily. They include conditions such as hereditary haemorrhagic telangiectasia.

Pregnancy: Hormonal changes in pregnancy are thought to contribute to increased incidence of nosebleeds during this period.

Nose bleeding and high blood pressure: Nosebleeds are not a result of high blood pressure. However, if you have severe high blood pressure, episodes of nosebleed may be worsened or prolonged.

Go for a full physical examination with your family physician or general practitioner. He/she should be able to narrow done the possible causes of your frequent nosebleeds. If need be, he/she might have to perform a few blood tests.

For your visit do not forget to carry any medication that you are currently using.

In addition, find out from close family if they, too, have problems with nosebleeds. If the underlying cause of your bleeds appears to be from abnormalities in either your nose or sinuses, you will be referred to an ear, nose and throat specialist (ENT). If you appear to be having a bleeding disorder or if there are concerns of leukaemia, you will need review by a hematoncologist.

—Avoid exposure to cigarette smoke. —Cut your nails. —Avoid unnecessary antihistamine use.