What caused my nosebleed? DR MARTIN SCURR gives answers
I recently had surgery on my nose following ten days of heavy bleeding from one nostril.
I was told the surgery is never 100 per cent effective, so I'm now afraid to go out. What caused these nosebleeds?
I've now been diagnosed with high blood pressure but am not clear if this is the cause. I'm 69.
C. Smith, Northfield, Birmingham
Around 60 per cent of adults will experience a nosebleed — technically called epistaxis — at some stage and most do not require medical attention.
Most nosebleeds can be stopped by squeezing the nostrils firmly for ten minutes, leaning forwards slightly, and breathing through the mouth. There are two types of nosebleeds: anterior and posterior, referring to the region of the nose that's bleeding (file pic)
Older patients are more likely to need hospital care, but this is partly because they are more likely to be taking low-dose aspirin or an anticoagulant, which impair blood clotting and potentially make bleeding far worse.
As well as these medicines, certain bleeding disorders or a tumour in the nasal passage can increase the risk of bleeding that is torrential and hard to control.
High blood pressure is linked to epistaxis, too — it doesn't cause it, but may prolong the bleeding when it occurs.
Most nosebleeds can be stopped by squeezing the nostrils firmly for ten minutes, leaning forwards slightly, and breathing through the mouth (don't lean backwards; the blood will run down your throat).
There are two types of nosebleeds: anterior and posterior, referring to the region of the nose that's bleeding.
Anterior nosebleeds are the more common, less serious type and are due to damage to the Little's Area, a point on the septum where three blood vessels meet, about 1-2 cm up from the nostril.
This can be fragile in some people and bleeding can result from physical trauma such as being hit in the face or nose-picking.
Posterior nosebleeds, which originate far back in the nasal cavity, are more worrying because the bleeding usually comes from the large arteries that pass through the back of the nasal cavity.
Posterior nosebleeds (file pic) are more worrying because the bleeding usually comes from the large arteries that pass through the back of the nasal cavity
As your longer letter reveals, in your case it was the sphenopalatine artery (one of the main arteries that supplies the nasal cavity) causing the bleed. An ear, nose and throat specialist should treat a posterior nosebleed.
Once the doctor has identified the bleeding point, the first treatment is tamponade, where a device is inserted to apply constant pressure to the fragile point in the nasal cavity.
In the past, this was achieved by packing the nose with gauze. More recently special balloons have been used. If this approach fails to stop the bleeding, then surgical treatment becomes necessary.
I must assume that this was the case with you after your ten-day ordeal. You say in your longer letter, you also underwent cautery. This is where doctors use a chemical that effectively burns the tissue and seals the bleeding vessel, but it failed in your case and you needed surgery to tie off the artery. This is known as ligation.
Rest assured that research shows this is effective. Long-term results of a study on more than 40 patients showed that ligation prevented recurrence in 93 per cent of cases.
The advice is to refrain from hot food and drink and avoid hot showers, bending and heavy lifting for a month after surgery, to allow time for the artery to heal.
......................................................................................................................................
I'm only 29 but I keep feeling this pounding sensation in my chest, as if my heart is skipping six or seven beats every minute.
I used to smoke ten cigarettes a day, but I quit last year. Also I've been preparing for exams so have been stressed and I drink two cups of coffee daily. I'm very concerned.
Should I see a cardiologist?
Dr A. Raees, by e-mail
Your symptoms should be investigated, but do not be alarmed as the cause is unlikely to be serious heart disease given your age.
The sensation you describe is in fact due to extra beats occurring (known as ectopic beats, or extra systoles). It's the gap before the next heartbeat, a compensatory pause, that you're noticing.
See your GP and — after explaining your medical history — you will undergo an electrocardiogram (ECG), where leads will be attached to your arms, legs and chest to obtain an electrical recording of your heart's activity. This will help your doctor to identify the type of disturbance.
Often patients find the symptoms come and go and, as luck will have it, the readings are normal during the ECG.
If this happens, usually you'd then undergo a 24-hour ECG recording with a portable device. Sometimes 48-hour or even seven-day recordings are needed.
Smoking, stress and excess caffeine may all be contributors to ectopic beats, so you must remain off tobacco permanently and not increase your coffee intake.
But, importantly, the abnormal rhythm needs to be captured on an ECG for a correct assessment before you make drastic changes.
If your GP concludes it requires further investigation, you will be referred to a cardiologist.
Most ectopic beats are harmless and lifestyle adjustments — such as taking regular exercise and getting enough sleep — will be the focus, along with strategies to help you cope with the pressures of life.