Why Is There Blood When I Blow My Nose?

When I blow my nose, there is blood laced in with the mucus. Is this bloody mucus a sinus infection? Some sort of cancer in there? The blood isn't there if I blow my nose because it's running, though. Do you have any clue what's up with my nose?

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We human beings have a very peculiar attachment to our heads -- and to our faces in particular. Many people would be more worried by a bloody nose than by rectal bleeding, even though the latter is more likely to represent a life-threatening condition.

Could the bloody mucus signify a cancer lurking in your nasal or sinus cavities? Maybe. Risk factors for nasal and sinus cancers include smoking and employment in certain occupations (such as furniture refinishing, woodworking and heavy-metal mining). Another risk factor is prior radiation to the face. (In the bad old days, radiation therapy was used to treat many benign conditions, such as acne. Individuals thus treated are at increased risk of developing a variety of head or neck cancers.)

Cancer is a possibility, but it is certainly not the most likely possibility, particularly if none of the above risk factors are present. Chronic sinus and/or nasal infection are also possibilities, but they would still not be at the top of my list.

No, at the top of my list, I would place "bleeding from an area of traumatized mucosa." Mucosa is the tissue that lines the nasal and sinus cavities. What sort of trauma? A wandering cuticle (nose-picking, in other words) could be the culprit. Dry environments can lead to "chapping" of the mucosa located just a bit deeper than the nostrils. Unusual anatomy can contribute to this problem. A deviated septum, for example, can cause uneven air flow, leading to local areas of dryness. (The septum is the bony/cartilaginous, mucosa-covered partition between the two nasal cavities.)

How do you find out which of these problems is YOUR problem? See an ENT (ear, nose and throat doctor). A good ENT will ask you a number of questions to help determine the source of the bleeding. Some of the more important questions include:

  • Do you have any symptoms of sinusitis and allergy?
  • Can you breathe through both nostrils equally well?
  • Do you have any of the risk factors discussed above?
  • Are you taking any medications, or do you have any other medical problems that could predispose you towards bleeding?
  • Do you have a history of severe trauma to the nose or face? (For example, have you ever broken your nose?)
  • Do you have any numb areas on your face, loose teeth, changes in your vision or changes in the contour (shape) of your face? (These symptoms can be signs of sinus or nasal cancer.)

A good ENT will then thoroughly examine your nose. If a direct examination (looking up your nose with a headlight) fails to reveal an obvious problem, it will be necessary to examine your nasal cavity with a flexible fiberoptic camera. If this examination still fails to reveal a source for the bleeding, your ENT may decide to order a CT scan of your sinuses. (Fiberoptic examination of the nasal cavity can give clues as to possible sinus problems, but only a CT scan -- or surgical exploration -- can reveal the interior of the sinuses.) So: Get thee to an ENT!

by Douglas Hoffman

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