Epistaxis, or a nosebleed, is generally caused by a broken blood vessel in the nose or sinuses. Bleeding from the nose, especially when blowing it, is very common and usually not a cause for concern.
An estimated 60 percent of people experience nosebleeds but only around 6 percent of cases require medical attention.
It can be hard to determine what causes broken blood vessels in the nose. However, there are several factors that may contribute to or cause the nose to bleed when blowing it.

Causes
Blood appearing when blowing the nose may be caused by dry nasal cavities, an injury, nose picking, or blowing too hard.
Common causes of blood appearing when blowing the nose include:
* blowing the nose too hard or too frequently
* inflammation or mucosal irritation caused by infection or allergies
* very dry nasal cavities or sinuses
* prolonged inhalation of very dry or cold air
* nose picking
* antibiotic medications
* blood thinning medications, such as warfarin, aspirin, and clopidogrel
* injury to the nose or face
* environmental factors, such as humidity or being at a high altitude
* abnormalities in the septum, which is the wall that separates the nostrils
Less common causes of nosebleeds include:
* nasal, sinus, face, or eye surgery
* foreign bodies in the nose
* nasal polyps or tumors
* inflammatory conditions
* high blood pressure
* holes in the septum
* blood disorders, such as low blood platelet levels and anemia
* conditions affecting the blood vessels, such as arteriosclerosis
* leukemia, a type of blood cancer conditions affecting the immune system
* liver or kidney problems
* scurvy, or severe vitamin C deficiency
* chemotherapy
* congestive heart failure
* chronic use or overuse of certain herbal supplements, most commonly vitamin E and gingko biloba
* exposure to toxic chemicals
* use of illicit drugs, especially cocaine
Some hereditary or genetic conditions that cause abnormal bleeding can also lead to blood appearing when the nose is blown. These conditions include:

* von Willebrand disease
* hereditary hemorrhagic telangiectasia
* factor VIII deficiency (hemophilia A)
* factor IX deficiency (hemophilia B)
* factor XI deficiency

Treatment options
Gently and firmly pinching the nose may be a recommended treatment option for bleeding noses.
In most cases, a nosebleed or minor bleeding from the nose eventually stops on its own after a few minutes.
There are a few at-home remedies, however, that may encourage nosebleeds to stop earlier or reduce the amount of bleeding.
Basic treatment options for bleeding noses include:
* laying down flat with the head tilted backward to reduce blood flow to the nose
* relaxing and breathing through the mouth
* not touching or picking the nose once it has stopped bleeding
* laying down or resting in a seated position for a few hours after the bleeding has stopped
* gently but firmly pinching the nose, especially if the site of the bleeding is known
Around 90 percent of nosebleeds occur in the front bottom portion of the septum, the fleshy wall that divides the nostrils.
Prolonged or repetitive nosebleeds, or those caused by an underlying medical condition, require medical attention and treatment.
If nosebleeds are severe, a person may require more aggressive treatment to prevent extensive blood loss.
Medical treatment options include:
* nasal packing, where sterile cotton pads or dressings are packed into the nostril to limit bleeding
* topical medications to limit bleeding, known as local hemostatic agents
* topical antiseptic and antibiotic ointments and creams
* sealing a blood vessel shut using an electrical device or chemical such as silver nitrate
* surgery where the blood vessel is packed with sterile materials to block it off
* surgery where the blood vessel is tied together to seal it shut
* clotting medications
* blood transfusions

Prevention tips
In many cases, there is no specific way to avoid nosebleeds, but there are some things that may help prevent or reduce the risk of them.
Blowing the nose gently and not picking at the skin can usually prevent minor bleeding.
Other tips for preventing bleeding when blowing the nose include:
* using over-the-counter nasal decongestant sprays or pills to treat allergies
* applying over-the-counter nasal lubricants or petroleum jelly in the nostrils to prevent dryness
* using saline sprays to prevent dryness
* avoiding picking the nose, especially scabs
* avoiding blowing the nose aggressively or too frequently
* protecting the nose from cold or dry air by using a scarf
* not overusing or misusing non-steroidal anti-inflammatory medications (NSAIDs) and antibiotics
* reducing inflammation and nasal congestion by using a nasal or sinus rinse
* avoiding exposure to toxic chemicals
* not using illicit drugs, especially cocaine
One example of a nasal rinse is a Neti pot. These are commonly available online and can be used at home.

When to see a doctor
If nosebleeds are chronic or repetitive, a healthcare professional should be consulted.
People should seek medical attention anytime a nosebleed does not stop naturally within 20 minutes. They should also seek medical attention if it does not respond to initial treatments, such as applying pressure.
Although nosebleeds tend to be harmless, severe or prolonged nosebleeds can cause serious blood loss, especially in:
* young children
* people over the age of 65
* people with immune conditions
It is also important to talk with a doctor about chronic or repetitive nosebleeds.
Chronic nosebleeds can be a sign of underlying medical conditions, such as blood or inflammatory disorders. Repetitive nosebleeds can also be a sign of nasal deformities or tumors, especially when they only involve one nostril.
People should also seek medical attention if nosebleeds are accompanied by any of the following symptoms:
* pain or tenderness around the eyes
* stuffy nose that continues to get worse and will not clear
* mucus that drips in the back of the throat
* change in the appearance of the nose or surrounding area
* pus in the nose
* chronic watery eyes
* reduced sense of smell
* change in vision
* enlarged lymph nodes in the neck
* pain or pressure in the ears
* hearing loss
* numbness in the face
* loosening, numbness, or pain in the teeth
* difficulty opening the mouth
* headache

Outlook
Bleeding from the nose when blowing it is a common experience. It is usually due to inflamed or damaged nasal tissues and blood vessels, and is not a cause for concern.
Nosebleeds are generally harmless, and stop on their own or after applying gentle pressure to the area.
Severe or repetitive nosebleeds can be a sign of an underlying medical condition that may require treatment, such blood disorders or obstructions.
People should speak with a doctor about severe or repetitive nosebleeds, especially when accompanied by additional symptoms.

Pregnancy tests help women to determine if they are pregnant. These tests work by picking up on markers in urine or blood that indicate pregnancy.
Knowing which type of pregnancy test is most suitable, and understanding how to use them, helps ensure results are accurate.
Whether taken at home or in a doctor’s office, being informed about the pregnancy test process makes it easier to understand what the results mean, and what to do next.
Types of pregnancy test
There are two main types of pregnancy test available: urine tests and blood tests.
Urine tests
Urine tests can be taken at home or at the doctor’s office. They detect the presence of the pregnancy hormone, human chorionic gonadotropin (hCG).
The hCG hormone circulates in a woman’s blood once a fertilized egg has attached to the uterus wall. This usually happens 6 days after fertilization.
According to the American Pregnancy Association, levels of hCG double every 2 to 3 days, peak by 8 to 11 weeks of pregnancy, and then begin to level off. HCG can usually be detected by a urine test 12 to 14 days after conception.
Home pregnancy test
Home pregnancy tests can be purchased in a pharmacy or drugstore. They normally cost less than $20 and are easy to use. If used correctly, they give excellent results.
Results are usually visible within 3 to 10 minutes or sometimes sooner.
Clinical urine test
Clinical urine tests are performed at a doctor’s office. Like home tests, they also look for the presence of the hCG hormone in urine.
Although they produce the same level of accuracy, tests performed in a clinical setting usually avoid some of the errors that can happen with home tests.
Blood tests
Although less common than urine tests, blood tests to detect hCG levels are available. These are always carried out at the doctor’s office, and results take longer than urine test results.
Blood tests are usually more expensive but some can be taken earlier than urine tests to determine results. The two types of blood tests are:
* Qualitative hCG blood test: This checks hCG levels, giving a “yes” (pregnant) or “no” (not pregnant) result. They can detect hCG levels around 11 days after conception.
* Quantitative hCG blood test: This is able to measure specific levels of hCG, even if levels are low.
Further tests may be needed if results aren’t as expected. For example, if the hCG level is higher or lower than it should be for the estimated pregnancy stage.
This process can help indicate ectopic pregnancy, miscarriage, or a more accurate due date.
Online tests
Several websites and phone applications have tests that claim to calculate the likelihood of being pregnant. These can be used as a source of information, but should not replace real pregnancy tests.

Who should use a pregnancy test?
Common early indicators of a possible pregnancy include nausea, vomiting, and excessive fatigue.
Any woman of childbearing age, who suspects she may be pregnant, should use a pregnancy test. In particular, women who recently had unprotected sex should consider using a pregnancy test.
Some signs of early pregnancy that should be followed up with a pregnancy test include:
* a missed period
* enlarged, tender, or swollen breasts
* fatigue
* increased urination
* nausea
* vomiting

How to use pregnancy tests
For a clinical urine test, the doctor will ask for a sample of urine. This can be tested immediately.
Blood tests require a sample of blood to be drawn and sent for testing.
Home pregnancy tests are simple to use. It is important to follow the instructions closely to get the most accurate result.
Most brands can be used on the first day of a missed period, but some more sensitive tests can be used sooner. Some clinical tests can also be taken earlier than this.
In general, home pregnancy urine tests involve one of the following methods:
* urinating directly onto the test stick
* urinating into a cup and dipping the test stick in
* urinating into a cup and using a dropper to drop urine onto the test window
Many manufacturers recommend taking two home tests to confirm results. This is because hCG levels may be too low to be detected at first. To ensure the most accurate results, it is best to wait a few days to 1 week between the two tests.

Accuracy
Many home pregnancy tests claim to be accurate up to 99 percent of the time. Clinical tests can be even more accurate.
However, using them correctly is vital. Several studies suggest incorrect use of tests has led to many women reporting false results.
Most tests can be used on the first day of a missed period but it’s advisable to wait 1 week after a missed period for accuracy.
This is because 10 to 20 percent of pregnant women won’t detect their pregnancy on the first day of their missed period. This can be due to many women having irregular periods, or miscalculating when their period is due.
In addition, a number of other factors play a role in the accuracy of results, including:
* time of day the test is taken
* length of time after conception
* when ovulation occurs
* how quickly the fertilized egg implants
* how well instructions are followed
* how sensitive the test is

What do the results mean?
If a home pregnancy test reads positive, it is important for a doctor to confirm the results with a clinical test.
Results of a pregnancy test are either positive or negative. If taking a clinical test, the doctor will explain what the results mean. If using a home test, it’s important that women refer to the test instructions to ensure they understand what the colors, symbols, or words indicate.
Positive result
A positive result indicates pregnancy, even if the color, symbol, or words on the test window are faint. It’s a good idea to confirm this result by taking a clinical test.
Very rarely, a false-positive result occurs. This means the woman taking the test is not pregnant, despite the test indicating she is. False-positives can occur due to:
* early miscarriage
* certain medications
* ovarian tumors
* liver disease
* kidney failure
* expired test kits
Negative result
A negative result means pregnancy is unlikely. However, false-negative results are common.
These are where pregnancy may still occur but is not yet showing up on the test. They can occur for a number of reasons, including:
* incorrectly taking the test
* testing too soon
* testing with urine that is too diluted
* not waiting long enough for results
* expired or faulty test
Retesting within a week is advisable for all test results. This is particularly important if a woman is experiencing some of the symptoms of early pregnancy or if the test result is negative.
When to see a doctor
A woman should always consult her doctor if she has any queries about the pregnancy or test results. If the home pregnancy test is positive, a doctor can confirm this with a clinical test and begin to arrange prenatal care.
If a home pregnancy test is negative but a woman’s periods don’t resume, she should consult a doctor to determine the cause of the missed periods.

As 2017 arrived, many of us are thinking about the healthy lifestyle changes we want to make for the coming year. Do you plan to exercise more? Lose weight? Quit smoking? How about cutting down on alcohol intake? While that last question may have prompted a highly resistant shake of the head from many readers who enjoy their after-work beer or a glass of wine with dinner, there is no better time to review your alcohol intake.
Are you planning to reduce your alcohol intake for 2017? If so, it could yield numerous health benefits.
During the month of January, millions of people will be giving up alcohol as part of a campaign dubbed “Dry January.”
Popularized by British organization Alcohol Concern, Dry January aims to “change the conversation” about alcohol by encouraging people to stop drinking for 1 month.
You might think that quitting the drink for just 31 days is unlikely to have a big impact on health, but many participants who take part in Dry January report better sleep, increased energy, and weight loss.
Most importantly, abstaining from alcohol for 1 month may encourage a reduction in alcohol intake in the longer term. A study published in the journal Health Psychology in March found that people who took part in Dry January showed a decrease in alcohol consumption over the subsequent 6 months.
In this article, we take a closer look at how alcohol affects the body, as well as the health benefits of reducing alcohol intake.
The scale of drinking in the U.S.
The Dietary Guidelines for Americans 2015-2020 recommend that adults who drink alcohol should only do so in moderation – that is, up to one alcoholic beverage a day for women and two for men.
However, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) report that in 2014, almost a quarter of adults in the United States engaged in binge drinking – consumption of around four drinks for women and five for men in a 2-hour period – over the past month.
Additionally, a further 6.7 percent reported engaging in heavy drinking over the past month, which is defined as consuming at least five drinks on one occasion for 5 or more days over the past 30 days.
Over the holidays and other special occasions, it can be hard to say no to that glass of bubbly when everyone else is celebrating with a drink in hand. Some of us may even see alcohol as a reward for a hard week at work or as a stress-relieving aid.
That bottle of beer or glass of wine might feel good in the moment, but if consumed in high amounts or too often, it could wreak havoc on your physical and mental well-being.
The effects of alcohol intake

The brain
Those of you who drink are likely to have experienced the dreaded hangover at least once. Feelings of sickness, dizziness, dehydration, and headache are all caused by drinking too much the night before.
Alcohol can cause an imbalance of neurotransmitters in the brain.
However, symptoms of excess alcohol intake can begin long before a hangover. In fact, alcohol can cause problems soon after the first sip.
The NIAAA explain that alcohol disrupts communication between nerve cells in the brain by causing an imbalance in the levels of neurotransmitters – the chemicals that relay signals from one nerve cell to another.
An imbalance of neurotransmitters can cause changes to mood, behavior, and coordination that are characteristic of excess alcohol intake.
Researchers have found that the brain can adapt to changes in neurotransmitter levels caused by alcohol, but this is not necessarily good news. An adjustment such as this enables us to build tolerance to alcohol, and it may fuel the development of alcohol use disorders.
In 2014, around 16.3 million adults in the U.S. had an alcohol use disorder, and in 2010, alcohol abuse cost the country around $249 billion.
The heart
According to the American Heart Association, excess alcohol consumption can increase levels of fats in the blood, which are called triglycerides. High triglyceride levels are known to contribute to the buildup of plaque in the arteries, known as atherosclerosis, which can raise the risk of heart attack and stroke.
Drinking too much – particularly over a long period of time – can also lead to high blood pressure, arrhythmia (irregular heartbeat), cardiomyopathy (enlargement of the heart muscle), and stroke.
It should be mentioned, however, that an increasing number of studies have suggested that moderate drinking may actually benefit heart health. A study reported by Medical News, linked moderate alcohol intake to reduced risk of heart attack and heart failure.
Still, some researchers have questioned the heart health benefits of moderate drinking, and health organizations recommend not initiating alcohol consumption solely to reap such – as yet unproven – rewards.
The liver
When we drink alcohol, the liver breaks it down so that it can be eliminated from the body. Drinking too much over time, however, can cause the liver to become seriously damaged.
In 2011, almost half of liver cirrhosis deaths in the U.S. were related to alcohol.
Heavy alcohol intake can lead to alcoholic fatty liver disease – characterized by a buildup of fat in the arteries – alcoholic hepatitis (inflammation of the liver), and alcoholic cirrhosis (severe liver scarring and structural damage).
The latter is the most advanced form of liver injury caused by heavy alcohol use; according to the NIAAA, of all cirrhosis deaths in the U.S. in 2011, around 48 percent were related to alcohol intake.
The pancreas
The pancreas is crucial for digestion and energy production; it sends enzymes to the small intestine to break down carbohydrates, proteins, and fats.
However, drinking alcohol excessively over a long period of time can disrupt pancreatic function; instead of enzymes being sent to the small intestine to aid digestion, they are secreted into the pancreas itself.
This can lead to pancreatitis, which is characterized by inflammation and swelling of the blood vessels in the pancreas. Around 5 percent of people with alcohol dependence develop the condition.
Alcohol and cancer
An increasing number of studies have associated even light to moderate alcohol intake with increased risk of certain cancers.
A recent study reported by MNT found that each glass of white wine consumed daily may raise the risk of melanoma by 13 percent, while an earlier study linked low alcohol intake to a greater risk of breast cancer.
Other cancers that have been associated with alcohol use include mouth, esophageal, throat, and liver cancers.
The health benefits of reducing alcohol intake
Of course, many of the health risks associated with alcohol intake are related to excessive, long-term drinking. However, even those who drink lightly and in moderation could benefit from reducing their alcohol intake.
Weight loss
Alcoholic beverages are full of calories; a standard glass of white wine contains around 121 calories, while a pint of beer contains at least 150 calories. Needless to say, just a few drinks per week can contribute to weight gain.
Reducing alcohol intake may help you to lose weight.
However, this can be turned around by reducing alcohol consumption; a survey from Alcohol Concern found that around 49 percent of people who take part in Dry January reported weight loss, as well as increased energy.
The NIAAA’s alcohol calorie calculator can help you work out how many calories you consume from alcoholic beverages each week.
Better mood
A drink or two on a Saturday night may put you in good spirits in the short term, but the effect is unlikely to last.
Alcohol intake – especially in large quantities – can interfere with the neurotransmitters that regulate mood, increasing the risk of anxiety, stress, and depression.
As such, cutting back on the liquor means that you are more likely to be in a happier state of mind.
A better night’s sleep
Studies have shown that alcohol can disrupt sleep. Research reported by MNT in 2014, for example, found that drinking can interfere with the body’s ability to regulate sleepiness and wakefulness, which can lead to insomnia.
Dr. Shawn Adhami recommends steering clear of drinking just before bedtime, as this can disrupt normal sleep patterns.
Deep sleep is when the body restores itself, and alcohol can interfere with this,” he explains. As the alcohol starts to wear off, your body can come out of deep sleep and back into REM [rapid eye movement] sleep, which is much easier to wake from. That’s why you often wake up after just a few hours sleep when you’ve been drinking.
It is no surprise, then, that cutting down on drinking can mean a better night’s sleep; a survey from Alcohol Concern found that 62 percent of participants who took part in Dry January reported sleep improvements.
A healthier stomach
Even a little alcohol can irritate the stomach, increasing its production of acid.
This can lead to inflammation of the stomach lining, known as gastritis, causing symptoms such as stomach pain, vomiting, and diarrhea. Heavy drinking may even cause stomach bleeding.
By reducing alcohol intake, such problems can be reduced or avoided.
Ready to cut down on drinking?
If cutting back on your alcohol intake has now made it on to your list of New Year’s resolutions, these tips from the NIAAA can help you get started:
* Monitor how much you are drinking: the NIAAA recommend carrying a drinking tracker card, allowing you to track every alcoholic beverage consumed
* Set a goal: do you want to give up alcohol completely, or just limit alcohol intake to once or twice a week? Set yourself a goal of how much you want to drink and when. The NIAAA recommend having some alcohol-free days
* Avoid drinking “triggers”: if you are more likely to drink around certain people or environments, try to avoid such scenarios
* Learn to say “no”: it can be hard to turn down a drink when offered one, especially on special occasions, but the NIAAA recommend having a polite “no, thank you” at the ready. The organization’s module on building drink refusal skills may help
* Pace yourself: aim to consume no more than one standard alcoholic beverage per hour when drinking, sip it slowly, and make every other drink a nonalcoholic one such as water or juice
* Avoid drinking on an empty stomach: eating food alongside an alcoholic beverage means that the alcohol will be absorbed into the bloodstream more slowly.

Dr Afshin Shawn Adhami