What causes Nosebleeds (Epistaxis)

Epistaxis or nosebleed is bleeding from the nose due to bursting of the blood vessel. It can be spontaneous or due to an injury. A nosebleed can occur from the front of the nose or anterior portion or from the back of the nose – posterior part. The nosebleeds that occur in the blood vessels underlying the delicate and thin mucus membrane along the front of the nasal septum can be prevented and treated easily.

The nosebleeds that occur in the posterior part of the nose, along the lateral nasal wall – especially in older people owing to high blood pressure are difficult to locate and control. A nosebleed usually stops on its own. A majority of the people get affected by epistaxis at some point in time. However, less percentage of those who experience nosebleed may require professional medical care.

The causes of epistaxis can be local, systemic and unknown (idiopathic). The local causes include infection, septal abnormality, mucosal irritation, trauma, tumours, inflammatory diseases, sinus surgery, medication use. The systemic causes include hereditary haemorrhagic telangiectasia, arteriosclerosis, and blood disorders.

Injury or Trauma

Injury to the mucosa and nasal septum is one of the common causes of nosebleeds. In addition, the other factors that can cause nosebleeds include face injuries, inhalation of dry air, nose picking, repeated stress caused by the usage of nasal spray bottles, fractures and deformation of the nose.

The design of the delicate, thin mucus membrane is to ensure smooth flow of air across it, but due to repeated stress in the form of nose-picking by using fingers, foreign bodies and tissues can cause abrasion of the tissue. In addition, even frequent nose-blowing and rubbing can also damage this delicate thin membrane. The rich supply of blood vessels beneath it gets damaged. Sometimes, repeated stress, pressure and trauma may also lead to the formation of a hole in the septum.

Infection

Respiratory tract infections, chronic sinusitis and allergies and sometimes chronic staphylococcal infections can damage the mucosal lining of the nose and cause inflammation and irritation, which may result in nosebleeds.

Hypertension

Hypertension or high blood pressure is the prominent cause of nosebleeds in older people. The risk of posterior nosebleed is usually high in people with high blood pressure and it increases further if they are on anticoagulant medication.

Stress

Can stress cause nosebleed? Yes, there is an indirect link. Which means anxiety and stress are related to some medications, health conditions and behaviours that can trigger nosebleeds. Stress can trigger a headache which may cause a nosebleed. Blood thinners used for the treatment of hypertension can also cause nosebleeds.

Prescription Nasal Sprays

If a person has one or more risk factors for nosebleeds, then prolonged usage of non-prescription nasal spray for sinus congestion should be avoided. The usage of nasal congestion spray can cause usually mild nosebleeds. However, several prescription nasal sprays can cause mild to severe nosebleeds. Therefore, it is always better to follow the instructions of your ENT specialist prior to using them.

Anticoagulants

Individuals who are undergoing treatment with anticoagulants, such as Warfarin, Aspirin, Plavix and Coumadin should become very careful about their nose and must take utmost precautions to avoid undue injury to the nose because they are at a very high risk of nosebleeds even with a minor facial and head injury or just with a bump.

Dry weather

Individuals who are prone to nosebleeds and even others who are at risk of nosebleeds should remain careful during dry weather conditions, particularly during summers. Dry air affects the mucosal lining of the septum causing membrane cracks and disruption and tearing the underlying blood vessels – which may result in nosebleeds.

Other causes of nosebleeds

Vascular malformations and tumours are the other causes of nosebleeds. Sometimes septal perforations, deviated septum, nasal fractures, septal dryness and medical treatment such as orbital surgery, skull-base surgery and endoscopic sinus surgery may also cause epistaxis.

 What causes nose bleeding in children?

The following are the most common causes of nosebleeds in children: dry weather and dry air; frequent scratching or picking; injury to the nose; cold; allergies and sinus infections. Abnormal blood vessels and problems related to blood clotting and clotting factors can also cause nosebleeds in children, but these problems are rare.

When to worry about a nosebleed?

You should seek immediate medical help if:

• You notice nosebleed in your child after taking a new medicine.
• Your child’s nosebleed is due to injury or a severe blow to the nose.
• The child has severe bruising all over the body.
• Your child is still bleeding even after two to three attempts of applying continuous pressure for up to 10 minutes each.
• The child is complaining of headache or dizziness.

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