Why Do People Have Nosebleeds (Epistaxis)?

Nosebleeds (epistaxis) refers to an active blood loss from the tissue that lines your nose. It can affect both nostrils, but most often occurs in only one nostril. The nose contains many blood vessels, which are located close to the surface in the front and back of the nose. These blood vessels are very fragile and bleed easily. Nosebleeds are common in adults and children between the ages of 3 and 10. Although nosebleeds are common and may be scary, they rarely indicate a serious medical problem.

There are two kinds of nosebleeds depending on the part of the nose where the blood vessels are affected. An anterior nosebleed occurs when the blood vessels in the front of the nose break and bleed. A posterior nosebleed occurs in the back or the deepest part of the nose. In this case, blood flows down the back of the throat. Posterior nosebleeds can be dangerous.

Some Facts To Know

  • Nosebleeds are rarely a cause for concern.
  • Most people experience at least one nosebleed during their life.
  • They are categorized as either anterior or posterior nosebleeds.
  • Climate and altitude can cause nosebleeds to occur.
  • Certain drugs can make nosebleeds last longer.

What Causes Nosebleeds (Epistaxis)?

Anterior nosebleeds are more common than posterior nosebleeds. Each of them have their specific causes and predisposing factors.

Sometimes, the cause of anterior nosebleeds is unknown. However, common causes include:

  • Picking the inside of the nose, especially if this is done often. Your nose can bleed if your fingernails are long, and the inside of the nose is already irritated or tender.
  • A knock or blow to the nose could damage the delicate blood vessels of the mucous membrane.
  • Sinusitis, which is an inflammation of the sinuses (air-filled cavities of the bone and skull surrounding the nose) can cause anterior nosebleeds.
  • A cold, flu or a nasal allergy can cause a nosebleed because people with these conditions blow their nose more often. Also, the inside of the nose may be irritated and tender during a viral infection, making it more susceptible to bleeding.
  • Deviated septum – when the wall separating the two nostrils is off center, or deviated.
  • Hot climates with low humidity or changes from bitter cold to warm dry climates can cause drying and cracking inside the nose, which can lead to a nosebleed.
  • High altitude – as altitude increases, the availability of oxygen decreases, making the air thinner and drier. The dryness can cause the nose to bleed.
  • Excessive use of certain kinds of medications, such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen.
  • Liver disease can interfere with blood clotting and result in frequent and/or severe nosebleeds.
  • Excessive use of illegal drugs, such as cocaine.

On the other hand, posterior nosebleeds can be caused by:

  • High blood pressure.
  • Nasal surgery.
  • Calcium deficiency.
  • Exposure to chemicals that may irritate the mucous membrane.
  • Blood diseases, such as hemophilia or leukemia.
  • Some tumors.

Other possible causes of nosebleed can include:

  • A foreign body – such as a small toy – getting stuck in the nostril.
  • Broken nose – a crack or break in the bone or cartilage of the nose.
  • Low platelet count (thrombocytopenia) – individuals are more prone to bleeding.
  • Osler-Weber-Rendu disease – a rare condition, affecting 1 in 5,000 people; it is a genetic disorder of the blood vessels that leads to excessive bleeding.
  • Ebola – one of Ebola’s late-stage symptoms is a bleeding rash all over the body.
  • Von Willebrand disease – a bleeding disorder due to a deficiency of von Willebrand factor.
  • Idiopathic thrombocytopenic purpura – a condition in which the blood does not clot correctly. Individuals experience excessive bleeding and bruising.
  • Deficiency of factor II, V, or VII – these rare conditions affect blood clotting and increase the chances of nosebleed.

Home Remedy To Stop Nosebleeds (Epistaxis)

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Some symptoms may accompany nosebleeds such as heavy bleeding and palpitations (an irregular heartbeat).
When you swallow large amounts of blood, this can cause vomiting. Some people may also experience shortness of breath and turn pale especially when the bleeding is heavy. You can try to stop the nosebleed at home by yourself.

Non-serious nosebleeds (epistaxis) can be effectively treated at home. The steps to stop the bleeding are:

  1. Sit down and pinch the soft parts of the nose firmly, whiles you breathe through the mouth.
  2. Lean forward (not backward) to prevent blood from draining into the sinuses and throat, which can result in inhaling the blood or gagging.
  3. Sit upright so that the head is higher than the heart; this reduces blood pressure and slows further bleeding.
  4. Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of 5 minutes and up to 20 minutes, so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is required.
  5. Apply an ice pack to the nose and cheek to soothe the area and avoid strenuous activity for the next few days.

Individuals are recommended to seek medical attention if they suffer from frequent nosebleeds. Frequent nosebleeds could be an indication of an underlying problem. Also seek medical attention if you just had an injury to the head, or take anticoagulants (blood thinning medications) and the bleeding does not stop even after trying the steps above.

Treatment of Nosebleeds (Epistaxis) at the Hospital

If home remedy does not stop your nosebleed, you should go to the hospital as soon as possible. If your doctor suspects there is an underlying cause, such as hypertension (high blood pressure), anemia, or a nasal fracture, they may run further tests, such as checking blood pressure and pulse rate. Your doctor might also order an X-ray before recommending a suitable treatment option.

There are several treatment options your doctor may offer to stop the nosebleed. These include:

  • Nasal packing – stuffing ribbon gauze or special nasal sponges as far back into your nose as possible, putting pressure on the source of the bleed.
  • Cautery – a minor procedure that cauterizes (burns) the area where the bleeding is coming from to seal it off. This is used if the specific blood vessel can be identified. However, the area around the cautery sometimes begins to bleed.
  • Septal surgery – a surgical procedure to straighten a crooked septum (the wall between the two nose channels), whether it was like that from birth or from an injury. This can reduce the occurrence of nosebleeds.
  • Ligation – a “last resort” surgical procedure that involves tying the ends of the identified blood vessels causing the bleeding. Sometimes even the artery from which the blood vessels stem is tied off. If the source of the bleed is further back, more major surgery may be required.

Quick Steps To Prevent Nosebleeds

  1. Avoid picking the nose.
  2. Apply lubricating ointment, such as petroleum jelly (Vaseline), inside the nose; especially in children whose nosebleeds are most commonly attributed to crusting inside the nostrils.
  3. Avoid blowing the nose too hard, or too frequently.
  4. Use a humidifier at high altitudes or in dry climates.
  5. To prevent recurring nosebleeds, avoid exertion or strenuous activity for a minimum of 1 week after the previous nosebleed.


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