Nosebleeds are one of the most common conditions all around the world. Nosebleeds can be scary but in rare cases they are sign that you have a serious medical problem. Our noses have many blood vessels. These blood vessels are located close to the surface in the front and back of your nose. Our blood vessels are very fragile and they can bleed easily. Nosebleeds are very common condition in adults and children who are between the ages of three and ten [1]. There are 2 types of nosebleeds. The first one is an anterior nosebleed. This type of nosebleed happens when the blood vessels in the front of your nose break and bleed. The second one is a posterior nosebleed. This type of nosebleed happens in the back or the deepest part of your nose. In this type of nosebleed, the blood flows down the back of your throat. It is known fact that the posterior nosebleeds can be dangerous. If you noticed that the bleeding seems excessive, then you need to talk with your doctor as soon as possible. If you are swallowing a large amount of blood which makes you vomit, then see your doctor as soon as possible.
Causes of nosebleeds
There are many different causes for nosebleeds. An infrequent or sudden nosebleed in rare cases is serious. But if you have more frequent nosebleeds, then you may have a more serious problem. The most common cause of nosebleeds is the dry air [2]. Using a central heating system and living in a dry climate can dry out the nasal membranes which are the tissues inside our nose. This dryness is causing crusting inside your nose. Crusting may become irritated or itch. If your nose is picked or scratched, then it can bleed. Also when you take antihistamines and decongestants for sinus problems, colds or allergies can also dry out your nasal membranes and this can lead to nosebleed. Frequent nose blowing is another cause for nosebleed. Here are other common causes for nosebleed:
- Large doses of aspirin [3]
- Upper respiratory infection
- Cold air [2]
- Chronic sinusitis [4]
- Picking the nose
- Repeated sneezing
- Blood thinners (anticoagulants) such as heparin and warfarin [5]
- Injury to the nose
- Cocaine use [6]
- Allergic reaction
- Nonallergic rhinitis [7]
- Acute sinusitis [4]
- Hemophilia and other bleeding disorders
- Chemical irritants such as ammonia
- Nasal sprays such as used to treat allergies, if used frequently [7]
- Dry air – when your nasal membranes dry out, they are more susceptible to bleeding and infections [2]
- Common cold
- Trauma to the nose
- Foreign object stuck in the nose
Less common causes for nosebleeds are:
- Second trimester pregnancy [8]
- Nasal tumor
- Nasal surgery
- Nasal polyps [9]
- Leukemia [10]
- Idiopathic thrombocytophenic purpura (ITP)
- Heredity hemorrhagic telangiectasia
- Alcohol use
Nosebleeds
But also there are other causes for nosebleeds such as cancer, blood clotting disorder, a bleeding disorder and high blood pressure. In the most cases, nosebleeds do not require medical help. If have noticed that your nosebleeds occur after an injury or if it lasts longer than twenty minutes, then you should talk with your doctor as soon as possible. This can be a sign of a posterior nosebleed which is a serious condition. A punch in the face, a car accident and a fall are some injuries which can lead to nosebleeds. Nosebleeds which happen after an injury may indicate internal bleeding, skull fracture or a broken nose. Also there are some cases in which certain medicines such as warfarin can lead to nosebleeds. Conditions which affect the blood clots or the blood vessels can also lead to nosebleeds. High blood pressure can be also a cause for nosebleeds. You should know that in general nosebleeds are not a result or symptom of high blood pressure. It is possible, but it is rare that the severe high blood pressure can prolong or worsen bleeding if you have a nosebleed. You need to talk with your doctor about the proper diagnosis and treatment.
Risk factors: There are some people who have increased risk of getting nosebleeds such as
- Pregnant women [8]
- Elderly people
- Children – they usually grow out of them by eleven [1]
References:
[1] Nardo-Marino A, Williams TN, Olupot-Olupot P. The frequency and severity of epistaxis in children with sickle cell anaemia in eastern Uganda: a case-control study. BMC Hematology. 2017.
[2] Harvard Women’s Health Watch. Is my nosebleed the result of winter air? Harvard Health Publishing. 2019. Retrieved from www.health.harvard.edu/diseases-and-conditions/is-my-nosebleed-the-result-of-winter-air
[3] Saloheimo P, Juvela S, Hillbom M. Use of aspirin, epistaxis, and untreated hypertension as risk factors for primary intracerebral hemorrhage in middle-aged and elderly people. Stroke. 2001;400-4.
[4] Sedaghat AR. Chronic rhinosinusitis. American Family Physician. 2017;96(8):500-6.
[5] Buchberger AMS, Baumann A, Jonhson F, et al. The role of oral anticoagulants in epistaxis. European Archives of Oto-Rhino-Laryngology. 2018;275(8):2035–43.
[6] Yaman H, Aydin Y, Yilmaz S, et al. Recurrent andmassive life threatening epistaxis due to nasal heroin usage. Clinical and Experimental Otorhinolaryngology. 2011;4(3):159–61.
[7] Girsh LS. Allergic rhinitis, a common cause of recurrent epistaxis in children. The American Journal of Diseases of Children. 1960;99(6):819-21.
[8] Piccioni MG, Derme M, Salerno L, et al. Management of severe epistaxis during pregnancy: A case report and review of the literature. Case Reports in Obstetrics and Gynecology. 2019.
[9] Jahromi AM, Pour AS. The epidemiological and clinical aspects of nasal polyps that require surgery. Iranian Journal of Otorhinolaryngology. 2012;24(67):75–8.
[10] Shephard EA, Neal RD, Rose PW, et al. Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. British Journal of General Practice. 2016;66(644):e182-8. doi: 10.3399/bjgp16X683989.
