The medical term for a nosebleed is epistaxis. Because of the position of the nose – right in the middle of the face – and its high density of blood vessels, most of us will have had at least one nosebleed at some time during our lives.
Although seldom a cause for alarm, nosebleeds can be life-threatening in rare cases.
Nosebleeds are most often caused by local trauma but can also be caused by foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air.
Tumors and vascular malformations are also potential causes of nosebleeds, but they are rare.
Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane (a mucus-secreting tissue inside the nose) dries, crusts, or cracks and is then disturbed by nose-picking, it is likely to bleed.
Because the nose is full of blood vessels, any minor injury to the face can cause the nose to bleed profusely.
Nosebleeds are also common in people taking anticoagulants (blood-thinning medications, such as Aspirin), as well as in older people whose blood may take longer to clot. If the person taking anticoagulants, has hypertension (high blood pressure), or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes.
Fast facts on nosebleeds
Here are some key points about nosebleeds. More detail and supporting information is in the main article.
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
Most commonly, nosebleeds are anterior nosebleeds.
Nosebleeds can be classed as anterior or posterior.
In anterior nosebleeds, the bleeding comes from the wall between the two nostrils. This part of the nose contains many delicate blood vessels. Anterior nosebleeds are easily treated at home; this is likely to be the type of nosebleed seen in a child.
In posterior nosebleeds, the bleeding originates further back and higher up the nose in an area where artery branches supply blood to the nose; this is why the bleeding is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention. They are more common in adults.
Causes of anterior nosebleeds
Sometimes, the cause of anterior nosebleeds is unknown. However, common causes include:
Picking the inside of the nose, especially if this is done often, if the fingernails are long, and if 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 – an inflammation of the sinuses (air-filled cavities of the bone and skull surrounding the nose).
A cold, flu or a nasal allergy can cause a nosebleed for various reasons: 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.
Posterior nosebleed causes
high blood pressure
exposure to chemicals that may irritate the mucous membrane
blood diseases, such as hemophilia or leukemia
Other causes of nosebleed
Other causes of nosebleeds 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.
Foreign body in the nose – this happens more commonly in children e.g. Lego.
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.
Factor X deficiency (Stuart-Prower factor deficiency) – a condition caused by a protein deficiency.
Aortic coarctation – a congenital narrowing of the aorta.