Why Do I Get Nosebleeds?

Although Nosebleeds are common, especially for children, it can be easily managed and it is not usually a dangerous condition. However, nosebleeds can be dangerous in some cases.

There are many causes of nosebleeds. The two most common causes are dry air and trauma due to nose picking. However, sometimes there is no specific cause behind why we get nose bleeds. 

There are also certain individuals who are more prone to bleeding or to getting nosebleeds, including children, elderly people and pregnant women.

Cases of epistaxis (the medical name for nosebleeds) can vary from an easily controlled bleeding to a dangerous event with life-threatening blood loss.¹ It is important to identify dangerous nose bleeding cases in order to seek medical attention in time.

What is a nosebleed

A nosebleed is the flowing of blood from one or both nostrils due to various reasons. Nosebleeds can be heavy or light depending on the underlying cause or the individual and might last a few seconds to  15 minutes. However, it can last even longer in some cases.

Causes of nosebleed

There are several local and systemic causes of nose bleeding. The reason for bleeding can be identified by your physician through a detailed history and physical examination. 

In order to determine the cause, your physician asks about previous bleeding episodes and treatment, other medical conditions you have as well as your medication use. Your physician also determines the side of the bleeding.

Local causes of nosebleeds include:

• Chronic sinusitis
• Environmental irritants or dry air
• Granulomatous disease
• Pyogenic granuloma
• Viral illness
• Deviation or perforation of nasal septum
• Nose picking
• Foreign body
• Broken nose
• Nasal oxygen treatment
• Surgical procedures such as sinus surgery
• Nasal intubation
• Topical medications such as nasal sprays
• Tumors and conditions related to blood vessels
• Cocaine use

Systemic causes of nosebleeds include:

• Blood thinning medications such as warfarin
• Disorders related to blood clotting or bleeding disorders
• Hemophilia
• Leukemia
• Liver disease
• Platelet deficiency
• Vitamin deficiencies (A, C, D, E, K) 

There is no clear evidence whether seasonal changes or high blood pressure has a direct role for causing nosebleeds.

Management and treatment for nosebleed

It is very important to know how to stop nosebleeds yourself by applying appropriate first aid. 

If you have a nosebleed, you should:

• Sit down, lean forward and tilt your head forward
• Pinch your soft part of your nose just above your nostrils applying direct pressure for 10 to 15 minutes
• During this time, breathe through your mouth
• Hold an ice pack or a bag of frozen peas wrapped in a towel on top of your nose (Although the evidence is weak, this might help reduce the blood flow to your nose.)

When a nosebleed stops, for the next 24 hours:

• Do not blow your nose
• Do not pick your nose
• Do not consume hot drinks or alcohol
• Do not do heavy lifting or exercise
• Do not pick any scabs

For some cases of nosebleeds, treatment at hospital is required. At the hospital, the bleeding point might be sealed, by pressing a stick with a chemical called silver nitrate on it. This procedure is called cauterization. If cauterization does not work, your nose might be packed with sponges to stop the bleeding. This is called nasal packing. 

After stabilization, a referral to an ENT specialist for further assessment might be necessary. In some cases,  you might need to stay at the hospital for a few days.

FAQs

Are there different kinds of nosebleed

There are two types of nosebleeds:

1. Anterior Nosebleeds: It is the bleeding from the front or anterior part of the nasal septum and medically known as anterior epistaxis. There is a rich vascular supply consisting of a group of vessels named as Kiesselbach plexus and located in the anterior area of the nasal septum. Around 90% of nosebleeds are anterior epistaxis cases
2. Posterior Nosebleeds: It is the bleeding from the back or posterior part of the nasal septum or side of the nasal wall and medically known as posterior epistaxis. Posterior epistaxis cases consist of around 10% of all nosebleed cases

There are some differences between anterior and posterior epistaxis in terms of management. Given the location of the bleeding vessels, it is usually difficult to locate the site of bleeding in posterior epistaxis. Therefore, compared with anterior epistaxis, patients with posterior epistaxis are more likely to require admission to hospital and are twice as likely to require nasal packing.

Are nosebleeds common?

Nosebleeds are one of the most common emergencies related to ear nose throat, occurring in up to 60% of the general population. 1 in 10 people who have nosebleeds seek medical attention. Nosebleed cases account for 1 in every 200 emergency department visits.

Nose bleed is frequently seen in children younger than 10 years and in adults between 70 and 79 years of age.

People assigned male at birth are slightly more likely to have nosebleeds compared to people assigned female at birth.

Can nosebleeds be prevented?

You can take some measures to prevent nosebleeds:

• Keep the inner lining of the nose moist. As dry air is one of the most common causes of nosebleeds, it is a good idea to keep the nasal mucosa moist. In order to achieve that, you might consider applying a thin, light coating of petroleum jelly (Vaseline) or other ointment with a cotton swab three times a day. Saline spray can also help moisten dry nasal membranes
• Keep your fingernails short. It helps discourage nose picking
• Use a humidifier. A humidifier can prevent dry air by adding moisture to the air

When should I call a doctor for a nosebleed?

It is highly recommended to see a healthcare provider in certain situations with nosebleed:

• If there is a nosebleed in a child under 2 years old
• If you have regular or frequent nosebleeds
• If you have symptoms of anemia, such as palpitations, shortness of breath and pale skin
• If you are taking a blood-thinner, such as warfarin
• If you have a condition which makes you prone to bleed, such as hemophilia

In some certain cases, you need to go to A&E  and seek medical attention as soon as possible. Those include:¹

• Nosebleed lasting longer than 10 to 15 minutes
• Excessive bleeding
• Swallowing a high amount of blood that makes you vomit
• Nosebleed after a blow to the head
• Feeling weak or dizzy
• Having difficulty breathing

Summary

Nosebleed or  medically known as   epistaxis, is a common medical problem. It is usually not something dangerous but in some situations or in certain  individuals, nosebleeds might cause some problems which require medical attention. 

There are many causes of nosebleeds but the most common ones are dry air and nose picking.

If you experience nosebleeds at home, you can sit down leaning forward and pinch your soft part of your nose for 10 to 15 minutes during which you need to breathe through your mouth. If the bleeding does not stop after 10 to 15 minutes, seek medical attention as soon as possible.