Epistaxis, the medical term for a nosebleed, involves blood loss from the tissue lining the inside of the nose. The nose contains numerous tiny, delicate blood vessels close to its inner surface. Air moving through the nose can dry and irritate these vessels, making them prone to injury and bleeding. While many nosebleeds have clear origins, some appear unexpectedly. About six in ten people experience at least one nosebleed during their lifetime.
Everyday Factors That Can Trigger Nosebleeds
Common environmental and behavioral factors often contribute to nosebleeds that seem to happen without a clear reason. Dry air, especially in arid climates or heated indoor spaces, can cause nasal membranes to dry out and crack. This dryness makes delicate blood vessels more susceptible to bleeding.
Minor irritation, such as from nose picking or forceful nose blowing due to allergies or colds, can also weaken these blood vessels. Repeated irritation or aggressive manipulation can damage the nasal lining, leading to bleeding.
Medications That Increase Bleeding Risk
Certain medications can increase the likelihood of nosebleeds by affecting the blood’s ability to clot. Anticoagulants, or blood thinners, such as warfarin, rivaroxaban, and heparin, interfere with the normal clotting process, making bleeding more prolonged. Antiplatelet drugs like aspirin and clopidogrel also reduce the blood’s ability to form clots, increasing epistaxis risk. Even non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can have this effect.
Some nasal sprays, particularly those with corticosteroids, can dry out and thin the nasal lining when used excessively, leading to nosebleeds. Other medications, including certain antidepressants, statins, and antibiotics, have also been associated with nosebleeds.
Medical Conditions Associated with Nosebleeds
Underlying health conditions can also contribute to nosebleeds, sometimes making them appear spontaneous. While high blood pressure (hypertension) is generally not a direct cause, it can damage nasal blood vessels over time, making them more fragile. Uncontrolled high blood pressure may also make nosebleeds more severe or difficult to stop.
Bleeding disorders, such as hemophilia or von Willebrand disease, directly impair the body’s clotting mechanisms, increasing the risk of frequent or prolonged nosebleeds. Liver disease can affect clotting factor production, and kidney disease may also impact blood clotting, both potentially leading to nosebleeds.
Less common causes include growths within the nasal passages. Nasal polyps, which are soft, noncancerous growths, can sometimes cause nosebleeds if they become large or irritated. Though rare, nasal tumors, both benign and cancerous, can also manifest with nosebleeds as a symptom, often accompanied by nasal congestion or facial pain. Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder causing fragile blood vessels throughout the body, with frequent nosebleeds often being an early sign.
When to Consult a Doctor
While most nosebleeds are not serious and can be managed at home, certain situations warrant medical attention. Consult a healthcare provider if nosebleeds are frequent or severe, occurring more than three to four times per week or six or more times a month. Bleeding that does not stop after 15 to 20 minutes of continuous direct pressure also requires professional evaluation.
Seek immediate medical care if nosebleeds are accompanied by symptoms like dizziness, weakness, pale skin, or shortness of breath, as these can indicate significant blood loss. A nosebleed after a head injury or a blow to the face should also be assessed by a doctor to rule out more serious trauma. If you are taking blood-thinning medications and experience a nosebleed that is difficult to control, or if there is a family history of bleeding disorders, medical advice is recommended.