Nosebleeds ("epistaxis" in medical terms), occur in 1 out of 7 people. With the exception of a rare, underlying clotting disorder or tumor, the vast majority of cases are benign in nature and will resolve spontaneously generally within 5 to 20 minutes. This article examines the common causes, treatment and prevention of nose bleeds.
Who Gets Nosebleeds?
Nosebleeds occur most commonly in children under the age of 10 and in adults between the ages of 45-65. The incidence is higher in men but after menopause, there is little difference in the incidence between men and women. Estrogen is felt to confer a protective benefit to women either because it helps keep mucosa moist or because of the vascular benefits.
Causes of Nosebleeds
There are numerous causes of nosebleeds but by far, the most common causes are from trauma, dryness and irritation. Contrary to popular belief, hypertension is not felt to cause nose bleeds but uncontrolled blood pressure can prolong a nose bleed.
Trauma
This is usually associated with nose picking (hence the prevalence in children) but there are other causes of trauma. Since the lining on the inside of the nose is rich in blood vessels, any slight trauma can trigger a nose bleed. Vigorous nose blowing or even repeated sneezing can cause trauma to the delicate tissues lining the nasal mucosa. Other causes of trauma can be a foreign body or blunt trauma.
How Dryness Contributes to Nosebleeds
Any condition that leads to dryness can cause nose bleeds. This is why epistaxis is more common in the winter when the air is dry and cold, lacking humidity. In just the same way that our skin becomes dry (and flakey) during the winter months, so too do our nasal passages. This dryness can lead to tears in the delicate lining and lead to nose bleeds even with the simple act of nose blowing or sneezing.
Irritation: A Contributing Factor
Seasonal allergies that cause chronic, runny nose, lead to repeated nose blowing that can dry out and traumatize nasal passages.
Upper respiratory infections lead to changes in the mucus secretions and the vascular beds that line the nasal passages.
Certain drugs and medications also lead to thinning of the nasal passages and these include cocaine (which can actually cause a hole in the nasal septum) and steroid nasal sprays which are used to treat seasonal allergies. These steroid sprays can cause tissue thinning.
Common Sites for Nosebleeds
Anatomically, the nose is divided into two regions: the anterior (front) and posterior (back) region. The vast majority (90%) of nose bleeds occur in the anterior region at an area known as Kieselbach's plexus This area is located just inside the nose on the upper nasal septum at the convergence of several major blood vessels.
Posterior nose bleeds are less common and typically occur in the elderly due to hypertension, atherosclerosis, and thinning nasal mucosa. These nose bleeds are more serious and difficult to control due to their location as well as the fact that the blood vessels that supply this area are larger, so bleeding can be more profuse. Posterior nosebleeds require prompt medical attention and often hospitalization with referral to an ear, nose and throat specialist (ENT).
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