Nosebleeds Explained: Causes, Care, and Nasal Cautery

Nosebleeds (epistaxis) are bleeding that occurs when blood vessels and tissues inside the nose are damaged. Dry air, a blow to the face or nose, picking the nose, allergies, infections, or stress are the most common causes of nosebleeds. Nosebleeds can occur in either the right or left nostril, but usually affect only one nostril. Nosebleeds are a common complaint and generally can be treated at home without causing serious health problems. However, sometimes other health issues can be the underlying cause of a nosebleed. Depending on the severity and frequency of the bleeding, a doctor's examination may be necessary to determine the cause, and treatments such as nasal cautery may be recommended to seal the affected blood vessels and prevent recurrent bleeding.

Epistaxis, or nosebleed, is a condition that can occur in one or both nostrils, resulting from the rupture of a blood vessel in the nasal lining and causing blood to leak from the tissue lining the inside of the nose. Nosebleeds are usually caused by trauma to the nose or face, allergic reactions, nose picking, insertion of an object into a nostril, dry or excessively hot air, high blood pressure, hemophilia, infections, and blood disorders such as leukemia. In persistent or severe cases, medical interventions, including nasal cautery, may be used to control bleeding and reduce the risk of recurrence.

What are the different types of nosebleeds?

Nosebleeds have different types depending on the location of the bleeding. These are classified as follows:

Anterior Nosebleed

Anterior nosebleeds originate in the anterior region, beneath the wall that divides the nose into two sides. The capillaries in this area are delicate and prone to bleeding. In the anterior nose, just at the entrance to the nasal cavity, in the midline, capillaries converge in a specific area within the mucous membrane (Kisselbach plexus or Little's area). In children, most nosebleeds originate in this area. Most nosebleeds are unilateral, caused by the rupture of a capillary in this region.

Because the blood vessels in this area are quite thin and superficial, they can bleed even from blowing the nose, a slight touch of a fingernail, or a mild impact. In such nosebleeds, usually a small amount of blood flows out while sitting or standing. The amount of bleeding may be more in some cases, but even this can often be controlled with finger pressure. They are frequently seen in children and young adults.

Posterior Nosebleed

Nosebleeds that occur at the back of the nose, near the throat, are called posterior nosebleeds. More common in adults, these bleeds can travel down the back of the throat, creating dangerous situations and requiring immediate medical attention.

Because they can be difficult to control and cause serious bleeding. Apart from head traumas and facial injuries, they are actually frequently seen in middle-aged and elderly people, and those with blood pressure problems. In children, they can occur in those with bleeding and clotting disorders. Since they originate from the upper back regions inside the nose, applying pressure to the front of the nose with a finger will not stop the bleeding. The bleeding will continue towards the mouth and throat. Bleeding in this area absolutely requires the intervention of an ENT specialist, and may even require the support of other branches such as Internal Medicine-Hematology and Interventional Radiology. If there are symptoms of significant blood loss, such as dizziness, feeling faint, palpitations (low blood pressure), and rapid pulse, the patient should go to the private clinic immediately.

What causes nosebleeds?

Causes of nosebleeds include trauma to the face and nose (blows), nose picking, forceful nose blowing, excessive nose sniffing, allergies, stress, excessively hot or dry air, blood thinners, high blood pressure, nasal polyps, nasal abnormalities, and types of blood cancer such as leukemia.

The general causes of nosebleeds are as follows:

• A blow to the face or nose

• Extremely hot or dry air

• Infections affecting the inside of the nose, such as sinusitis.

• Allergies like hay fever

• Hypertension

• Bleeding or clotting problems (hemophilia)

• Blood cancers

• Getting a foreign object in the nose or picking one's nose

• A blow to the face or nose 

Blows to the face or nose cause trauma. In these traumas, nasal tissues and capillaries are damaged and sometimes even broken. As a result of these situations, a nosebleed occurs.

Hot and dry air

The nose is one of the most vascularized organs in the body. The turbinates and mucous membranes play a role in warming, humidifying, and cleaning the air inhaled through the nose. The turbinates, commonly known as nasal polyps, have the ability to swell and shrink depending on increased or decreased blood circulation. This allows our nostrils to open and close alternately, ensuring proper nasal function.

The nasal turbinates and the entire nasal cavity are covered with a mucous membrane. A gel-like layer of mucus covers this mucous membrane, maintaining moisture in the nose and preventing dryness. Just as our skin bleeds when it is scraped or injured, nosebleeds occur when the mucous membrane is damaged. Basically, hot, dry weather, infections, and nose picking weaken the mucous membrane, causing capillaries to open and thus leading to bleeding.

Stress

Stress and anxiety are among the leading negative impacts on people today. While an increase in stress-related illnesses is observed, nosebleeds can also occur due to stress.

Intense sun exposure

In very hot and sunny weather, the nasal passages can become dry and irritated. Therefore, intense sun exposure is one factor that triggers nosebleeds.

Dry air

Dryness of the environment and air can cause the nasal membranes to dry out, crust over, or crack, leading to bleeding.

Infections

Conditions such as the common cold, upper respiratory infections, the flu, or sinusitis can cause nosebleeds.

Allergies

Nosebleeds can occur in both allergic and non-allergic rhinitis.

Chemical substances

Household cleaning products, chemical fumes in the workplace, and other harmful, strong odors, as well as intoxicating substances, can all cause nosebleeds.

Blood thinners

Medications such as aspirin, anti-inflammatory drugs, and warfarin can trigger nosebleeds.

High altitude

As you ascend to higher altitudes, the amount of oxygen in the air decreases, causing dryness in the nose. This can lead to nosebleeds.

Repeated sneezing

Avoid actions that trigger sneezing, such as picking or scratching the nose. These actions can damage the nasal membranes and lead to nosebleeds during sneezing.

While all these reasons can cause nosebleeds, they generally don't require serious medical intervention. However, if the bleeding lasts longer than 20 minutes, a doctor's intervention may be necessary, as this could indicate another underlying cause.

Conclusion

In addition, alcohol consumption, uncontrolled high blood pressure, bleeding disorders, nasal polyps, recent nasal surgery, hereditary hemorrhagic telangiectasia, leukemia, atherosclerosis, and hormonal changes during pregnancy are among the less common causes of nosebleeds. Structural abnormalities inside the nose, long-term use of certain medications such as blood thinners, and chronic sinus conditions may also contribute to recurrent episodes of epistaxis. In some cases, frequent or heavy nosebleeds can indicate an underlying medical condition that requires thorough assessment and specialized care. If bleeding is persistent, recurrent, or difficult to control, seeking evaluation from experienced Mr. Adeel, ENT consultants West Yorkshire can help identify the root cause and provide appropriate treatment options. These may include medical management, nasal cautery, nasal packing, or further diagnostic investigations to ensure safe and effective long-term relief.