Nosebleeds, medically known as epistaxis, are a common ailment experienced by most adults at some point in their lives. Often, these occurrences are isolated incidents that resolve on their own without significant concern. However, for a considerable portion of the adult population – approximately 15% – nosebleeds become a recurring issue.
According to Dr. David A. Gudis, a leading expert in otolaryngology/head & neck surgery at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, frequent nosebleeds should not be dismissed. “Frequent nosebleeds are a reason to see a primary care doctor or an ENT (an ear, nose, and throat) specialist,” he advises. “When nosebleeds are frequent, they can really get in the way of daily activities and be a significant hindrance to having a normal and healthy quality of life.”
While applying pressure to the nose can often manage recurrent nosebleeds, some cases necessitate medical or even surgical intervention. In rarer situations, frequent nosebleeds might indicate a more serious underlying health condition, making it crucial to consult a specialist to pinpoint the root cause. Furthermore, certain nosebleeds can result in substantial blood loss, potentially leading to airway obstruction or becoming life-threatening emergencies.
To better understand this common yet sometimes concerning condition, let’s delve into the primary causes of nosebleeds in adults and when it’s important to seek professional medical advice.
The Role of Kiesselbach’s Plexus in Nosebleeds
illustration of Kiesselbach
The majority of nosebleeds originate from a specific area in the front of the nasal septum known as Kiesselbach’s plexus. This region is a convergence point for numerous arterial branches, creating a rich blood supply essential for the health of the sinuses. However, this dense network of blood vessels also makes the area particularly vulnerable to bleeding. The superficial location of these vessels means they are easily affected by various factors, leading to nosebleeds.
Common Causes of Nosebleeds in Adults
Several factors can contribute to nosebleeds in adults, ranging from environmental conditions to underlying medical issues. Understanding these causes is the first step in prevention and effective management.
1. Turbulent Airflow and Dry Air
The nasal passages are designed to regulate airflow, but conditions like a deviated nasal septum can create turbulent airflow within the nose. Dr. Gudis explains, “Even though it’s essentially unnoticeable to the average person, over time it can cause trauma to the mucous membrane that covers Kiesselbach’s plexus and cause recurrent nosebleeds.” This constant, albeit minor, trauma can thin the delicate lining and make it more prone to bleeding.
Furthermore, dry air, especially during winter months or in dry climates, is a significant trigger for nosebleeds. Dry air can dehydrate the nasal mucous membranes, causing them to become cracked and more susceptible to injury and bleeding. This is why nosebleeds are often more frequent during colder seasons when indoor heating systems further dry out the air.
2. Medications: Anticoagulants and Antiplatelet Drugs
Certain medications, particularly those that thin the blood, significantly increase the risk of nosebleeds. Individuals taking aspirin, warfarin, or other anticoagulant or antiplatelet medications to prevent heart attacks or strokes are more prone to experiencing nosebleeds. These medications impair the body’s ability to form blood clots, making it harder for bleeding to stop once it starts.
Dr. Gudis notes, “I often see patients who are taking some kind of antiplatelet or anticoagulant medication. It’s easier for us to manage nosebleeds than to manage a stroke or a heart attack, so I would rather treat their nosebleeds aggressively so that patients can stay on their anticoagulant or antiplatelet medications.” This highlights the importance of managing nosebleeds effectively in patients who require these medications for other critical health conditions.
3. Nasal Trauma and Irritation
While less common in adults than in children who pick their noses, direct trauma to the nose can still cause nosebleeds in adults. This can include bumping the nose, forceful nose blowing, or even excessive nose picking. Any action that irritates or damages the delicate lining of the nasal passages can lead to bleeding, especially in the vulnerable Kiesselbach’s plexus area.
4. Underlying Medical Conditions
In some cases, recurrent or severe nosebleeds can be a symptom of an underlying medical condition. One such condition is hereditary hemorrhagic telangiectasia (HHT), a genetic disorder that causes abnormal blood vessel formation. Dr. Gudis describes the nosebleeds associated with HHT as particularly severe: “These people can lose a pint of blood every time they take a really hot shower or bend over to tie their shoes.” HHT can also cause abnormal blood vessels in other parts of the body and should be considered in cases of frequent, severe nosebleeds, even without a family history of the condition.
Tumors, both benign and malignant, in the nasal passages or sinuses are another, albeit rarer, cause of nosebleeds. These growths can cause fragile blood vessels to bleed, resulting in recurrent nosebleeds. While less common than other causes, tumors must be ruled out, especially if nosebleeds are persistent, one-sided, or accompanied by other symptoms such as nasal congestion or facial pain.
5. Other Potential Causes
Other less common causes of nosebleeds in adults can include:
- Allergies and Infections: Nasal allergies and upper respiratory infections can irritate and inflame the nasal lining, making it more prone to bleeding.
- High Blood Pressure: While not a direct cause, high blood pressure may prolong nosebleeds once they start and can make them more difficult to stop.
- Alcohol Consumption: Alcohol can dilate blood vessels, potentially increasing the risk of nosebleeds.
- Chemical Irritants: Exposure to certain chemicals, such as those found in cleaning products or industrial environments, can irritate the nasal lining.
When to Seek Medical Attention for Nosebleeds
While most nosebleeds are minor and resolve on their own, it’s crucial to know when to seek medical help. Dr. Gudis advises patients to consider the impact of nosebleeds on their daily life: “If nosebleeds are troublesome for the patient, upsetting, or interfering with daily activities, it’s worth seeing a specialist.”
Specifically, you should seek medical attention for nosebleeds if:
- Frequent Recurrence: Nosebleeds occur more than once a week.
- Prolonged Bleeding: A nosebleed lasts longer than 20 minutes despite applying pressure.
- Heavy Bleeding: The nosebleed is heavy, filling more than a few tissues or a cup with blood. Dr. Gudis states, “If a nosebleed is severe enough that it can fill up a cup with blood, then we are in the territory of something where urgent medical attention is necessary.”
- Difficulty Breathing: The nosebleed is causing difficulty breathing or airway obstruction.
- Associated Symptoms: Nosebleeds are accompanied by other symptoms such as dizziness, weakness, chest pain, or confusion.
- Underlying Medical Conditions or Medications: You have a known bleeding disorder, are taking blood-thinning medications, or have other medical conditions that might be contributing to the nosebleeds.
- Nosebleed After Injury: The nosebleed occurs after a head injury or trauma to the nose.
In cases of severe nosebleeds with significant blood loss, immediate medical attention is necessary, potentially requiring a visit to the emergency room.
Home Remedies and Medical Treatments for Nosebleeds
For minor, infrequent nosebleeds, several home remedies can be effective:
- Direct Pressure: Pinch the soft part of your nose just above your nostrils for 10-15 minutes, leaning slightly forward. This is usually sufficient to stop most nosebleeds.
- Nasal Saline Spray or Gel: Keeping the nasal passages moist can prevent dryness and irritation. Using a nasal saline spray or applying a small amount of petroleum jelly to the inside of the nose can be helpful, especially in dry environments.
- Humidifier: Using a humidifier, particularly in the bedroom, can add moisture to the air and prevent nasal dryness.
However, some common home remedies, like putting a copper penny on the forehead, are not supported by evidence and are unlikely to be effective.
For more persistent or severe nosebleeds, medical treatments are available:
- Silver Nitrate Cauterization: This in-office procedure involves applying silver nitrate to the bleeding blood vessels to chemically cauterize them. Dr. Gudis explains, “Essentially the silver ions in the silver nitrate are released around the blood vessels and cause an inflammatory reaction that creates scarring in the little arteries and veins in the nose. With the scars, blood doesn’t flow as much through the vessels, and they’re far less likely to bleed.” While briefly uncomfortable, this procedure is often quick and effective.
- Nasal Packing: In cases of more severe bleeding, a doctor may pack the nasal cavity with gauze or specialized nasal sponges to apply pressure and stop the bleeding.
- Medication Adjustment: If medications are contributing to nosebleeds, a doctor may adjust the dosage or consider alternative medications, if appropriate.
- Surgery: In rare cases, surgery may be necessary to correct structural issues like a deviated septum or to treat underlying conditions such as tumors.
Conclusion
Nosebleeds in adults are a common occurrence with various potential causes, ranging from dry air and minor irritations to medications and underlying medical conditions. While most nosebleeds are easily managed with simple home remedies, frequent or severe nosebleeds warrant medical evaluation to identify the underlying cause and receive appropriate treatment. Understanding the reasons behind nosebleeds and knowing when to seek professional help is essential for maintaining good health and quality of life. By being proactive and informed, adults can effectively manage nosebleeds and minimize their impact on daily activities.
