Causes of Nosebleeds in Adults

Causes of Nosebleeds in Adults:

Nosebleeds (epistaxis) in adults are common and can be caused by a variety of factors, ranging from minor irritations to serious medical conditions. They are classified into two types based on their origin:

1. Anterior Nosebleeds (Most Common – 90% of cases)

• Originate from the front of the nose (Kiesselbach’s plexus).
• Usually less severe and easier to control.

2. Posterior Nosebleeds (Less Common but More Serious)

• Originate from deeper blood vessels in the nose (sphenopalatine artery).
• Often heavier, may flow down the throat, and require medical attention.

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Common Causes of Nosebleeds in Adults

A. Local Causes (Direct Nasal Irritation or Injury)

1. Trauma or Injury
   • Nose picking (most common in adults).
   • Blowing the nose too hard.
   • Foreign objects in the nose.
   • Facial or nasal fractures (accidents, sports injuries).
2. Dry Air & Environmental Factors
   • Low humidity (winter months, air-conditioned/heated rooms).
   • High altitudes.
3. Nasal & Sinus Conditions
   • Allergic or non-allergic rhinitis (inflammation).
   • Sinus infections (acute or chronic).
   • Deviated septum (structural abnormality).
4. Nasal Sprays & Medications
   • Overuse of decongestant sprays (oxymetazoline, phenylephrine).
   • Steroid nasal sprays (if used improperly).
5. Chemical Irritants
   • Smoke (tobacco, wildfires).
   • Strong fumes (cleaning products, industrial chemicals).
6. Nasal Tumors or Abnormal Growths
   • Benign (e.g., nasal polyps, angiomas).
   • Malignant (e.g., squamous cell carcinoma, lymphoma).

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B. Systemic Causes (Underlying Medical Conditions)

1. High Blood Pressure (Hypertension)
   • Can make bleeding harder to stop but is rarely the sole cause.
2. Blood-Thinning Medications
   • Aspirin, warfarin, clopidogrel, NSAIDs (ibuprofen, naproxen).
   • Newer anticoagulants (apixaban, rivaroxaban, dabigatran).
3. Bleeding Disorders
   • Hemophilia, von Willebrand disease.
   • Thrombocytopenia (low platelet count).
4. Liver Disease
   • Cirrhosis impairs clotting factor production.
5. Chronic Alcohol Use
   • Can lead to liver dysfunction and blood vessel dilation.
6. Hormonal Changes
   • Pregnancy (increased blood flow to nasal vessels).
7. Infections
   • Viral (common cold, flu).
   • Bacterial (sinusitis).
8. Autoimmune Diseases
   • Granulomatosis with polyangiitis (Wegener’s granulomatosis).

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When to Seek Medical Attention

• Bleeding lasts longer than 20 minutes despite pressure.
• Heavy bleeding (soaking multiple tissues or dripping down the throat).
• Frequent recurrent nosebleeds (multiple times a week).
• Signs of anemia (fatigue, dizziness, pale skin).
• History of bleeding disorders or anticoagulant use.

Diagnostic Tests (if needed)

• Nasal endoscopy (to locate the bleeding source).
• Blood tests (CBC, coagulation profile, liver function).
• Imaging (CT scan if a tumor or fracture is suspected).