Epistaxis is the medical term for bleeding from the nose, often called a nosebleed or bloody nose. It is not an uncommon phenomenon and may occur many times in a person’s life where it is not related to any serious cause. The most common causes of a bloody nose are trauma, usually due to nose picking or nose blowing due to a runny nose and sneezing, and it also occurs as a result of dry, cold weather.
Frequent nosebleeds however, are less common and if it is recurring, it is important to investigate for a number of conditions that may case a chronic bloody nose. It is important to identify whether the bleeding is persistent and continues despite one’s effort to stop the bleed. Packing the nose may sometimes be the only option in these cases. However, in most people who report a chronic bloody nose, the bleeding is episodic and frequent and resolves, often spontaneously, after a period of time only to recur a short while later.
The nasal mucosa is a thin delicate membrane that lines the nasal cavity. A vast network of underlying blood vessels are prone to rupture and is the source of most nosebleeds. Rarely, the bleeding may stem from a neighboring site and drain through the nose.
Causes of a Chronic Bloody Nose
The more common causes of a recurring nosebleed that needs to be excluded is :
- Compulsive nose picking (rhinotillexomania)
- Dry cold weather – adaptation to the environment will eventually result in a cessation of bleeding.
- Rhinitis – usually allergic rhinitis (perennial more than seasonal).
Other causes of a chronic nosebleed are less common :
- Chronic or recurring infections of the nose, nasal cavity and sinuses. Predisposing causes like immune deficiency needs to be considered if the condition is unresponsive to treatment. Other infections may include scarlet fever, typhoid fever, malaria and rheumatic fever
- Foreign bodies lodged in the nasal cavity will usually result in a one-sided obstruction (one blocked nostril), tenderness, offensive discharge and diminished sense of smell (hyposmia). This is more likely to be seen in children.
- Tumors of the nasopharynx or paranasal sinuses may be the source of the bleed. This includes both benign tumors, including nasal polyps, and malignant tumors.
- Bleeding disorders that affect coagulation (clotting). This may also be a result of using anticoagulants (‘blood thinners’) like warfarin. Other blood disorders that may cause a chronic nosebleed includes leukemia, aplastic anemia, polycythemia vera and thrombocytopenia although a bloody nose is an uncommon symptom.
- Excessive use of inhalants (nasal sprays).
- Perforated septum – cocaine sniffing or the inhalation of abrasive dusts in the work environment needs to be considered in persistent cases.
- Telangiectasias – Rendu-Osler-Weber syndrome.
- Systemic disorders – AIDS, sarcoidosis, systemic lupus erythematosus (SLE).