What Causes Nosebleeds? Read This Before Assuming It’s Cancer

There are different types of nosebleeds, and they can all look scary. Read on to learn what causes nosebleeds and how to treat and prevent them.

Woman attends to nosebleed with tissue

When a character in a TV drama has a nosebleed, this usually foreshadows a terrible terminal illness. But in real life, only 10% of nosebleeds require medical attention. That said, if you have a nosebleed, also known as epistaxis, there are key steps you can take to stop the bleeding and address what causes nosebleeds.

The more common type is called an anterior nosebleed. It is when bleeding occurs in the lower part of the septum separating the two nostrils. This type accounts for the majority of nosebleed cases, especially in children and teens.

A posterior nosebleed, occurring further up and inside the nose, is more common in adults. It is also more likely to require medical attention. 

What Causes Nosebleeds

Illustration of nasal cavity and surround blood vessels and arteries
Anterior nosebleeds involve smaller blood vessels to the front of the nose while posterior nosebleeds are caused by the rupture of larger arteries in the back.

Our nose may appear like two simple orifices in our face that let us breathe (along with our mouth). But inside, it has a complex structure filled with blood vessels that warm the air we inhale. It’s also lined with mucosa that keeps the nasal passage moist and comfortable while making sure dirt and other foreign particles don’t make it into our lungs.

When we experience a nosebleed, this means a blood vessel has either ruptured due to some kind of trauma to the nose or a blood vessel has spontaneously ruptured due to an internal condition that renders the blood vessels weak. 

Physical trauma rupturing blood vessels 

Toddlers, young children, and early tweens are more likely to pick their nose or stick other objects into their nose. This causes trauma to the blood vessels, especially in areas where fingers and objects tend to get stuck. Colds and other upper respiratory diseases could be what causes nosebleeds because of the frequent sneezing, coughing, and nose-clearing that can cause the rupture.

Drying of the nasal lining 

Those of us who might have studied or worked overseas in cold places may recall bleeding noses and ears. Cold winter air dries the mucosa, making it more likely to crack and bleed. On top of that, turning on the heater indoors also makes the air dry. That said, dry air in air-conditioned rooms can also be what causes nosebleeds in humid places like Malaysia.

You might notice that your nose, mouth, skin, and eyes feel a little dry after sitting in air-conditioned rooms indoors while trying to avoid the hot humid air outside. Some medications such as nasal sprays and decongestants can also dry out the mucosa. 

Inflammation of the nasal lining 

Sometimes the nasal lining can get inflamed, causing blood vessels in the nose to fill with blood. That can easily rupture the blood vessels when you rub or blow your nose too hard .

An allergy-related immune response such as having hay fever could also cause inflammation. Unrelated to allergies, an acute response to a chemical such as strong-smelling cleaning products or narcotics like cocaine can also cause nosebleeds. 

Slower clotting and weakening blood vessels due to age or certain medication 

What causes nosebleeds is related to the nature of the blood vessels themselves. Middle-aged or older adults tend to get nosebleeds. Blood clotting can take a little longer with age, alongside other risk factors such as high blood pressure, which may cause them to take blood thinning medication like aspirin and warfarin.

Less common causes 

In rare cases, what causes nosebleeds could be a rare disease. Cancerous growths such as nasal polyps or tumours alter the physiology of the nose, and blood cancers like leukaemia or rare blood disorders like thrombocytopenia decrease blood platelets in the body, could be what causes nosebleeds. 

How to Treat and Prevent Nosebleeds  

The correct response to a treating a nosebleed is to sit upright while leaning forward slightly. Lying down or tilting your head backwards could lead to the blood flowing back into your throat. This causes coughing and choking. You could even ingest blood by accident, which can cause an upset stomach.

Pinch the soft part of your nose on the outside of both nostrils with your fingers for about five to ten minutes. Breathe through your mouth. If the bleeding doesn’t stop after ten minutes, pinch again for another ten to 20 minutes. Use an ice compress on the nose to help constrict blood vessels. After about 20 minutes, take a five-minute break and try again. Do not blow your nose into a tissue to empty out the blood as this may cause further rupture and bleeding. 

Bleeding that persists for more than 20 to 30 minutes requires medical attention. At the clinic or the hospital, the doctor may do a cauterisation, a procedure that burns and seals the ruptured vessel using either a chemical or an electrical implement. The doctor may also try a nasal pack to absorb and control the blood. Failure to stop bleeding using the previous methods may require surgery to seal off the ruptured vessel. 

Patterns of Disharmony: Another Perspective

Dried American ginseng root on a plate next to a cup of tea and teapot
Cooling herbs that tonify the yin like American ginseng can help calm conditions that cause nosebleeds.

Traditional Chinese Medicine (TCM) physician Ng Teck Xian explains that since your nose is connected to your lungs, your qi can be obstructed by heat. “The upward reversal of qi and blood will lead to nosebleeds, which is related to the three viscera of the Lungs, Liver and Spleen,” he explains. 

However, internal heat is not the only cause. Nosebleeds can also be a symptom of sthenia syndrome caused by fever, or asthenia syndrome caused by weakness. Physician Ng further shares that there are five different categories of nosebleeds. These are Lung Heat, Stomach Heat, Liver Heat, Liver and Kidney yin Deficiency, or Spleen failing to control blood.

Specific treatment would differ depending on which syndrome is causing the nosebleed. The general protocol would be to stop the bleeding and clear the Heat while nourishing the organs.

In addition to the Western treatment options and prevention methods shared earlier, in TCM, it is also advisable to avoid spicy and oily foods that can be bring excessive Heat into the body. Physician Ng also shares that a simple hot ginseng tea recipe with about 5g each of American ginseng, dwarf lilyturf, and rehmannia root brewed in about 500 ml of hot water and a bit of salt can help eliminate Heat, promote body fluids, tonify the Lungs, and nourish yin

In other words, the best prevention for nosebleeds is to maintain good health and internal balance. Pay attention to what causes nosebleeds and avoid substances that could cause it. Keep your nasal cavity moist, avoid sneezing, coughing, or blowing your nose too forcefully, as well as excessive nose picking.

Keep an eye on medication or drugs that may be causing systemic nosebleeds. Limit or eliminate alcohol or tobacco smoke, as these can also be the culprit. Most nosebleeds aren’t a cause for alarm but frequent nosebleeds could be a sign of an emerging illness or disease, so it’s always best to check with your doctor. 

References

  1. myHEALTH, Ministry of Health Malaysia. 2014. Epistaxis (Nose Bleeds).  [Accessed 8 March 2022]. 
  2. Cleveland Clinic. 2019. Nosebleed (Epistaxis).  [Accessed 8 March 2022]. 
  3. StatPearls, National Institute of Health. 2021. Epistaxis.  [Accessed 8 March 2022]. 

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