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The Major Causes of Nosebleeds, According to Experts

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Nosebleeds, also known as epistaxis, are a relatively common symptom, with experts indicating that approximately 60% of people will experience a nosebleed at some point in their lives. While it may seem benign in many cases, a nosebleed can be indicative of various underlying causes, including local conditions, systemic diseases, and environmental factors.

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Local factors are among the primary causes of nosebleeds. Common local conditions include inflammation, tumors, trauma, foreign bodies, and nasal septum deviation. Inflammation, such as rhinitis or sinusitis, can lead to damage of the nasal mucosa and cause bleeding. Tumors within the nasal cavity, whether benign or malignant, can irritate blood vessels and result in bleeding. Trauma, such as a blow to the nose or post-surgical complications, can lead to ruptured blood vessels. The presence of foreign bodies can irritate the nasal cavity and trigger bleeding. Nasal septum deviation may compress local blood vessels, increasing the risk of bleeding. Nosebleeds caused by these local factors often present as blood in nasal discharge, blood-streaked phlegm in the morning, or fresh blood flowing from the nostrils. In some cases, blood may even reach the throat, leading to vomiting of blood. Alongside bleeding, patients may experience other symptoms such as nasal congestion, runny nose, headaches, and reduced sense of smell.

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Systemic factors also play a significant role in causing nosebleeds. These factors include hypertension, elevated venous pressure, coagulation disorders, and various systemic diseases. Hypertension, particularly with significant fluctuations in blood pressure, can lead to the rupture of nasal blood vessels and cause bleeding. Elevated venous pressure, often caused by conditions such as cor pulmonale, chronic bronchitis, or masses in the chest or neck, can affect venous return and increase venous pressure, leading to nosebleeds. Coagulation disorders, such as thrombocytopenia or leukemia, can impair blood clotting and increase bleeding risk. Febrile illnesses, such as rheumatic fever, can also contribute to nosebleeds by accelerating blood circulation and drying out the nasal mucosa. Liver diseases, such as chronic hepatitis or cirrhosis, affect the production of coagulation factors, increasing the risk of nosebleeds. Kidney diseases, such as chronic nephritis or renal failure, can cause chronic damage to blood vessels and abnormalities in coagulation mechanisms, leading to bleeding.

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Additionally, conditions related to menstrual cycles or estrogen levels, hereditary hemorrhagic telangiectasia, and long-term use of anticoagulants or low-dose aspirin can also cause nosebleeds. Hereditary hemorrhagic telangiectasia is a genetic disorder characterized by abnormal dilation of capillaries in the anterior inferior portion of the nasal septum, which can lead to nosebleeds. Long-term use of anticoagulants or low-dose aspirin can prolong bleeding time, increasing the risk of nosebleeds.


The causes of nosebleeds are diverse and complex. Understanding these causes not only aids in accurate diagnosis and treatment but also helps in comprehensive health management. Since nosebleeds can be a symptom of various underlying conditions, it is advisable to seek medical attention promptly if a nosebleed occurs. A healthcare provider will typically consider the patient's overall health status, other symptoms, and relevant test results to determine the most appropriate treatment plan.

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