Epistaxis: why does the nose bleed?

The scientific term for what is usually called “nosebleed” – the loss of blood from the nose – is epistaxis. The origin of the name comes from the Greek word “epistazo”, which means “to drip, drop by drop”. Nosebleeds can be triggered by various factors. Let's investigate their physiology and causes together, in this in-depth article.

The physiology of epistaxis and some data

Epistaxis is a form of haemorrhage from the nose that, according to a research published in 2009 in The New England Journal of Medicine, about 60% of people experience during their lifetime: a rather remarkable frequency, due to the fact that the mucous membrane in our nasal area is particularly rich of blood vessels, which can break and bleed. Nosebleeds are prevalent in children under the age of 10 and increase again after the age of 35. However, we must point out that epistaxis turns out to be a medical problem only in about 6% of cases. The vast majority of nosebleeds – approximately 90% – only involve the anterior part of the nasal cavities, corresponding to a specific area called the Kiesselbach plexus. The remaining 10% of nasal bleedings originate in the back of the nose and are more common in adults over 60: the part of ​​the nasal mucosa associated with this type of epistaxis is known as Woodruff area. Knowing the difference between these two types of nasal bleeding is important because it allows you to distinguish between anterior epistaxis, with bleeding only from the nostrils, and posterior epistaxis, which causes blood to drain in the nasopharynx.

Local causes of nosebleeds

The onset of nosebleeds may be due to local problems or to more general causes, such as blood pressure. Localised bleeding is often triggered by some form of trauma: for example, many children are in the habit of picking their nose, and we all sometimes blow our nose too vigorously; in these cases, it is very easy to rupture a blood vessels of the nasal septum. Another of the most common local causes of nosebleeds is dry air, to which we are exposed in both heated and air-conditioned environments: the low humidity of the air we breathe, indeed, dehydrates the nasal mucous membranes and causes itchy crusts to form. Scratching, or even simply repeatedly touching the nose, could break or detach the scabs with consequent bleeding. Finally, epistaxis can also be a symptom of an ongoing respiratory tract infection, such as a cold or sinusitis. 

General risk factors associated with epistaxis

Among the scientifically ascertained general risk factors of epistaxis, when it occurs in frequent and abundant form, we must certainly mention hypertension, a circulatory system pathology that is frequent in old age and exerts excessive pressure on blood vessels’ walls. But there’s more: heart disease and diabetes can also induce epistaxis. In other cases, nasal haemorrhages are associated with taking antiplatelet or anticoagulant drugs, especially in elderly subjects whose mucosa is highly vulnerable due to age, and whose capillaries – in the highly vascularised area at the front of the nose – might be more fragile.

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