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A punch in the nose can certainly lead to a bloody nose. But, you may be surprised how many
other things – from your prescription medications or the climate in which you live, to the
common cold – can cause nosebleeds.

Here’s a brief explanation of some of the common, and a few uncommon, causes of nosebleeds.

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Nasal Allergies, Colds and Infections

Allergies, colds and sinus infections are major causes of recurring nosebleeds. In the U.S.
alone, 35 million people suffer with nasal allergies, 31 million people experience sinus infections,
and more than 1 billion colds are reported annually.

All of these conditions can lead to a bloody nose as a result of:
• Swelling and irritation of the nasal cavities
• Side effects of certain medications used to treat the condition, particularly steroid nasal sprays
• Excessive nasal dryness caused by frequent use of nasal decongestants

Several prescription or over the counter nasal sprays report nosebleeds as a side effect,
including: Veramyst, Flonase, Nasonex, Omnaris, Astepro, Nasalide, Decadron, Beconase,
Vancenase and Rhinocort Aqua.

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Nosebleeds And Pregnancy

A bloody nose can be a common occurrence during pregnancy. As a pregnancy develops, blood flow
increases by 30% to 50%. The increased blood flow is necessary to maintain a healthy placenta
and a healthy baby. This increased blood supply puts more pressure on the delicate vessels in
the nose, causing them to rupture more easily. These nosebleeds are typically minor and last
only a short time.

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Climate-Related Nosebleeds

Climate-related dryness is a cause of frequent nosebleeds. Common dry-climate environments
include:
• High heat, low humidity weather conditions such as those typically found in the Southwest U.S.
• Home heating and air conditioning systems can reduce humidity
• Climbing or hiking at higher altitudes
• Change in pressures during airplane travel

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Blood Thinners

A blood thinner, also called an anti-coagulant, is used to stop platelets, or heavy cells, present
in blood plasma from forming clots. Millions of people take blood thinners every day – from
prescription drugs to aspirin. They are prescribed therapeutically, typically to those at risk of or
those who may have suffered a cardiovascular event.

Recurring nosebleeds are a common side effect of the use of blood thinners. In fact, data
suggests that 3% to 4% of the millions of people taking blood thinners will experience
nose bleeding.

Coumadin and Plavix represent two of the most widely prescribed blood thinners in U.S. – with
35 million Coumadin and 25 million Plavix prescriptions written annually. The most widely used
blood thinner, however, is baby aspirin (81mg) with some 50 million people in the U.S. taking
them daily.

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Cancer Therapies

Cancer therapies, especially chemotherapy, can result in nosebleeds. With chemotherapy,
nosebleeds occur for two reasons:

1.Chemotherapy causes thinning of the mucosa, resulting in more bleeding.

2.The chemotherapy causes a drop in your platelet count, resulting in increasing the chances for a bloody nose and bruising.

Radiation therapy by itself doesn’t cause nosebleeds, but when used in combination with
chemotherapy, the incidence of bleeding will increase.

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Nasal Cancer And Polyps

Nasal cancer and polyps can be a cause of nosebleeds.

Nasal cancer is very rare, with only 1,000 new cases reported in the U.S. every year. When a
bloody nose does occur, it is the result of the infection and inflammation associated with the
cancer. Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa
or the paranasal sinuses. They may or may not be cancerous. Nosebleeds can be symptomatic
of nasal polyps.

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Hereditary Hemorrhagic Telangiectasia (HHT) Or Osler Weber Rendu

HHT causes abnormalities of blood vessels. This genetic disorder impacts 1 in every
5,000 people or 60,000 sufferers in the U.S. alone. 95% of people with HHT experience
frequent nosebleeds.

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Bleeding Disorders – Hemophilia And von Willebrand

Genetic, blood based bleeding disorders that inhibit clotting can also be a cause of nosebleeds.
The two most common are hemophilia and von Willebrand disease. Hemophilia impacts about
20,000 people in the U.S., while von Willebrand is prevalent in 3.3 million people in the U.S.

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Hypertension/High Blood Pressure

Many lay people and some within the medical community attribute hypertension or high blood
pressure as a cause of nosebleeds. The scientific data doesn't support hypertension as a direct
cause of nosebleeds. Hypertension will impact the severity and/or frequency of bleeding from the nose.

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Spontaneous Nosebleeds In Children

Children often experience spontaneous nosebleeds, without any apparent underlying cause.
Most originate in the middle wall of the nose (Hasselbach’s plexus). Blood vessels in this area
often become dilated when inflamed. Increased pressure on these vessels when reclining or
bending over, when sneezing or coughing, or after experiencing minor nasal trauma can result
in a spontaneous nosebleed.

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Sports Related Nasal Trauma

Sports activities are a popular cause of nosebleeds. Sports such as wrestling, soccer, hockey
and football, just to name a few, are all sports in which a higher incidence of nasal trauma or
injury to the nose can lead to a bloody nose.

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Other Nasal Trauma

A significant number of nosebleeds are caused by nasal trauma due to chronic nose picking
and extreme nose blowing. In addition, nasal trauma as a result of a fight or accident can
also cause a blood nose.

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