Nosebleeds can signal local injury to the nose or reflect health issues in other parts of the body. In a detailed discussion, a specialist from SM-Clinic explained the range of factors that can cause this symptom and how they appear in clinical evaluations.
The nasal mucosa is highly vascular, with the greatest density of blood vessels located in the Kisselbach area on the lower front part of the nasal septum. This region is the source of about 90 percent of nosebleeds, making it a common focus for diagnosis and treatment in patients presenting with epistaxis.
Cold, dry air stands out as a frequent local trigger for nosebleeds. Dryness can desiccate the mucous membrane and increase the fragility of blood vessel walls, particularly when actions such as sneezing, rubbing the nose, or picking crusts cause trauma. Humidification and avoiding irritants are often recommended as initial preventive steps.
Local factors also include injuries to the nose from accidental trauma or improper nose blowing, improper use of nasal sprays directed toward the septum, and various forms of rhinitis (allergic, inflammatory, or atrophic). Postoperative bleeding, growths within the nasal cavity or sinuses (such as polyps or juvenile angiofibromas), a deviated septum, and the presence of a foreign body in the nose can all contribute to epistaxis. Exposure to chemical irritants and other irritants in the environment is another recognized local cause.
Systemic contributors extend beyond the nose itself and involve conditions that affect overall blood pressure, coagulation, and vascular health. Hypertension, blood disorders, and impaired clotting mechanisms (including hemophilia, thrombocytopenia, or leukemia) can predispose individuals to nosebleeds. Physiological states such as pregnancy and certain genetic conditions like telangiectasia (Rendu-Osler disease) may also play a role. Chronic liver diseases, including cirrhosis or hepatitis, can influence clotting factors and bleeding risk.
Dietary and nutritional factors are sometimes overlooked. Deficiencies in vitamins that support mucosal integrity and blood coagulation—namely vitamin C, vitamin A which supports epithelial health, and vitamin K which is essential for clotting—can contribute to a higher tendency for nosebleeds. Maintaining adequate levels of these nutrients is particularly important for athletes and people with high physical demands, where minor traumas are more likely to occur and recovery may be slower.
Another set of triggers includes episodes of physical stress or overheating, such as heat exposure or sun exposure that leads to body strain. Medications that affect platelets or blood clotting, including certain anticoagulants and medications containing aspirin, can increase bleeding risk and provoke nosebleeds in susceptible individuals. In some cases, nosebleeds may occur after episodes of intense physical exertion or dehydration where fluid balance has shifted significantly.
In clinical practice, practitioners emphasize the importance of recognizing when nosebleeds are a simple, self-limited event or a sign of a more serious underlying condition. Proper assessment involves looking at both local and systemic factors, reviewing medication use, and evaluating for signs of dehydration, infection, or inflammatory diseases. When nosebleeds become frequent, persistent, or difficult to control, a healthcare professional may perform examinations and tests to determine the specific cause and to guide targeted treatment. This might include nasal cavity inspection, imaging studies for structural issues, or blood tests to assess clotting status and related health concerns. The overarching aim is to reduce episodes, protect nasal mucosa, and address any systemic contributors that could pose longer-term health risks [Citation: SM-Clinic expert guidance].