Chronic Epistaxis: What Causes Recurring Nosebleeds?

What Is Chronic Epistaxis?

frequent nosebleeds

Epistaxis refers to bleeding from the nose, therefore chronic epistaxis is when an individual suffers from chronic nosebleeds. While getting a nosebleed is very common, with about 60% of the population having had at least one nosebleed in their lifetime, getting frequent nosebleeds is cause for concern and should be evaluated by a medical professional.

Causes

Epistaxis can stem from harmless underlying conditions, or serious, life-threatening illnesses. The following are underlying conditions and illnesses that can lead to chronic epistaxis:

  • Anatomical deformities
  • Blunt trauma
  • Foreign bodies in the nasal cavity
  • Chronic sinusitis
  • Intranasal tumors
  • Environmental irritants
  • Rhinitis
  • Respiratory infections
  • Cocaine use
  • Prolonged use of nasal sprays
  • Infectious diseases
  • Hypertension
  • Low humidity
  • Middle ear barotrauma
  • Surgery and/or damage to the nasal passages
  • Excessive alcohol consumption
  • Anemia
  • Blood dyscrasias
  • Connective tissue disorders
  • Liver disease
  • Hemophilia
  • Pregnancy
  • Vitamin C deficiency
  • Potassium deficiency
  • Heart failure
  • Idiopathic thrombocytopenic purpura
  • Hematological malignancy
  • Von Willebrand’s disease
  • Hemorrhagic telangiectasia
  • Vascular disorders
  • Thrombotic thrombocytopenic purpura

stopping nosebleed

Types

There are two main types of epistaxis:

Anterior

Anterior epistaxis is the most common type of nosebleed. These nosebleeds originate in the front part of the nose or nasal septum, an area that has many blood vessels.

Posterior

Posterior epistaxis is the more rare and severe type of nosebleed. These nosebleeds originate in the back of the nose from the Woodruff’s plexus. These nosebleeds are often harder to control and do not stop on their own.

Symptoms

  • Blood exiting one or more nostrils
  • Blood flowing to the back of the throat
  • Nausea
  • Vomiting
  • Coughing

Diagnosis

Epistaxis can usually be diagnosed by a primary care physician based on physical exam and assessment of medical history and symptoms. In cases of chronic epistaxis, your doctor will want to run tests to find an underlying cause. This may include bloodwork and diagnostic imaging to rule out some serious conditions that can cause nosebleeds. They may refer you to an ENT (ears, nose and throat specialist) to do a thorough examination of your nasal passages.

epistaxis treatment

Treatment

In many cases, epistaxis does not require any treatment as it is typically harmless. In cases of severe and chronic epistaxis, the underlying cause may need to be addressed to resolve the nosebleeds. Topical medications can be prescribed to stop the bleeding when epistaxis occurs. The patient may require nasal packing, which entails packing the nasal cavity with gauze to block blood flow. In chronic cases, the patient may need surgery, such as laser therapy or embolization to block the blood vessels that are continuously bleeding. If the epistaxis is caused by certain lifestyle factors, like exposure to chemicals or environmental irritants, your doctor may recommend wearing a mask when exposed to these things.

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