Reasons for Bloody Noses

The lining of the nose contains many tiny blood vessels that lie close to the surface and damage easily. Consequently, many injuries, drugs and diseases can cause a bloody nose, also called epistaxis. Dr. D.J. Pallin, in “Annals of Emergency Medicine,” reports that epistaxis accounts for about one in every 200 emergency room visits in the U.S., with the highest rates among the elderly.


Trauma can cause broken nose bones, which can cause cuts to nasal membranes. According to, the most frequently broken bones in the face are the two nasal bones that form the bridge of the nose. These bones support the upper part of the nose between the eyes. Athletes involved in contact or collision sports, such as boxing, wrestling, hockey and football commonly experience nosebleeds. Trauma to the inside of the nose from nose picking often causes a nosebleed.

Dry Air notes that dry air most commonly causes nosebleeds in the front, or anterior part of the nose. A dry climate or indoor heat in winter irritates and dries out nasal membranes, causing crusts that may itch and then bleed when picked.

Posterior nosebleeds are less common and often occur in elderly people. Bleeding originates from an artery in the back, or posterior part of the nose.

Hereditary Hemorrhagic Telangectasia

According to “Harrison’s Principles of Internal Medicine,” hereditary hemorrhagic telangiectasia, also called Osler-Weber-Rendu disease, is a rare hereditary disease characterized by nasal and gastrointestinal bleeding from abnormal capillaries. It occurs in both sexes with the primary symptom being nosebleeds. Treatment consists of cauterization.

Cocaine Use

Nose bleeds occur very commonly from sniffing cocaine, which has a strong vasoconstrictive effect that can cause complete obliteration of the nasal septum.

Warfarin Use

Many patients take warfarin, an anticoagulant used to thin blood to prevent stroke or blood clots. A side effect of warfarin is nosebleeds. Even minor trauma to the nose can result in a substantial amount of bleeding in people taking warfarin.

Von Willebrand Disease

According to “Harrison’s Principles of Internal Medicine,” von Willebrand disease, the most commonly inherited bleeding disorder, occurs in 1 to 2 percent of the population. Von Willibrand is a factor that combines with platelets to clot blood at the site of an injury. People with von Willbrand disease have decreased amounts of von Willibrand factor. Consequently, affected patients may have spontaneous, prolonged epistaxis. Treatment includes infusion of Factor VIII concentrate containing von Willibrand factor.

About this Author

Based in New Jersey, John Riefler III has been writing since 1987. His articles have appeared in “MD Magazine,” “Emergency Medicine” and “Hospital Practice.” Riefler holds a Bachelor of Science in biology from Bucknell University, a Master of Science in microbiology from M.U.S.C. and an M.D. from St. George’s U. School of Medicine.