What is the reason for recurrent nosebleeds

Nosebleeds are a common condition in daily life. There are many reasons for nosebleeds, sometimes it is due to hot weather, sometimes it is due to accidental injury to the nose, and sometimes it is due to some diseases of the nasal cavity causing nosebleeds, etc. In general, when you have a nosebleed, just stop it in time. If you have frequent and recurring nosebleeds, you need to go to the hospital for examination.

Local causes

(1) Nose injury:

① Mechanical trauma:

Common causes of nosebleeds include car accidents, falls, boxing injuries and nose picking.

②Barotrauma:

During high-altitude flying or diving, if the air pressure difference inside and outside the sinuses suddenly changes too much, the blood vessels in the mucosa of the nasal cavity and sinuses will dilate, rupture and bleed.

③Radiotherapy injury:

During and after radiotherapy of the head and neck, the nasal mucosa may become congested and edematous, or the epithelium may fall off, and nose bleeding may also occur.

(2) Nasal septum deviation:

It often occurs near the bone ridge or bone spine (rectiform process) or the convex surface of the deviated nasal septum. The mucosa there is thinner and the direction of air flow changes here, so the mucosa becomes dry, causing blood vessels to rupture and bleed. Patients with nasal septum perforation may suffer from recurrent nosebleeds due to dryness, erosion, and shedding of the mucosa at the edge of the perforation.

(3) Nasal inflammation:

① Nonspecific inflammation of the nose:

Acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. can easily cause nose bleeding, but the amount of bleeding is generally not much.

② Specific infection of the nose:

Specific infections such as tuberculosis, lupus, syphilis, leprosy and diphtheria can cause nose bleeding due to mucosal erosion, ulcers, granulation tissue and nasal septum perforation.

(4) Tumors of the nasal cavity, paranasal sinuses and nasopharynx:

Among them, the most prone to nosebleeds are nasal septum hemangioma, nasopharyngeal angiofibroma, hemorrhagic nasal polyps and malignant tumors of the nasal cavity and paranasal sinuses. Minor nose bleeding or blood in the mucus is one of the main early symptoms of malignant tumors.

(5) Foreign bodies in the nasal cavity:

It is common in children, mostly unilateral nosebleeds, because foreign objects remain in the nasal cavity for a long time, which can cause erosion and bleeding of the nasal mucosa. Animal foreign bodies in the nasal cavity, such as leeches, can cause repeated heavy nosebleeds.

Systemic causes

(1) Bleeding diseases and blood diseases:

① Diseases of vascular wall structure and function defects:

Such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura, von Willebrand disease, etc.

② Platelet quantity or functional disorders:

Such as idiopathic thrombocytopenic purpura, secondary thrombocytopenia caused by various reasons, etc.

③Coagulation factor disorders:

Such as various types of hemophilia, vitamin K deficiency, etc.

④ The blood's own anticoagulant effect is too strong:

Such as improper use of anticoagulants, the presence of anticoagulant substances such as antifibrinogen in the blood circulation, or excessive or accelerated fibrinolysis, such as disseminated intravascular coagulation.

(2) Acute febrile infectious diseases:

Such as cold, influenza, hemorrhagic fever, scarlet fever, malaria, measles and typhoid. It is mostly caused by high fever, toxic damage to blood vessels, congestion, swelling and dryness of the nasal mucosa, resulting in rupture and bleeding of capillaries. Generally, the amount of bleeding is small, mostly occurs during the fever period, and the bleeding site is mostly located in the front of the nasal cavity.

(3) Cardiovascular system diseases:

① Hypertension and arteriosclerosis:

Hypertension and arteriosclerosis are important causes of nosebleeds in middle-aged and elderly people, and vascular sclerosis is its pathological basis. Increased blood pressure, especially when constipated, overexerting or emotionally excited, can rupture blood vessels in the nose and cause nosebleeds. In addition, sneezing, coughing hard, vigorous nasal breathing or nasal massage are also factors that cause nosebleeds to recur and become difficult to control.

② Increased venous pressure:

Diseases such as emphysema, cor pulmonale, mitral valve stenosis, and space-occupying lesions in the neck or mediastinum can cause superior vena cava hypertension. The nasal cavity and nasopharyngeal veins of these patients are often dilated and congested. When the patient coughs violently or due to other inducements, the blood vessels may rupture and bleed. The bleeding site is mostly located in the distribution area of ​​the nasopharyngeal vein at the posterior nostril.

(4) Other systemic diseases:

Pregnancy, premenopause, and menopause can all cause nose bleeding, which may be related to increased capillary fragility. Patients with severe liver disease may experience nosebleeds due to impaired liver synthesis of coagulation factors. Uremia can also cause nose bleeding. Nosebleeds can be one of the early symptoms of rheumatic fever.