Nose Bleeds: Overlooked Causes and Treatments of Epistaxis

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Nose Bleeds: Often Overlooked Dietary, Drug and Genetic Causes of Epistaxis

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I had recurrent nose bleeds on and off for years, in addition to a wide variety of other bleeding problems. Oddly, the nose bleeds would only occur in my left nostril. My eye had hemorrhaged on the left side of my face as well. I went to see a wide variety of different doctors for these problems, but for years no one had any solutions.

After many years I finally found out, through a combination of my own research and advice from a knowledgeable doctor and physical therapist, that there were a variety of causes that had been contributing to my nose bleeds. These were:

1) I had an inherited genetic disorder where easy bleeding is one of the traits. It is estimated that inherited bleeding disorders effect a significant portion of the population, though in my experience doctors seldom are aware that nose bleeds and other bleeding problems may be symptoms of an inherited disorder.

2) I had a vitamin K deficiency. Vitamin K is needed to clot the blood, so without enough vitamin K people tend to have nose bleeds and all sorts of other bleeding problems - heavy menstrual bleeding (menorrhagia) in women, easy bruising, bleeding gums, hematuria, etc. (Also see my section on menorrhagia for more on this topic.)

3) I had a uneven shoulder muscles from scoliosis and pectus excavatum causing constricted blood vessels. The muscles on the left side of my shoulder were overly tight and overdeveloped. As such they were constricting my veins and arteries on that side of my body, causing high blood pressure on just the left side of my head. This was why my nose bleeds occurred just on my left side. My physical therapist figured this out for me. It was the same reason my arm would go numb just on my left side. It was from tight muscles putting pressure on my nerves.

After I fixed all of these problems, my nose bleeds stopped. It used to be very disturbing to have blood start dripping from my nose, at any hour of the day, for no apparent reason. I've been very fortunate to have found people, books and web sites to help me piece all of the factors causing my nose bleeds together. I put up this web site to help other people who may have epistaxis from some of the same causes.

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Nosebleeds and Vitamin K

The following links contain information about vitamin K deficiency as a cause of nosebleeds:

Vitamin K deficiency - from emedicine - The emedicine site lists the following symptoms:

bleeding from major or minor trauma
hematomas
nose bleeds
gum bleeding
blood in the urine
oozing from blood draw punctures
easy bruising

The Merck Manual on Vitamin K Deficiency - Notes that the main symptom of a deficiency is bleeding. Specifically, easy bruising, bleeding from the nose, gastrointestinal bleeding, hematuria and menorrhagia can occur. Blood may also seep from wounds or incisions.

I've noticed that many web sites state that nose bleeds from minor trauma are normal. I question whether this is really true. There's a big difference between what's "normal" and what is "common". Many people these days suffer from obesity, but just because that is a common condition does not make it normal.

Perhaps the people who get nose bleeds from minor trauma are also vitamin K deficient. Vitamin K deficiencies may be common, as noted in the next section, but that doesn't make them normal. I seriously doubt having blood spurt out of your nose frequently for no apparent reason is ever a normal condition.

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Vitamin K Deficiencies

Vitamin K deficiencies can occur from a variety of causes. At one time it was thought vitamin K deficiencies were rare, but some experts are now questioning this line of thinking. Some experts now believe vitamin K deficiencies may be more common that previously thought.

Vitamin K in our bodies comes from two main sources. The first source is the vitamin K contained in the foods we eat. Most leafy green vegetables are high in vitamin K. The second source of vitamin K is synthesis by good bacteria that reside in our intestines.

Prescription antibiotics destroy this beneficial bacteria, which is why some people develop bleeding problems after taking antibiotics. Children tend to get nose bleeds more often than adults. Children also tend to take more antibiotics than adults. I do wonder if a vitamin K deficiency isn't a cause of nose bleeds in children. Children also tend to consume a lot of fruit and fruit juices, foods that are high in salicylates (aspirin like substances). Salicylates can block vitamin K. This may be another reason why children get frequent nosebleeds.

Nosebleeds and Antiseptics

One of my sons had a severe nose bleed shortly after I bought him a bottle of antiseptic hand cleaner that contained vitamin E as an ingredient. Vitamin E is an antagonist of vitamin K, and as such, it tends to thin the blood. Prior to using the hand cleaner, he had never had a nose bleed develop for no obvious reason before. (He did have nose bleed once before from an accident at school where he got hit on the nose by a child swinging a lunch box, but I think that bleeding was caused by the impact.)

I gave him some lettuce to eat for vitamin K, and his nose stopped bleeding immediately. After that we threw out the hand cleaner and he has never again had another nose bleed.

People who have an imbalance in their intestinal flora from conditions like systemic candida (yeast) infections may also be low in vitamin K. In these cases the pathogenic organisms tend to crowd out the beneficial bacteria that we need to synthesize nutrients in our digestive system, including vitamin K. (The "K" in vitamin K comes from the Danish word for coagulation.)

Here is an interesting web site on vitamin K: Vitamin K: Another Reason To Eat Your Greens - "New studies find that vitamin K isn't as abundant in the diet as once thought."

Anticoagulants can also cause nose bleeds because they thin the blood by blocking vitamin K. Here are some good links on anticoagulants as a cause of nose bleeds:

Complementary and Alternative Healing University - Warfarin Sodium: "Long term usage can cause nose bleeding, gum bleeding, purpura, blood in urine, uterine bleeding, blood in stool, bleeding of ulcers and wounds."

Click here to see my section on Vitamin K.

View this page to see my section on foods, spices and herbs that thin the blood.

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Bleeding Disorders and Genetic Disorders as a Cause of Nosebleeds

Most people have heard of hemophilia, but there actually are are a lot of other more common bleeding disorders that are not as well known. Despite having a life long history of bleeding problems and relatives with bleeding problems, I was never checked for an inherited disorder until I was in my forties. Then I was diagnosed with an inherited connective tissue disorder called Ehlers-Danlos syndrome where easy bleeding is one of the common problems. I also have scoliosis, mitral valve prolapse and hypermobility, conditions research has shown are all linked to bleeding problems.

Other bleeding disorders besides Ehlers-Danlos syndrome that have nose bleeds as a symptom include:

Factor II Deficiency - There are two types of this deficiency, a congenital version called hypoprothrombinemia, and an acquired version called dyspothrombinemia.

von Willebrand's disease - A hereditary deficiency or abnormality of the von Willebrand factor in the blood, a protein that affects platelet function. It's the most common hereditary disorder of platelet function, affecting both women and men. The disease is estimated to occur in 1% to 2% of the population.

Idiopathic Thrombocytopenic Purpura (ITP) - from www.familydoctor.org - "Most children with ITP have a very low platelet count that causes sudden bleeding. The usual symptoms are bruises and the tiny red dots on the skin. Nosebleeds and bleeding gums are also common."

Diet and Platelet Count

It is interesting that this article above mentions low platelet count as a cause of nose bleeds and sudden bleeding. I've found that I can change my platelet count by changing my diet. When I eat a lot of foods high in vitamin K, saturated fat, avoid salicylates, take probiotic supplements and avoid vitamin E, my platelet count increases. On a recent blood test it was actually out of range on the high side, I think because I had overcorrected my vitamin K deficiency problems. When I saw the test results, I immediately cut back on vitamin K and started eating more fruit and other food high in salicylates. On my next blood test, my platelet count had dropped by about 25%.

Click here for more information on bleeding disorders from the The National Hemophilia Foundation.

There is additional information on bleeding disorders to be found at the Online Inheritance in Man database at the U.S. National Institute of Health's Web site. When I entered "epistaxis" in their search criteria, 35 disorders were returned. Ehlers-Danlos syndrome was not mentioned in the OMIM site as being linked to nose bleeds, but if you check out a survey of people with EDS, a wide variety of bleeding problems, including nose bleeds, are listed as being common problems.

One of my web site readers emailed me with yet another cause of nosebleeds, hereditary hemorrhagic telangiectasia (HHT) which is not a bleeding disorder but rather a a genetic disorder of the blood vessels.

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Constricted Blood Vessels / High Blood Pressure

While I knew that high blood pressure could cause nose bleeds, what I found out from my physical therapist was that in my case I had localized high blood pressure just on one side of my head from constricted blood vessels in my left shoulder. This turned out to be the reason I had nose bleeds on just on the left side of my nose.

Nose bleeds and Night Sweats?

There actually are logical reasons why these conditions occur together and at night.

Some people, especially children, only get nose bleeds when they are in bed at night. They also get sweaty heads. Ayurvedic (traditional Indian) medicine actually has a logical explanation for why these conditions occur more at night and also why they occur together.

In Ayurvedic medicine, one cause of high blood pressure is an acid stomach. People's stomachs get more acid at night when they haven't eaten any food for awhile, and also perhaps also due to normal body rhythms. This increase in stomach acid causes a person's metabolism to rise, which in turn makes people hotter. The increase in stomach acid also raises blood pressure, which is a known cause of nose bleeds.

When people are sitting up during the day there is less blood flow to their heads because gravity pulls the blood down towards their feet. That is why people often get swollen ankles during the day, but at night, when people lay down, there is less blood in the feet and ankles and more blood flowing to the head. Besides increased stomach acid, this change of position also contributes to higher blood pressure in the head than there usually is during the day when people are sitting or standing upright and blood can flow out of the head region easier.

The muscles in my left shoulder were unusually taut, overdeveloped and unbalanced compared to my right shoulder as a result of having scoliosis since childhood. My muscles were so tight they were constricting my blood vessels and nerves causing thoracic outlet syndrome on my left side. The constriction had also caused left side nose bleeds, eye pain and an eye hemorrhage. An eye hemorrhage is where the blood vessel in your eye burst and the white part of your eye looks all bloody for a week or so. On my right side I had TMJ and neck pain from muscles that were stretched out and underdeveloped.

The physical therapist I went to for my scoliosis and thoracic outlet syndrome is the person who explained the connection to me between all of these different conditions, my body alignment and my nosebleeds. He also showed me how to balance my muscles through stretching and acupressure. With his help and information from yoga, stretching and acupressure books, I was able to get my muscles much more balanced between my right and left shoulders.

When the muscles in my left shoulder area relaxed and my right shoulder muscles were strengthened, then all of the different conditions I'd had -- scoliosis, TMJ, thoracic outlet syndrome, neck pain and back pain --- started to clear up in unison.

For diagrams of how my body alignment was contributing to my nose bleeds, and the exercises and books I found to correct my alignment, see my sections on How Exercise Helped My Scoliosis.

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Summary

Nose bleeds may have a wide variety of possible causes. In my case, I had a multitude of factors all contributing to my epistaxis. These included a genetic disorder called Ehlers-Danlos syndrome, a vitamin K deficiency and constricted blood vessels in my left shoulder.

I went to many doctors over a period of years for my nose bleeds and other bleeding problems without finding any solutions. Based on my experience and from looking at web sites on nose bleeds, I would say it is not common practice for doctors to check patients with a history of epistaxis for genetic disorders, vitamin K deficiencies and/or blood vessel constriction. However, it would seem like these would all be highly logical possible causes to consider and evaluate in patients with a history of otherwise undiagnosed nose bleeds.