What causes epistaxis while running?

Causes of Bloody Nose While Running

The most common causes of epistaxis (nosebleeds) while running include nasal mucosal dryness, trauma to nasal blood vessels, and increased blood flow to the nasal mucosa during physical exertion. 1

Primary Causes

1. Environmental Factors

• Dry air/low humidity - Running in dry environments causes nasal mucosa to dry out and crack
• Cold air exposure - Cold air can irritate nasal passages and reduce mucosal moisture
• Altitude - Higher elevations have lower humidity and can increase risk of epistaxis

2. Physiological Changes During Exercise

• Increased blood flow - Exercise increases blood flow to facial and nasal tissues
• Elevated blood pressure - Temporary increases in blood pressure during exertion can stress nasal blood vessels
• Vasodilation - Blood vessels expand during exercise, making them more prone to rupture

3. Anatomical Factors

• Kiesselbach's plexus trauma - This highly vascularized area in the anterior nasal septum is particularly vulnerable
• Nasal septal deviation - Can create areas of turbulent airflow that dry out mucosa
• Previous nasal trauma - Prior injuries may weaken blood vessels

Risk-Increasing Factors

Medications

• Anticoagulants/antiplatelet drugs - Significantly increase bleeding risk (OR 1.15-3.55) 2

  • Vitamin K antagonists (e.g., warfarin)
  • Direct thrombin inhibitors (e.g., dabigatran)
  • Platelet aggregation inhibitors (e.g., aspirin, clopidogrel)
  • Direct factor Xa inhibitors (e.g., rivaroxaban)

• Nasal corticosteroids - Can cause local irritation and epistaxis (6.0-6.9% incidence) 3, 2

• SSRIs - Associated with increased bleeding risk 2

Medical Conditions

• Hypertension - Associated with epistaxis (OR 1.532), though causal relationship not established 1
• Chronic sinusitis - Increases risk (OR 1.13-1.44) 2
• Bleeding disorders - Von Willebrand disease, hemophilia, etc.
• Hereditary Hemorrhagic Telangiectasia - Causes abnormal nasal vasculature 1

First Aid Management

When epistaxis occurs while running:

1. Stop running and sit down with head tilted slightly forward 1
2. Apply firm, sustained compression to the lower third (soft portion) of the nose for 10-15 minutes continuously 1
3. Breathe through the mouth and spit out any blood to prevent swallowing 1
4. Do not tilt head backward as this can cause blood to flow into the throat 1, 4

When to Seek Medical Attention

Seek medical care if:

• Bleeding doesn't stop after 15 minutes of continuous pressure 1
• You become lightheaded from blood loss 1
• You're taking anticoagulant/antiplatelet medications 1
• You have a known bleeding disorder 1
• Epistaxis is recurrent or particularly severe 1

Prevention Strategies

• Maintain nasal moisture:

  • Use saline nasal sprays before running
  • Consider a humidifier at home
  • Apply petroleum jelly to the inside of nostrils before running in dry/cold conditions

• Modify running environment:

  • Run in more humid environments when possible
  • Use a face mask or scarf in cold weather to warm and humidify inhaled air

• Address underlying issues:

  • Manage hypertension if present
  • Consider evaluation for anatomical issues like septal deviation
  • Review medications with your healthcare provider

Common Pitfalls

• Incorrect head positioning - Tilting head back can lead to blood aspiration or swallowing
• Insufficient compression time - Many people release pressure too soon (less than 10 minutes)
• Checking too frequently - Repeatedly releasing pressure to check if bleeding has stopped disrupts clot formation
• Ignoring recurrent episodes - Repeated nosebleeds while running warrant medical evaluation

Remember that while most exercise-induced epistaxis is benign, recurrent episodes should prompt evaluation to rule out underlying conditions that may require specific treatment.