Small flecks of blood in the nose or mouth after a tonsillectomy is normal, but any amount of bright red bleeding can be a sign of post-tonsillectomy hemorrhage, which requires immediate treatment.

A tonsillectomy is a surgical procedure to remove the tonsils. People may experience small flecks of blood in the nose or saliva following a tonsillectomy. Bleeding greater than this or bright red in color requires immediate medical attention.

A post-tonsillectomy hemorrhage may occur if the procedure causes damage to blood vessels around the tonsils, resulting in bleeding. As this can be life threatening, people will require immediate treatment.

This article looks at signs of post-tonsillectomy hemorrhage, causes, treatment, and when to seek medical help for bleeding after a tonsillectomy.

A young person standing outside with their mouth open. -2Share on Pinterest
Dave G Kelly/Getty Images

“Hemorrhage” is the term for bleeding from a damaged blood vessel. Signs of hemorrhage after a tonsillectomy may include:

  • bleeding from or around the mouth or tonsil area
  • oozing from the tonsil area
  • blood clots
  • bright red blood

If a child experiences bleeding after a tonsillectomy, they may swallow the blood without realizing or telling a parent or caregiver. This may lead to an upset stomach or bloody vomit.

Caregivers should watch for the above symptoms in case a child does not recognize them or is scared to tell someone.

When bleeding may occur

According to a 2021 study, doctors classify post-tonsillectomy hemorrhage into two types:

  • Primary: When bleeding occurs within 24 hours of surgery.
  • Secondary: When bleeding occurs over 24 hours after surgery.

The study suggests secondary bleeding may occur twice as often as primary bleeding.

A 2018 article suggests that a hemorrhage occurs, on average, 5–7 days after a tonsillectomy.

Very small flecks of blood in the saliva or nose usually occur following a tonsillectomy.

People will develop scabs at the site of the tonsil removal. The scabs may be thick, can be gray or white in color, and can cause bad breath. They usually fall off within 5–10 days following a tonsillectomy.

Bright red bleeding is abnormal, and minor bleeding may lead to severe bleeding. If someone experiences bright red bleeding after a tonsillectomy, they should contact a doctor or go to the emergency room.

There are many blood vessels around the tonsils, with the lingual, maxillary, and facial arteries all supplying blood to that area. Damage to the smaller blood vessels during a tonsillectomy may result in post-tonsillectomy hemorrhage.

The risk of bleeding following a tonsillectomy may differ depending on the type of tonsillectomy. Doctors define the types as follows:

  • Traditional or total tonsillectomy: Complete removal of both tonsils.
  • Intracapsular tonsillectomy: Removing affected tonsil tissue and leaving a layer to protect muscles in the throat.

An intracapsular tonsillectomy has lower rates of postoperative bleeding compared to the traditional or total type.

Bleeding may be more common at night, particularly from 10 p.m.–1 a.m. and 6–9 a.m. This may be due to the effects of mouth breathing, snoring, or changes in circadian rhythm.

A 2020 study suggests that males and people who smoke have a higher risk of post-tonsillectomy hemorrhage.

Sex and gender exist on spectrums. This article uses the term “male” to refer to a person’s sex assigned at birth.

If people experience any bright red bleeding around the tonsils after a tonsillectomy, they should contact a doctor straight away or go to the emergency room. Even if the bleeding is minor or stops, it is still important to seek medical attention.

According to 2019 guidelines, a pediatric doctor should arrange a follow-up after carrying out a tonsillectomy to note any bleeding within or after 24 hours postsurgery. This may be over the phone rather than in person.

However, if someone is taking care of a child who has had a tonsillectomy, they may need to check for bleeding since a child may be unaware that they are swallowing blood.

If a caregiver notices signs of bleeding in a child who has had a tonsillectomy, they should not wait for the doctor to initiate a follow-up. Instead, they should contact the doctor immediately.

When is bleeding after a tonsillectomy an emergency?

Post‐tonsillectomy hemorrhage is a medical emergency, and people should seek medical help immediately.

According to a 2018 article, minor bleeding after a tonsillectomy may develop into severe bleeding. Bleeding that stops or clots still has a risk of leading to severe bleeding.

It is important to go to the emergency department for minor bleeding or bleeding that has stopped after a tonsillectomy. Healthcare professionals treat any active bleeding following a tonsillectomy as a surgical emergency.

According to a 2021 article, treatment for post-tonsillectomy bleeding may include the following:

  • Electrocautery: Electrocautery uses a fine needle or instrument to apply an electric current to the affected area to control bleeding.
  • Topical hemostatic agents: Hemostatic agents are substances a doctor will apply topically to the tonsils to stop blood flow.
  • Sutures: Sutures, or stitches, use a fine, sterile surgical thread to close a wound. People may have sutures of the tonsillar pillars, the tissue in front of the tonsils, to stop bleeding.
  • Embolization: Endovascular embolization uses a small coil to close up a blood vessel in order to stop any bleeding.

A doctor may observe bleeding without intervention to determine whether treatment is necessary. They may also apply direct pressure to the site of the bleeding to stop blood flow, though this is not a definitive treatment by itself.

People may experience small flecks of blood in the nose or saliva after a tonsillectomy, but any bleeding greater than this requires medical attention.

If people experience any amount of bright red bleeding from the tonsils after a tonsillectomy, they should contact a doctor or go to the emergency room straight away.

Treatment for post-tonsillectomy hemorrhage may include electrocautery, direct pressure or topical agents to the tonsil area, or sutures to stop blood flow and prevent bleeding complications.