Minor bleeding after a tonsillectomy (tonsil removal) may be nothing to worry about, but in some cases, bleeding could indicate a medical emergency.

If you or your child has recently had a tonsillectomy, it’s important to understand when bleeding means you should call your doctor and when you should head to the ER.

You’re most likely to bleed small amounts right after the surgery or about a week later when the scabs from the surgery fall off. However, bleeding can occur any time during the recovery process.

For this reason, for the first two weeks after surgery, you or your child shouldn’t leave town or go anywhere you can’t reach your doctor quickly.

According to Mayo Clinic, it’s common to see small specks of blood from your nose or in your saliva following tonsillectomy, but bright red blood is a concern. It could indicate a serious complication known as post-tonsillectomy hemorrhage.

Hemorrhage is rare, occurring in about 3.5 percent of surgeries, and is more common in adults than in children.

Primary post-tonsillectomy hemorrhage

Hemorrhage is another word for significant bleeding. If the bleeding happens within 24 hours after a tonsillectomy, it’s called primary post-tonsillectomy hemorrhage.

There are five primary arteries that supply blood to your tonsils. If the tissues surrounding the tonsils don’t compress and form a scab, these arteries may continue to bleed. In rare cases, the bleeding can be fatal.

Signs of primary hemorrhage right after a tonsillectomy include:

  • bleeding from the mouth or nose
  • frequent swallowing
  • vomiting bright red or dark brown blood

Secondary post-tonsillectomy hemorrhage

Between 5 and 10 days after a tonsillectomy, your scabs will begin to fall off. This is an entirely normal process and may cause a small amount of bleeding. Bleeding from scabs is a type of secondary post-tonsillectomy hemorrhage because it occurs more than 24 hours after the surgery.

You should expect to see specks of dried blood in your saliva as the scabs fall off. Bleeding can also happen if scabs fall off too soon. Your scabs are more likely to fall off early if you become dehydrated.

If you are bleeding from your mouth earlier than five days after surgery, contact your doctor right away.

Small amounts of dark blood or dried blood in your saliva or vomit may not be a cause for concern. Continue to drink fluids and rest.

On the other hand, seeing fresh, bright red blood in the days after tonsillectomy is concerning. If you’re bleeding from your mouth or nose and the bleeding doesn’t stop, remain calm. Gently rinse your mouth with cold water and keep your head elevated.

If the bleeding continues, seek immediate medical care.

If your child has bleeding from the throat that is a rapid flow, turn your child onto his or her side to make sure the bleeding doesn’t obstruct breathing and then call 911.

After surgery, contact your doctor if you’re experiencing the following:

  • bright red blood from the nose or mouth
  • vomiting bright red blood
  • fever higher than 102°F
  • inability to eat or drink anything for more than 24 hours

Adults

According to a 2013 study, adults have a higher chance of experiencing bleeding and pain following tonsillectomy than children. The study specifically looked at the thermal welding tonsillectomy procedure.

Call 911 or go to the ER if you’re experiencing:

  • severe vomiting or vomiting blood clots
  • a sudden increase in bleeding
  • bleeding that is continuous
  • trouble breathing

Children

If your child develops a rash or diarrhea, call the doctor. If you see blood clots, more than a few streaks of bright red blood in their vomit or saliva, or your child is vomiting blood, call 911 or go to the ER immediately.

Other reasons to visit the ER for children include:

  • inability to keep liquids down for several hours
  • trouble breathing

Most people recover from a tonsillectomy without problems; however, there are a few complications you should watch for. Most complications require a trip to the doctor or emergency room.

Fever

A low-grade fever up to 101°F is common for the first three days after surgery. A fever that goes above 102°F could be a sign of an infection. Call your doctor or your child’s doctor if the fever gets this high.

Infection

As with most surgeries, tonsillectomy carries a risk of infection. Your doctor may prescribe post-operative antibiotics to help prevent infections.

Pain

Everyone has pain in the throat and ears after a tonsillectomy. Pain may worsen about three or four days after surgery and improve in a few days.

Nausea and vomiting

You might get nauseous and vomit within the first 24 hours after surgery due to anesthesia. You may see a small amount of blood in your vomit. Nausea and vomiting generally go away after the anesthesia’s effects wear off.

Vomiting can cause dehydration. If your child is showing signs of dehydration, call your doctor.

Signs of dehydration in an infant or young child include:

  • dark urine
  • no urine for more than eight hours
  • crying without tears
  • dry, cracked lips

Difficulty breathing

Swelling in your throat can make breathing a little uncomfortable. If breathing is becoming difficult, however, you should call your doctor.

You can expect the following to happen during your recovery:

Days 1–2

You’ll likely be very tired and groggy. Your throat will feel sore and swollen. Rest is imperative during this time.

You can take acetaminophen (Tylenol) to help reduce pain or minor fevers. Don’t take aspirin or any nonsteroidal anti-inflammatory (NSAID) medications like ibuprofen (Motrin, Advil) as this may increase the risk of bleeding.

Be sure to drink plenty of fluids and avoid eating solid foods. Cold foods like popsicles and ice cream can be very comforting. If your doctor prescribed antibiotics, take them as directed.

Days 3–5

Your throat pain may get worse between days three and five. You should continue resting, drink lots of fluids, and eat a soft foods diet. An ice pack placed over your neck (ice collar) can help with pain.

You should continue taking antibiotics as prescribed by your doctor until the prescription is finished.

Days 6–10

As your scabs mature and fall off, you might experience a small amount of bleeding. Tiny red flecks of blood in your saliva is considered normal. Your pain should lessen over time.

Days 10+

You’ll start feeling normal again, though you may have a small amount of throat pain that gradually goes away. You can go back to school or work once you’re eating and drinking normally again.

As with any surgery, recovery time can vary significantly from person to person.

Children

Children might recover faster than adults. Some children can return to school within ten days, but others can take up to 14 days before they’re ready.

Adults

Most adults recover fully within two weeks after a tonsillectomy. However, adults may have a higher risk of experiencing complications compared to children. Adults may also experience more pain during the recovery process, which could lead to a longer recovery time.

After a tonsillectomy, specks of dark blood in your saliva or a few streaks of blood in your vomit is typical. A small amount of bleeding is also likely to happen about a week after surgery as your scabs mature and fall off. This isn’t something to be alarmed about.

You should call a doctor if bleeding is bright red, more severe, doesn’t stop, or if you also have a high fever or significant vomiting. Drinking lots of fluids in the first few days after surgery is the best thing you can do to ease pain and help prevent bleeding complications.