Your tonsils are the two round pads of tissue at the back of your throat. They’re part of your immune system. When germs enter your mouth or nose, your tonsils sound the alarm and call the immune system into action. They also help trap viruses and bacteria before they can lead to infection.

Many things can make your tonsils inflamed. Sometimes, this results in redness or broken blood vessels that might look like bleeding. There are many conditions that can cause the tonsils to become inflamed.

It’s also possible for your tonsils to bleed, but this is rare. Your tonsils can also have prominent blood vessels on their surface that can look like an area of bleeding. In this case, though, you wouldn’t see blood in your saliva.

Read on to learn more about the causes of red or bleeding tonsils.

Any kind of infection in your throat can make your tonsils red and irritated. Tonsillitis refers to inflammation of your tonsils, usually due to an infection. Viruses often cause tonsillitis.

However, sometimes a more serious bacterial infection can result in inflammation. Strep throat is the most common bacterial infection of the throat.

Common symptoms of tonsillitis include:

  • sore throat
  • swollen, red tonsils
  • white spots on tonsils
  • trouble swallowing
  • fatigue
  • fever
  • scratchy voice
  • bad breath

Tonsillitis caused by a viral infection will resolve on its own. Bacterial infections require antibiotics. If you have symptoms of tonsillitis, it’s best to make an appointment with your doctor. A throat swab culture or antigen test is the only way to know if the infection is from the bacteria that causes strep throat.

In very rare cases, tonsillitis can cause your tonsils to bleed. This is more likely with certain viruses that cause ulcers or sores on the tonsils.

Your tonsils are next to many major blood vessels, so severe bleeding can quickly become life-threatening. If you notice blood on your tonsils, make an appointment with your doctor. If your tonsils are bleeding heavily or if they’ve been bleeding for more than an hour, seek emergency treatment.

Tonsil stones, also called tonsilloliths, are small balls of debris that form in the pockets if your tonsils. These small collections of mucus, dead cells, and other materials can harden as they grow. Bacteria feed on them, leading to bad breath.

Tonsil stones are usually small, but can grow big enough that you feel like something is lodged in your throat. If you try to dislodge a tonsil stone, usually with a cotton swab, you might notice a little blood after the stone comes out.

Symptoms of tonsil stones include:

  • white or yellow spots or patches on your tonsils
  • feeling like something is stuck in your throat
  • coughing
  • sore throat
  • difficulty swallowing
  • bad breath

Tonsil stones typically fall out on their own. You can speed up the process by gargling with salt water. In severe cases, your doctor might need to surgically remove the stones or your tonsils.

A tonsillectomy removes your tonsils. It’s a very common surgical procedure. According to a 2016 study, you have a 0.2 to 2 percent chance of serious bleeding within 24 hours of the procedure. After that, you have a 0.1 to 3 percent chance of bleeding.

If you notice any bleeding after a tonsillectomy — especially any that lasts for more than an hour — seek emergency medical treatment.

Keep in mind that you may notice a little bit of blood once the scabs from the procedure start to fall off. This is normal and not cause for concern. Learn more about tonsillectomy scabs.

Some people have bleeding disorders that cause them to bleed easily. The most well-known blood disorder, hemophilia, happens when the body doesn’t produce a certain clotting factor protein.

Other things that can make you bleed easily include:

Medications used to prevent blood clots, including heparin, warfarin, and other anticoagulants, can also result in easy or excessive bleeding.

General symptoms of bleeding disorders include:

  • unexplained nosebleeds
  • excessive or long-lasting menstrual flow
  • prolonged bleeding after small cuts or wounds
  • excessive bruising or other skin marks

Minor cuts in the mouth and throat are common, especially if you’re eating something with sharp edges. While these injuries usually don’t cause bleeding, they can in people with bleeding disorders. Throat infections that damage blood vessels are also more likely to cause bleeding in people with bleeding disorders.

Seek emergency treatment for any excessive bleeding in your tonsils or bleeding that lasts for more than an hour.

Tonsil cancer can sometimes cause open sores and bleeding. This type of cancer is most common in people over the age of 50. It also affects men three to four times more than women, estimates Cedars-Sinai. The primary risk factors for tonsil cancer include the use of alcohol and tobacco.

Symptoms of tonsil cancer include:

  • a sore on the tonsils that won’t heal
  • a tonsil that’s growing larger on one side
  • bleeding or blood in your saliva
  • mouth pain
  • constant sore throat
  • ear pain
  • difficulty swallowing, chewing, or speaking
  • pain when eating citrus
  • pain when swallowing
  • lump or pain in your neck
  • bad breath

Treatment for tonsil cancer depends on its stage and whether it’s spread to any other areas. Early stage tonsil cancer can be treated with radiation. More advanced stages may require a combination of therapies, including chemotherapy or surgery to remove a tumor.

Bleeding tonsils are fairly uncommon. However, when your tonsils are irritated, like due to an infection, they may look red and bloody.

If you have a bleeding disorder or recently had your tonsils removed, you might also notice some bleeding. While it isn’t always a symptom to worry about, it’s best to make an appointment to rule out any underlying conditions.

If you notice heavy bleeding or bleeding that lasts for more than an hour, head to the emergency room.