Throwing up blood after drinking alcohol isn’t necessarily a medical emergency, but it warrants checking in with a healthcare professional to determine the underlying cause.

Throwing up blood after drinking isn’t normal — but it isn’t always a medical emergency, either.

There are several things that can cause you to vomit blood, also known as hematemesis. The amount of blood and its color can give you clues as to what might be happening and how worried you should be.

For example, a few streaks of bright red blood could be caused by something as simple as a nosebleed that’s run back into your throat and down into your stomach.

Black flecks that look like coffee grounds are usually dried blood that’s been in the stomach a while.

A lot of blood, regardless of color, could indicate bleeding in your gastrointestinal (GI) tract, which is serious.

A little bit of blood doesn’t necessarily require a ride in an ambulance or hightailing it to the nearest ER, but it does warrant a visit to your primary doctor or a local clinic just to be sure there isn’t an underlying issue that’s causing the bleeding.

Losing even small amounts of blood overtime can lead to anemia, which is a low red blood cell count (RBC). Anemia can make you feel tired and weak and lead to complications if left untreated.

Emergency symptoms

Call your local emergency number or head to the nearest ER right away if you vomit a lot of blood or experience:

Knocking back a few drinks shouldn’t cause you to throw up blood, but there are certain circumstances that can make it happen.

Throat irritation

Retching — aka dry heaving — and vomiting after drinking too much can irritate the tissues in your throat. This can cause tiny tears that bleed, resulting in streaks of blood in your vomit. Forceful coughing can also do it.

Your throat may also feel raw and scratchy or look a bit red.

Gastritis

Gastritis is inflammation of the stomach lining. Drinking too much alcohol is a common cause, as it can irritate and erode your stomach lining.

Along with throwing up blood, gastritis can also cause:

  • gnawing or burning upper abdominal pain
  • nausea
  • bloating
  • feeling unusual fullness after eating

In addition to drinking alcohol, other factors can increase your risk of gastritis, including:

Ulcers

The same things that can cause gastritis, including regular alcohol consumption, can also cause peptic ulcers. These are painful sores in the lining of the stomach, esophagus, or small intestine (duodenum).

A 2016 study linked drinking one or more drinks of liquor a day to an increased risk of upper GI bleeding and peptic ulcer. Even if the ulcer isn’t caused by alcohol, drinking alcohol can worsen your symptoms.

Ulcers can bleed or perforate the gut, which requires urgent care.

Other symptoms of an ulcer include:

  • gnawing or burning pain in the middle or upper part of your stomach
  • pain that’s worse when your stomach is empty
  • heartburn
  • bloating
  • nausea

Esophageal varices

Esophageal varices are enlarged blood vessels in the esophagus. They develop when scar tissue or a blood clot in the liver interrupts blood flow and causes the veins in your lower esophagus to swell.

Alcohol-related liver disease is a common cause of esophageal varices. Heavy drinking and excessive vomiting can cause them to bleed or rupture, which is a medical emergency.

Esophageal varices don’t usually cause symptoms unless they bleed. Symptoms of bleeding esophageal varices include:

Alcohol-related liver disease

Long-term alcohol misuse can damage the liver and cause what’s known as alcohol-related liver disease, which includes three types of liver disease:

Women are more likely to experience liver damage from drinking, but it can happen to anyone who drinks excessively for years.

Signs and symptoms of alcohol-related liver disease include:

If you throw up blood after drinking, it’s probably best to follow up with your healthcare provider to rule out any underlying health issues.

In the meantime, there are a few things you can do to reduce your risk of it happening again. Not drinking or at least drinking in moderation is a good start.

Moderate drinking is defined as up to 1 drink per day for females and 2 drinks per day for males.

Drinking 4 drinks in the same instance if you’re female or 5 if you’re male is considered binge drinking. Bingeing on booze makes it harder for your body to keep up, increasing your chances of stomach irritation and vomiting.

Here are a few other things you can do to try to avoid another episode of bloody vomit:

  • Eat before you drink to protect your stomach from irritation and slow how quickly alcohol enters your bloodstream.
  • Avoid mixing alcohol with other medications and drugs.
  • Pace yourself by spreading out your drinks and sipping instead of chugging.
  • Stay hydrated and alternate between water and alcoholic beverages.
  • Stick to bland foods to avoid further irritation if you find that alcohol bothers your stomach.

Throwing up blood after drinking can sometimes be a signal that you might be misusing alcohol.

If you’re worried about your symptoms or your alcohol use, your healthcare provider can offer guidance.

You can also use the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Treatment Navigator to find treatment in your area.

If those steps feel a bit overwhelming at the moment, you can also reach out to the Substance Abuse and Mental Health Services Administration’s helpline at 1-800-662-HELP (4357) for support.

Throwing up blood after drinking is more likely to happen if you drink too much or have an underlying medical condition.

While it may not always be a medical emergency, even if it only happens once and isn’t very much blood, it’s best to follow up with your healthcare provider.

Adrienne Santos-Longhurst is a freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow, or splashing about the lake trying to master the stand-up paddleboard.