Is bleeding after tonsillectomy normal?

Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Light bleeding after tonsillectomy (tonsillectomy) is probably nothing to worry about, but in some cases, bleeding can be a sign of a medical emergency. If you or your child recently had a tonsillectomy, it's important to understand when bleeding means you should call your doctor and when you should go to the emergency room.

You will most likely have a small amount of bleeding shortly after surgery or about a week later when the scabs from surgery fall off. However, bleeding can occur at any time during recovery.
For this reason, during the first two weeks after surgery, you or your child should not leave your home or go anywhere where you cannot get to a doctor quickly.
According to the Mayo Clinic, you often see small spots of blood from your nose or in your saliva after a tonsillectomy, but bright red blood is something to worry about. It can indicate a serious complication called post tonsillectomy bleeding.
Hemorrhagic symptoms are rare, occurring in only about 3.5% of surgeries and are more common in adults than children.

Hemorrhage is another word for significant bleeding. If bleeding occurs within 24 hours of tonsillectomy, it is called primary post-tonsillectomy.
There are five major arteries that supply blood to the tonsils. If the tissues around the tonsils do not compress and form a scab, these arteries can continue to bleed. In rare cases, bleeding can be fatal.
Initial signs of bleeding immediately after tonsillectomy include:
Bleeding from the mouth or nose Frequent swallowing Vomiting of bright red or dark brown blood

5 to 10 days after tonsillectomy, your scabs will start to fall off. This is a completely normal process and may cause a small amount of bleeding. Ectopic bleeding is a type of bleeding secondary to tonsillectomy because it occurs more than 24 hours after surgery.
You will see spots of dried blood in the saliva as the scabs come off. Bleeding can also occur if the scabs fall off too soon. Scales are more likely to fall off prematurely if you are dehydrated.
If you experience bleeding from your mouth earlier than five days after surgery, contact your doctor immediately.

A small amount of dark blood or dried blood in your saliva or vomit is probably not a cause for concern. Continue to drink fluids and rest.
On the other hand, passing bright, bright red blood in the days after tonsillectomy is worrisome. If you're bleeding from your mouth or nose and the bleeding doesn't stop, stay calm. Gently rinse your mouth with cold water and elevate your head. If bleeding continues, seek immediate medical attention.
If your child has rapid bleeding from the throat, turn your child to lie on their side to make sure the bleeding does not interfere with breathing and then call 911.
When should you call the doctor? After surgery, contact your doctor if you have the following:
Bright red blood from your nose or mouth Vomiting bright red blood Fever higher than 39 degrees Celsius Unable to eat or drink anything for more than 24 hours

Adults According to a 2013 study, adults have a higher risk of bleeding and pain after tonsillectomy than children. The study specifically looked at the process of cutting tonsils by heat sealing.
Call 911 if you are experiencing: Severe vomiting or vomiting of blood clots Sudden increase in bleeding Continuous bleeding Difficulty breathing For children If your child has a rash or diarrhea, call doctor. If you see blood clots, bright red streaks of blood in your child's vomit or saliva, or your child is vomiting blood, call 911, the emergency number of hospitals, or go to the emergency room. right away.
Other reasons for children to go to the ER include:
Inability to hold fluids for several hours Difficulty breathing

Most people recover from tonsillectomy without problems; However, there are some complications you should watch for. Most complications require a visit to a doctor or emergency room.
Fever Mild fever up to 38°C usually occurs in the first three days after surgery. A fever higher than 38°C can 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 antibiotics after surgery to help prevent infection.
Pain Everyone has a sore throat and ears after having their tonsils removed. Pain may get worse about three or four days after surgery and improve within a few days.
Nausea and vomiting You may experience nausea and vomiting within the first 24 hours after surgery due to anesthesia. You may see a small amount of blood in your vomit. Nausea and vomiting usually go away after the effects of the anesthetic wear off.
Vomiting can cause dehydration. If your child shows signs of dehydration, call the 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 of the throat can make it difficult to breathe. However, if breathing becomes difficult, you should call your doctor.

You can expect the following to happen during your recovery:
Days 1-2 You will likely be very tired and wobbly. Your throat will feel sore and swollen. Rest is a must during this time.
You can take acetaminophen, Paracetamol to help relieve pain or reduce fever. Do not take aspirin or any nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) as this can increase the risk of bleeding.
Make sure to drink plenty of water and avoid eating solid foods. Cold foods like popsicles and ice cream can be very comforting. If your doctor prescribes antibiotics, take them as directed.
Days 3-5 Your sore throat may get worse from the third to the fifth day. You should continue to rest, drink plenty of fluids, and eat soft foods. Applying ice to your neck (ice ring) can help relieve pain.
You should continue to take the antibiotic prescribed by your doctor until the prescription is gone.
Days 6–10 When the scabs in your incision are fully formed and fall off, you may experience some bleeding. Tiny red streaks of blood in your saliva are considered normal. Your pain should decrease over time.
Day 10 and on You should start to feel normal again, although you may have a little sore throat that will gradually go away. You can return to school or work once you return to eating and drinking normally.

As with any surgery, recovery time can vary considerably from person to person.
Children Children can recover faster than adults. Some children can return to school within ten days, but others can take up to 14 days before they are ready.
Adults Most adults make a full recovery within two weeks of having their tonsils removed. However, adults may be at higher risk of complications than children. Adults may also experience more pain during recovery, which can lead to a longer recovery time.
After tonsillectomy, typically dark spots of blood in your saliva or a few streaks of blood in your vomit. A small amount of bleeding may also occur about a week after surgery as your scabs mature and fall off. This is not something to worry about.
You should call your doctor if the bleeding is bright red, is more severe, does not stop, or if you have a high fever or are vomiting a lot. Drinking plenty of fluids for the first few days after surgery is the best thing you can do to relieve pain and help prevent bleeding complications.
Currently, the new method of cutting tonsils by the Coblator system, using a plasma knife, applied in recent years has shown high efficiency and safety. The plasma knife is created from high frequency electromagnetic waves, called radio waves, the energy from these radio waves will create a conductive cloud around the cutting device, allowing to cut and destroy tissue at high temperatures. degree is only from 60 to 70 degrees Celsius, much lower than electric or laser knives (200 to 400 degrees Celsius).
Vinmec International General Hospital is currently using the latest Coblator system using a multi-function transducer that can both cut high frequency waves (acting as a plasma knife) and water to cool down and cool down. suck up debris. Besides, radio waves also cause blockage of small blood vessels, which has a good hemostatic effect in surgery.
Thanks to limited damage to surrounding tissues, less pain, and completely reduced bleeding complications after surgery, tonsillectomy is no longer a fear of many people.

References to the article: Ersözlü T, et al. (two thousand and thirteen). Comparison of pediatric and adult tonsillicomies performed by thermal welding system; Hussain S, et al. (2017). Time between first and second posttonsillectomy bleeds; Mayo Clinic Staff. (2018). Tonsillectomy