How Can the Blood Appear in the Mouth?
Blood, appearing in the mouth, can originate from the mouth, throat, nose, paranasal sinuses, voice box (larynx), windpipe (trachea), bronchi, lungs, gullet (esophagus) or stomach.
A person coughing up blood without knowing the exact cause should seek medical care promptly. Blood in the mouth may appear from banal reasons, like picking the nose or from life threatening diseases, like lung cancer.
Meaning of some terms used in the article:
- Phlegm, medically sputum, refers to mucus coughed up from the lower airways: voice box, windpipe, bronchi or lungs.
- Post nasal drip, medically catarrh, is mucus leaking from the nose or paranasal sinuses backwards into the throat.
- Hemoptysis (Greek haima = blood; ptysis = spitting) refers to spitting up blood that originated in the lungs or bronchi.
- Hematemesis (greek haima = blood; emesis = vomiting) refers to vomiting blood originated in the gullet (esophagus) or stomach.
Finding the Cause of Coughing Up Blood from Symptoms
A person, spitting up blood, may suspect its origin from accompanying symptoms:
- In a smoker, coughing up thick phlegm with blood, chronic bronchitis and lung cancer should be considered.
- A person with chronicly blocked nose and spitting up blood can have polyps orcancer in the nose or paranasal sinuses.
- Low grade fever, night sweats, malaise and coughing up blood , lasting several weeks to months can be symptoms of tuberculosis. Symptoms lasting few days to weeks may be from acute bronchitis.
- High fever, rapid breathing and heartbeat, chest pain and frothy bloody mucus can be from bacterial pneumonia.
- A person with deep vein thrombosis, experiencing sudden chest pain, low-grade fever and difficulty breathing can have pulmonary embolism.
Not Every Red Spittle Contains Blood!
Apart from the blood, the following may stain spit red:
- Red colored foods, like beetroot, candies, artificialy colored drinks, wine, etc.
- Saliva of patients with asthma can appear pink, if it contains large amount of eosinophils (a type of blood cells).
Bleeding from the Mouth and Throat
Bleeding from the mouth may be due to:
- Injuries: teeth brushing, biting the tongue, tooth extraction, rough food, foreign objects, etc.
- Dry mouth
- Mouth sores
- Periodontosis, an infection of gums with detached gums and loose teeth; the main cause is poor mouth hygiene.
- Oral cancer, appearing anywhere in the mouth as a small red or white spot that can bleed; heavy drinkers and smokers are at most risk.
- Infections: Herpes simplex virus, shingles, measles, oral thrush (candida yeast infection)
- Ingestion of corrosive fluids, like acids or petrol, may cause severe damage and bleeding from the mouth, throat, esophagus and stomach mucosa.
- Lead, arsenic or mercury poisoning may cause bleeding gums.
Disorders that can cause bleeding in the mouth, nose, throat or heavy menstrual bleeding at the same time:
- Viral hemorrhagic fevers
- Vitamin C deficiency (scurvy) - in chronic alcoholism or other cause of inadequate vitamin C intake; symptoms include skin bruises and bleeding gums.
- Malnutrition - due to starving, alcoholism or malabsorption - can lead to weight loss, fatigue and skin, nose or mouth bleeding.
- Low blood platelets (trombocitopenia) - due to blood diseases, like leukemia, chemotherapy or radiotherapy.
- Impaired blood coagulation - due to hemophilia or blood thinning medications; the main symptom is easy bleeding after small injuries.
Bleeding from the Nose and Sinuses
The blood alone or blood mixed with mucus arising from the nose or sinuses may leak into the throat as a postnasal drip and therefore appear in the mouth. Causes of nasal bleeding include:
- Nose picking or nose injury
- Head injury
- Cold, dry air
- Infections of the nose or sinuses (sinusitis)
- Inhaling irritant gases or drugs like cocaine
- Nasal polyps
- Cancer in the nasal cavity or sinuses
- Inborn errors of nasal cavity
- Rheumatic fever
- SLE (systemic lupus erythematosus)
- Barotrauma – pressure related injuries during diving or explosions
- Other causes of nasal bleeding
Bleeding from the Trachea and Bronchi
Causes of bleeding from windpipe (trachea) or bronchi:
- Acute bronchitis - an infection (usually viral) of the bronchi, sometimes following common cold or influenza. Coughing up yellow mucus with occasional red streaks, moderate chest pain and low grade fever are typical symptoms.
- Inhaled foreign object may trigger dry cough and spitting up small amount of blood. Often a bronchoscopy is needed to remove the object.
- Chronic bronchitis – coughing up yellow, green, brown or blood streaked mucus for at least 3 months, 2 years in a row, are the main symptoms. Causes include long-term smoking and irritant environmental or occupational gases.
- Brochiectasis (Greek ectasis = dilation, widening) is a permanent widening of breathing tubes (bronchi) due to destruction of bronchial walls from repeating chronic infections. Chronic cough with yellow, green or bloody mucus and recurrent pneumonia are characteristic.
- Bronchial (lung) cancer - newly appearing cough that does not go away, a change in a cough, coughing up blood, hoarseness and pressure or pain in the chestcan appear at early or late stage of cancer. Bronchial cancer may press upon the vein that drains blood from the neck and head, thus causing facial and neck swelling (superior vena cava syndrome). Poor appetite and weight loss are late symptoms. Diagnosis is with a chest X-ray and bronchoscopy.
Bleeding from the Lungs
Causes of bleeding from lungs:
- Violent cough can cause a rupture of the lung arteries.
- Bacterial pneumonia – symptoms include: suddenly appearing high fever, rapid breathing and heartbeat, coughing up green or rusty sputum. Non-treated pneumonia can be deadly.
- Tuberculosis – symptoms include: low grade fever, night sweets, feeling unwell, slowly developing dry cough that may later contain yellow/green or blood streaked phlegm.
- Pulmonary edema is a life threatening condition refering to fluid collection in the lungs due to heart failure, living on high altitudes (climbers), certain medicines, irritant gases, inhaling vomit content, etc. Extreme shortness of breath, paleness, anxiety and spitting up pink frothy mucus are main symptoms.
- Pulmonary embolism refers to blockage of a pulmonary artery by a blood clot, often dislodged from the leg or arm veins in deep vein thrombosis. Sudden chest pain resembling heart attack, shortness of breath and coughing up frothy red streaked sputum are main symptoms.
- Trauma to the chest: pressure of a steering wheel in car accidents, falling from height, knife, shooting or blast (explosion) injuries can all cause lung bleeding.
- Sarcoidosis is a chronic inflammation of uncertain origin, affecting several organs, mainly the lungs; chronic fatigue, night sweets, skin rashes, and, rarely, coughing up bloody mucus are possible symptoms. X-ray of lungs shows enlarged “hilar nodes” – lymph nodes at the point where main bronchi enter the lungs.
Vomiting Blood (Hematemesis)
Blood in the vomit may arise from the:
- Esophagus: esophageal varices in alcoholic cirrhosis or chronic hepatitis; tear in the lower part of esophagus during violent vomiting (Mallory-Weiss syndrome); esophageal ulcers due to severe gastric acid reflux; esophageal cancer
- Stomach: gastritis, gastric ulcer or cancer, injury
- Wind pipe (trachea) – when blood is swallowed. Detailed list of causes of vomiting blood.