Vomiting, Coughing and Spitting Blood – Causes of Mouth Bleeding

The sight of blood coming from the mouth can be quite distressing. Depending on the nature and site of the bleed, the blood may be passed out on its own or within sputum/phlegm or vomit. If blood is pooling in the mouth, then this requires immediate medical attention as it indicates a rupture of an artery.

Vomiting Up Blood

The medical term for vomiting up blood is haematemesis (US ~ hematemesis). It may vary from bright red and fresh blood in the vomit to pink streaks or dark brown to black clumps resembling coffee grounds.

The colour and consistency of the blood in the vomit may indicate the site of the bleeding. Bleeding within the mouth, throat (pharynx) or oesophagus (food pipe) will usually appear bright red and fresh. Darker coloured blood, brown or even black blood in the vomit indicates a bleed within the stomach or small intestine.

Blood from the throat and esophagus may be passed out without vomiting. It may appear in the saliva or drain into the larynx and be coughed out with mucus. However, bleeding from the stomach and small intestine can only be passed out with vomit.

Coughing Up Blood

The medical term for coughing up blood is haemoptysis (US ~ hemoptysis). The blood is usually mixed with phlegm from the lower respiratory tract or sputum from the upper respiratory tract.

It indicates a bleed within the respiratory tract and this includes the larynx (voice box), trachea (wind pipe), bronchi or lungs. Bleeding from within the mouth (oral cavity) or even the nasal cavity may also drain down the throat and be coughed up. An infection is the most common cause but with the rising incidence of lung and throat cancer, a persistent bleed needs to be investigated.

Spitting Up Blood

Passing out blood in the saliva may indicate a bleed from within the mouth or lower down the respiratory or gastrointestinal tract. In most cases it is due to an injury or infection within the mouth, including the teeth or gums. The saliva may be streaked with blood or be totally bloody. The latter, especially if it is pooling in the mouth, is a serious sign possibly indicating a rupture of an artery.

The possibility of oral cavity cancer needs to be considered in the event of a persistent/recurrent bleed, especially if the person smokes cigarettes, or chews tobacco or areca nut-betel leaf.

Causes of Bleeding from the Mouth

Passing out blood from the mouth, whether in the saliva, vomit or sputum/phlegm, should always be investigated. It can be a sign of serious and even life threatening diseases. Some of the causes include :

Mouth

• Bleeding gums – gingivitis, periodontitis
• Tooth cavity
• Bleeding mouth sores (aphthous ulcers)
• Infectious stomatitis – oral candidiasis (thrush), herpes simplex virus
• Trauma to the mouth – vigorous brushing, after dental work or other mouth, nose, throat surgery, or chemicals like heavy metals, strong acids or alkalines.
• Oral cavity cancer

Throat

• Infections – pharyngitis, tonsillitis which are usually viral or bacterial.
• Ingesting chemicals – heavy metals, strong acids, alkalines.
• Abscess (peritonsillar, parapharyngeal, retropharyngeal)
• Allergies
• Cancer of the throat – pharynx, larynx

Esophagus

• Fresh, red blood
• Esophagitis due to mechanical or chemical trauma, infections or autoimmune
• Varices
• Perforation (tear) or laceration including a Mallory-Weiss tear
• Barrett’s esophagus
• Esophageal cancer
• Dark, brown to black blood
• Bleeding stomach ulcer or duodenal ulcer (peptic ulcers)
• Gastritis – chemical, infectious, autoimmune
• Stomach cancer
• Duodenitis
• Arteriovenous malformation

Larynx, Trachea, Bronchi and Lungs

• Infections – viral, bacterial including tuberculosis (TB) or fungal (more common in HIV/AIDS).
• Injury
• Bronchitis
• Bronchiectasis
• Cancer
• Abscess
• Pulmonary artery rupture
• Pulmonary embolism
• Sarcoidosis

Bleeding within the nasal cavity may be passed out through the nose (epistaxis, nosebleed) but may also drain into the back of the throat (pharynx) and be passed out through the mouth.

References

1. Blood in the Mouth. Health Hype
2. Gastrointestinal Bleeding. Merck