Blood in Throat Upon Waking: Causes and Solutions

Q: Blood in Throat Upon Waking: Causes and Solutions

Hi Xiao Gu： <br>Chronic pharyngitis can indeed cause symptoms such as dryness in the throat, a sensation of a foreign body, and an increased feeling of mucus. <br>However, it is generally uncommon to have blood in the sputum. <br>If the symptoms persist, it is advisable to visit

Coughing up blood upon waking up?

1.
About a month ago, one night while I was sleeping, I felt something foreign in my throat.
After I coughed it out, I saw it was a yellowish-green chunk that smelled very bad.
Following that, I noticed blood in my saliva, but it stopped after I rinsed my mouth.
The next day, I went to an ENT clinic, and the doctor said there was nothing wrong, possibly a microvascular rupture or gum bleeding.

2.
I can't remember how many days later, I noticed blood streaks again.
This time, I was so anxious that my stomach felt uncomfortable, and I experienced heartburn.
So, I underwent an upper gastrointestinal endoscopy, and the doctor diagnosed me with mild gastroesophageal reflux disease (GERD) and prescribed medication.
However, the throat clearing with blood still occasionally occurs.
3.
I sought a second opinion at another ENT clinic, where the doctor advised me not to worry too much, stating that my trachea was slightly inflamed (as assessed with a stethoscope).
He prescribed anti-inflammatory medication, and my condition improved while on the medication, but the previous symptoms returned when I stopped taking it.
Interestingly, despite the tracheal inflammation, I do not have any coughing symptoms.
4.
Since the symptoms did not completely resolve, I visited a nearby clinic today for a chest X-ray.
The doctor reviewed the results and said there was nothing abnormal, just slight bronchial inflammation, and that my throat lymph nodes were a bit swollen, suggesting a mild cold.
I have been smoking for about 10 years and am currently trying to quit; I haven't smoked for a month due to the bleeding, which caused my concern.
5.
Currently, the situation remains the same; I only notice blood when I clear my throat upon waking up, but not at other times.
Now, due to my worry about the bleeding, I find myself clearing my throat and coughing up phlegm almost all day, which is making me a bit anxious.
I researched online and found a condition called chronic pharyngitis, which resembles my symptoms, including a dry throat and a sensation of a foreign body.
6.
I also noticed that sometimes I feel a gas in my throat that I want to burp out, and when I force it, it comes out as saliva that is sticky and foul-smelling.
I wonder if this could be related to acid reflux.
7.
I would appreciate the doctor's help in clarifying these issues and providing some advice.

Xiao Gu, 20~29 year old female. Ask Date: 2015/02/23

Dr. Zheng Jueyi reply Otolaryngology

Hi Xiao Gu:
Chronic pharyngitis can indeed cause symptoms such as dryness in the throat, a sensation of a foreign body, and an increased feeling of mucus.
However, it is generally uncommon to have blood in the sputum.
If the symptoms persist, it is advisable to visit an otolaryngology department for a nasopharyngoscopy to check for any issues in the nasopharynx and oropharynx.
Additionally, a gastroenterology consultation for an upper gastrointestinal endoscopy may be necessary to rule out any gastrointestinal problems, and a pulmonology evaluation to check for any lung or tracheal issues.
If all of the above are normal, a dental examination should be conducted to determine if periodontal disease is causing the gums to bleed.

Wishing you safety and health,
Director Zheng Jue-Yi
Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2015/02/23

More Info

Understanding the presence of blood in the throat upon waking can be concerning, and it is essential to consider various potential causes and solutions. Based on your description, several factors could contribute to this symptom, and I will outline them along with possible management strategies.

Potential Causes
1. Microvascular Rupture: As your initial ENT doctor suggested, the presence of blood could be due to the rupture of small blood vessels in the throat or gums. This can happen due to various reasons, including dry air, vigorous coughing, or even minor trauma during sleep.

2. Gingival Bleeding: If you have gum disease or inflammation, it could lead to bleeding, especially if you are experiencing any oral health issues. This could explain the yellow-green discharge you mentioned, which may be related to an infection or inflammation in the gums.

3. Gastroesophageal Reflux Disease (GERD): Your mention of experiencing heartburn and the diagnosis of mild gastroesophageal reflux could be significant. Acid reflux can irritate the throat lining, leading to inflammation and potential bleeding. The sensation of having something stuck in your throat could also be related to this condition.

4. Chronic Pharyngitis: Chronic inflammation of the throat can occur due to various irritants, including smoking, which you have mentioned you are trying to quit. This condition can lead to symptoms like dryness, a sensation of a lump in the throat, and occasional bleeding.

5. Infection: The presence of inflammation in the bronchial tubes and swollen lymph nodes in your throat could indicate an infection, which might not always present with typical symptoms like coughing.
6. Psychological Factors: Anxiety about your symptoms can exacerbate your condition, leading to increased throat clearing and tension, which may contribute to the sensation of needing to clear your throat and the perception of blood.

Management Strategies
1. Hydration: Ensure you are drinking plenty of fluids to keep your throat moist. This can help alleviate dryness and irritation.

2. Humidification: Using a humidifier in your bedroom can help maintain moisture in the air, especially during dry seasons, which may reduce throat irritation.

3. Oral Hygiene: Maintain good oral hygiene to prevent gum disease. Regular brushing and flossing, along with dental check-ups, can help manage any gingival issues.

4. Dietary Adjustments: Since you have been diagnosed with mild GERD, consider dietary changes to avoid foods that trigger your symptoms. This includes spicy foods, caffeine, and acidic foods.

5. Medications: Continue with the medications prescribed for GERD and any anti-inflammatory medications as directed by your healthcare provider. If symptoms persist, a follow-up with your doctor may be necessary to adjust your treatment plan.

6. Avoid Irritants: Since you are a former smoker, it is crucial to avoid exposure to smoke and other irritants, as they can exacerbate throat inflammation.

7. Stress Management: Engage in relaxation techniques such as deep breathing, meditation, or yoga to help manage anxiety related to your symptoms.

8. Follow-Up Care: Since your symptoms have not fully resolved, consider scheduling a follow-up appointment with an ENT specialist or a gastroenterologist for further evaluation. They may recommend additional tests, such as a laryngoscopy or esophageal pH monitoring, to assess the underlying causes of your symptoms.

Conclusion
While the presence of blood in the throat can be alarming, understanding the potential causes and implementing appropriate management strategies can help alleviate your concerns. It is essential to maintain open communication with your healthcare providers and seek further evaluation if symptoms persist or worsen. Your proactive approach to your health, including quitting smoking, is commendable and will contribute positively to your overall well-being.

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