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What is a Vocal Fold Haemorrhage (vocal bleed)

Vocal Fold Haemorrhage is not only uncomfortable but can have a serious affect on your ability to sing, here I discuss its causes and how to avoid them.



Vocal Fold Haemorrhage or vocal bleed is a ruptured blood vessel bleeding into the vocal fold. When vocal-fold haemorrhage (bruise, burst blood vessel) occurs the performer or speaker experiences a loss of voice immediately, which may be painless or could be a discomfort on just one side of the throat.  The haemorrhage is usually just on one fold (there are two).


Complete voice rest is necessary as continued singing could increase the risk of laryngeal polyps developing.


Vocal folds have living tissue and require a constant blood supply.  The capillaries which supply the vocal fold surface are under considerable stress because the vocal folds vibrate at high frequency and intensity. Even more so at a higher pitch.


The surface of the vocal folds are prone to drying, which is why hydration is important.


When a blood vessel ruptures, blood will flow out and spread under the surface of the epithelium  (the outer, top layer of the vocal fold) and the vocal fold becomes stiffer, heavier, red and swollen.


There will be a sudden onset of hoarseness, which may be slight or intense, but although sudden, will usually be pain free.  Because haemorrhaging can be mild or intense, it is probable that people receive many more haemorrhages than diagnosed but as hoarseness will usually occur instantly, vocal rest for several days is necessary.


What causes vocal fold haemorrhaging?


Aspirin and other anti-inflammatory analgesics, ibuprofen, Advil etc  are anti-inflammatory medications. Aspirin is found in a number of over-the-counter products for coughs cold, headaches etc. They thin the blood and with an upper respiratory infection (ie a cold) the blood vessels of the vocal folds can become swollen and more prone to rupturing with heavy vocal use.  Some ‘Voice’ manuals recommend Paracetamol but check with your GP or pharmacist for more informed advice.


Childbirth– during the third trimester of pregnancy be more conservative with practising and performing when acting, teaching and singing. Vocal folds have already swollen with oestrogen, the rise in progesterone increases the blood volume and your body retains more salt and water. The decrease in the diaphragmatic motion due to the growing foetus, increases the effort needed for singing and there is a tendency to push more air through the vocal folds and normal abdominal muscle is hindered. The likelihood of acid reflux during pregnancy as well as effortful vocalising could turn into vocal inflammation making the vocal folds vulnerable to haemorrhage especially when vocally exerting during labour and childbirth.


Menstruation. Haemorrhage is more likely to occur during the menstrual cycle because there is more fluid in the vocal folds making them heavier to vibrate. The difficulty in moving the voice will incline the performer to push their voices.  During menstruation the increased size of the blood vessels make the vocal folds very fragile and are therefore vulnerable. Don’t use Aspirin products!


Not warming up the voice before intense use causes muscle inflammation, which can lead to vocal fold haemorrhage.


Singing with a sore throat – People tend to take desensitising (painkilling) remedies so that they can vocalise easier. However, the inflamed vocal folds have enlarged blood vessels. Blood is heavier than other bodily fluids and will make vocalising more difficult, making the vocal folds prone to haemorrhaging.


Vocal abuse and misuse – comes in many guises clearing the throat, coughing, vomiting, intense singing, weight lifting, loudly vocalising a sneeze, yelling, shouting. Vocal fold haemorrhage occurs after straining when there is an acute rise in blood pressure in the head.

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