Black Stool

Overview

Black, tarry, foul-smelling stools — medically called melaena — usually mean there is bleeding from the upper part of the digestive tract, such as the stomach or the first part of the intestine. Blood that is digested as it passes through the gut turns black and tarry. This is a symptom that needs prompt medical evaluation, not self-management. (Note: some medicines, such as iron, and some foods can also darken the stool — but any new, unexplained black stool should be assessed as possible bleeding until proven otherwise.)

Possible causes

• Bleeding from a stomach or duodenal ulcer.
• Gastritis with bleeding.
• Bleeding from the oesophagus or stomach, sometimes related to liver disease.
• A tear in the lining of the oesophagus or stomach from severe vomiting.
• Certain medicines that irritate the stomach lining.

Non-bleeding causes to consider

• Iron supplements, which commonly darken the stool.
• Bismuth medicines (such as some stomach remedies).
• Certain foods, such as liquorice or blueberries, in large amounts.
• Even so, new black stool should be assessed to exclude bleeding.

Evaluation and investigations

Evaluation treats black stool as possible upper-gut bleeding until proven otherwise. Blood tests check for anaemia, and an upper gastrointestinal endoscopy is usually arranged to find and, where possible, treat the source of bleeding. Stool and other tests may be added. Prompt assessment is important because significant bleeding can cause anaemia or become dangerous.

Management

Management depends on the source and severity of bleeding. It may include acid-suppressing medicines, treatment of ulcers or H. pylori, stopping irritating medicines, and, for significant bleeding, hospital care with endoscopic treatment and blood support if needed.

Warning signs — seek urgent care

• Black, tarry stools with dizziness, fainting or weakness — emergency.
• Black stool with vomiting blood or coffee-ground material — emergency.
• Black stool with severe abdominal pain.
• Black stool with paleness, tiredness or breathlessness (anaemia).
• Any new, unexplained black stool — needs prompt assessment.

How we help

Dr. Nayak assesses black stool promptly, arranges endoscopy and blood tests, and directs significant bleeding to hospital care. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• Blood in Stool
• Peptic Ulcer Disease
• Gastritis
• Vomiting
• Liver & Fatty Liver Health
• Anaemia & Blood Problems