What causes black tarry stools. How to identify if your stool color is concerning. When should you see a doctor for black stools. What treatments are available for black stools. How to prevent black tarry stools.

Understanding Black Tarry Stools: What They Are and Why They Occur

Black tarry stools, also known as melena, are a type of fecal matter that appears dark black or tar-like in color and often has a distinctly foul odor. This condition can be alarming for many people, as it may indicate an underlying health issue. But what exactly causes stools to become black and tarry?

The primary cause of black tarry stools is the presence of digested blood in the gastrointestinal tract. When blood is exposed to stomach acids and digestive enzymes, it turns black, giving the stool its characteristic appearance. This blood often originates from the upper gastrointestinal tract, which includes the esophagus, stomach, and first part of the small intestine.

Common Causes of Black Tarry Stools

• Peptic ulcers
• Gastritis
• Esophageal varices
• Gastroesophageal reflux disease (GERD)
• Stomach or esophageal cancer
• Certain medications (e.g., iron supplements, bismuth subsalicylate)

Are black tarry stools always a sign of internal bleeding? While black tarry stools often indicate bleeding in the upper GI tract, there are some benign causes as well. Consuming certain foods or medications can sometimes lead to dark or black stools without any associated health concerns.

Distinguishing Between Harmless and Harmful Causes of Black Stools

It’s crucial to differentiate between benign causes of black stools and those that require medical attention. Some harmless reasons for black stools include:

• Eating dark-colored foods like blueberries, black licorice, or blood sausage
• Taking iron supplements or medications containing bismuth (e.g., Pepto-Bismol)
• Consuming large amounts of dark beer or red wine

How can you tell if your black stools are cause for concern? Pay attention to these factors:

1. Odor: Melena typically has a distinctly foul, tar-like smell
2. Consistency: True melena is often sticky and tar-like
3. Duration: If black stools persist for more than a day or two, it’s more likely to be a medical issue
4. Associated symptoms: Watch for other signs like abdominal pain, fatigue, or dizziness

The Role of Upper GI Bleeding in Black Tarry Stools

Upper gastrointestinal bleeding is a primary cause of black tarry stools. But why does bleeding in this area lead to such distinctive-looking feces? The answer lies in the digestive process.

When blood enters the upper GI tract, it mixes with digestive juices and enzymes. As it travels through the intestines, the blood is broken down and chemically altered, resulting in the characteristic black, tar-like appearance of melena.

Common Sources of Upper GI Bleeding

• Peptic ulcers
• Esophageal varices
• Gastritis
• Mallory-Weiss tears
• Esophagitis

Can upper GI bleeding be life-threatening? In some cases, yes. Severe or prolonged bleeding can lead to anemia, shock, or other serious complications. This is why it’s crucial to seek medical attention if you suspect you have melena.

Diagnostic Approaches for Black Tarry Stools

When a patient presents with black tarry stools, healthcare providers employ various diagnostic methods to determine the underlying cause. These may include:

• Physical examination
• Blood tests to check for anemia or other abnormalities
• Stool tests to confirm the presence of blood
• Endoscopy or colonoscopy to visualize the GI tract
• Imaging studies like CT scans or X-rays

How do doctors distinguish between upper and lower GI bleeding? The color and consistency of the stool often provide important clues. Black, tarry stools typically indicate upper GI bleeding, while bright red blood in the stool usually suggests lower GI bleeding.

Treatment Options for Black Tarry Stools

The treatment for black tarry stools depends on the underlying cause. Some common approaches include:

• Medications to reduce stomach acid production (for ulcers or GERD)
• Antibiotics for H. pylori infections
• Endoscopic procedures to stop bleeding
• Blood transfusions in cases of severe blood loss
• Surgery for more serious conditions like tumors or severe bleeding

Is hospitalization always necessary for black tarry stools? Not always. Mild cases may be managed on an outpatient basis, but severe bleeding or unstable patients often require hospital admission for close monitoring and treatment.

Preventing Black Tarry Stools: Lifestyle and Dietary Considerations

While not all causes of black tarry stools are preventable, there are steps you can take to reduce your risk:

• Avoid excessive alcohol consumption
• Quit smoking
• Manage stress effectively
• Eat a balanced diet rich in fruits and vegetables
• Use NSAIDs cautiously and under medical supervision
• Get regular check-ups, especially if you have a history of GI issues

Can dietary changes alone prevent black tarry stools? While a healthy diet can reduce the risk of some GI problems, it’s not a guarantee against all causes of melena. Regular medical check-ups and prompt attention to concerning symptoms are equally important.

When to Seek Medical Attention for Black Tarry Stools

Knowing when to seek medical help for black tarry stools is crucial. Here are some guidelines:

• Persistent black stools lasting more than a day or two
• Accompanying symptoms like dizziness, weakness, or abdominal pain
• Signs of significant blood loss (rapid heart rate, shortness of breath)
• Vomiting blood or coffee ground-like material
• Unexplained weight loss or fatigue

Should you go to the emergency room for black tarry stools? If you’re experiencing severe symptoms or signs of significant blood loss, immediate medical attention is warranted. In less severe cases, contacting your primary care physician for guidance is appropriate.

Long-term Outlook and Complications of Black Tarry Stools

The prognosis for patients with black tarry stools varies depending on the underlying cause and the timeliness of treatment. Potential complications include:

• Anemia due to chronic blood loss
• Shock in cases of severe bleeding
• Malnutrition if the cause affects nutrient absorption
• Increased risk of future bleeding episodes

Can black tarry stools recur after treatment? In some cases, yes. Conditions like peptic ulcers or inflammatory bowel disease may require ongoing management to prevent recurrence. Regular follow-ups with your healthcare provider are essential for monitoring and maintaining your digestive health.

Understanding black tarry stools and their potential causes is crucial for maintaining overall health. While not all instances of dark stools are cause for alarm, persistent or severe cases warrant prompt medical attention. By staying informed and attentive to your body’s signals, you can ensure timely intervention and better health outcomes.

What are bloody or tarry stools?

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► Bloody or Tarry Stools

Also known as: black or tarry stools, bloody stools, melena, hematochezia

What are bloody or tarry stools?

If your bowel movements appear bloody, black or tarry and are foul-smelling, it might be the sign of internal bleeding or another more serious medical condition. On the other hand, certain foods or medications can also lead to stools that appear bloody or tarry.

What might cause bloody or tarry stools?

Bloody and tarry stools can have another of potential causes, including the following:

• Eating beets, foods with red coloring, blueberries, blood sausage or black licorice
• Taking pills that contain iron, activated charcoal or bismuth (this includes Pepto-Bismol)
• Bleeding in the esophagus, stomach or upper part of the small intestine (leads to black or tarry stools).
• Bleeding in the rectum or anus (leads to bloody stools).
• Abnormal blood vessels
• Stomach lining inflammation (gastritis)
• Complications of liver cirrhosis
• Certain cancers
• Swallowed maternal blood
• Polyps
• Clotting disorder
• Infection
• Autoimmune disorder
• Intolerance to milk protein
• Hemorrhoids
• Anal fissure

How can it be treated?

If you suspect that a particular food is causing your stools to appear bloody, black or tarry and no other symptoms are present, then removing the offending food may relieve the symptoms. Still, it’s a good idea to discuss the symptoms with your doctor to rule out anything more serious. In addition, your doctor can recommend a potential change in medication if medication is the possible cause of your symptoms.

When should you seek medical attention?

Contact your doctor if you notice blood or any other unusual changes in the color of your stool or any fever associated with the blood in the stool. Seek immediate medical attention if you also vomit blood, feel dizzy or lightheaded.

Reviewed by: Shifra Koyfman, MD

This page was last updated on: August 26, 2020 03:18 PM

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5 Reasons Your Stool is Black

1. Gastrointestinal & Buttocks

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2. Black Stool

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Black, sticky stool can mean there’s too much iron in your diet. It could also be a sign of internal bleeding.

Medically reviewed by

Shria Kumar, MD.

Therapeutic Endoscopy Fellow, MD Anderson Cancer Center, Houston, TX

Last updated June 8, 2023

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What is black stool?

Causes

Next steps

Treatment

Table of Contents

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Medically reviewed by

Shria Kumar, MD.

Therapeutic Endoscopy Fellow, MD Anderson Cancer Center, Houston, TX

Last updated June 8, 2023

Black stool quiz

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Black stool may be from dark foods and drinks (beets and dark beer), supplements like iron, or a sign of bleeding in the upper GI tract. If stool is black and has a bad odor, it is likely a sign of bleeding, from a peptic ulcer, gastritis, inflammation, colon polyps, or colon cancer. Call your doctor, who may recommend an endoscopy or colonoscopy to locate the problem.

5 most common causes

Stomach Ulcer

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Colonic neoplasm

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Colon Cancer

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Dyspepsia

Constipation

Black stool quiz

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Most common questions

Possible causes of black stool include dark foods and drinks, iron supplements, internal bleeding from conditions such as peptic ulcers, gastritis, colon polyps, or colon cancer, as well as certain medications. It is important to consult a doctor for proper diagnosis and treatment, especially if accompanied by other symptoms such as abdominal pain, diarrhea, nausea, or vomiting.

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If you are having black stool and experiencing symptoms such as vomiting blood, severe pain, uncontrolled bleeding, confusion, difficulty thinking, lightheadedness, fainting, chest pain, or shortness of breath, you should go to the emergency room immediately.

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Treatment options will depend on the underlying cause, which can only be determined by a medical professional. If you notice black stool, it can be a sign of a serious condition such as internal bleeding, or could be something much less severe, such as a medication side effect or diet. It is important to consult a doctor to determine the underlying cause to treat properly.

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Black stool can be caused by several factors. If you have black stool, it is important to discuss with your doctor as it could be a sign of bleeding in the upper GI tract, medication side effects, or other underlying conditions. Your doctor may recommend an endoscopy or colonoscopy to locate the problem. If you are experiencing vomiting blood, severe pain, uncontrolled bleeding, confusion or difficulty thinking, lightheadedness, fainting, chest pain, or shortness of breath, you should go to the ER.

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What is black stool?

Stool can be many shades of brown. But when it veers towards black, it can be a sign of a problem.

Black stool can be caused by blood in your gastrointestinal (digestive) tract. But it could also just mean you ate something red, maroon, or dark, like beets, blueberries, or black licorice. Dark beers and lagers can also make stool look black.

Certain supplements and medications, such as iron and Pepto-Bismol, are another reason for black stool.

When you notice black blood in the stool, it usually is from higher in your intestine (stomach or small bowel). It starts out red, but as it travels through your intestine, the hemoglobin in the blood turns black. Black blood in the stool usually also has a bad odor.

In the first day of life, newborns have black stool made up of amniotic fluid, skin cells, and other things ingested while in the womb. This is normal and changes to a tan color within a few days.

Pro Tip

People think: “Blood is always red!”—it’s not! Our intestines are very long. As blood travels down your intestine, from the upper to the lower portions, it is acted on by digestive enzymes and intestinal bacteria. This turns it black and tarry. —Dr. Shria Kumar

1. Peptic ulcer

Symptoms

• Abdominal pain (usually in the center of your abdomen, usually does not move to your back or shoulder, and is worse when eating)
• Black, tarry stool
• Heartburn
• Weight loss
• Nausea or vomiting (sometimes with blood)
• Avoidance of eating
• Bloating and feeling full
• Difficulty or pain with swallowing

A peptic ulcer, a sore in the lining of the stomach or the first part of your small intestine (the duodenum), which can bleed and cause pain after meals or on an empty stomach. The inflammation can be from an infection from the bacteria H pylori. Or it can be caused by medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

If it’s caused by H pylori, you’ll be prescribed antibiotics to treat the infection. If NSAIDs are the cause, your doctor will consider lowering or changing what you are taking. Reducing stomach acid with a proton pump inhibitor (like Nexium and Prilosec) can help with healing.

2. Gastritis

Symptoms

• Nausea and vomiting
• Bloating
• Stomach pain
• Indigestion (a burning feeling)
• Upset stomach
• Loss of appetite

Gastritis is an inflammation of the lining of the stomach. The stomach has a layer of mucus to protect it from the strong acids that break down foods. If that mucus lining has tears or is not healthy, the stomach can become inflamed.

Damage to your stomach lining can happen for a variety of reasons, including stress, an autoimmune response, or an infection. Other causes include NSAIDs, smoking, or drinking alcohol or eating foods that irritate the lining of the stomach. Inflammation can cause small amounts of bleeding, which can turn your stool black.

Treatment depends on the cause. If the gastritis is caused by smoking, stop smoking. If it’s caused by drinking, cut back on alcohol.

If it’s from taking NSAIDs, your doctor will likely recommend lowering the dosage or changing what you take. If the cause is an autoimmune response, you may need other medications and more follow-up.

3. Colon polyps

Symptoms

• Black or bloody stool

Colon polyps are small growths in the colon. Polyps begin as benign (not cancerous) growths, but can develop into cancer over time. Usually, they do not have any symptoms, but sometimes, they can ooze small amounts of blood.

A colonoscopy can find polyps before they become cancerous. When they are found during the procedure, the gastroenterologist will remove them. This prevents them from turning into cancer.

Some people are more likely to form colon polyps because of their genetics. Other factors that are associated with polyps (and future colon cancer) are being overweight, smoking, and eating a lot of red meat and processed foods.

4. Colorectal cancer

Symptoms

• Changes in bowel habits
• Not feeling hungry
• Weight loss
• Black or bloody stool
• Abdominal pain
• Fatigue

Colon cancer and cancer of the rectum are sometimes described under the umbrella term “colorectal cancer.” Noncancerous polyps in the rectum can become cancerous over time, which is why regular colon screening with a colonoscopy is recommended. Colorectal cancer is the third most common cancer in men and women, according to the Centers for Disease Control and Prevention (CDC).

Colorectal cancers can be diagnosed at any age, but it usually affects people over 50. Obesity, a sedentary lifestyle, smoking, and alcohol use can increase your risk for colorectal cancer.

Colon cancer is usually treated with a combination of surgery and chemotherapy.

5. Constipation

Pro Tip

“Black tarry stool, like oil, and foul smelling”—this is blood! “Small, pellet like stool, but really dark”— this is more suggestive of constipation and iron supplementation. —Dr. Kumar

Symptoms

• Difficulty passing a bowel movement
• Hard, pebbly stool
• Dark brown or black colored stool
• Abdominal discomfort or bloating

Constipation is when you have infrequent bowel movements and stool is very hard and dry. The stool may appear darkish or black. When you try to have a bowel movement, you may strain, or your stool may look like hard pellets. You may feel abdominal pain, cramping, or bloating.

Laxatives, good nutrition, and drinking a lot of fluids can all help with constipation. See a doctor if constipation doesn’t get better, if you have severe abdominal pain with it, or you see streaks of red blood or other unusual colors in your stool.

Other possible causes

A number of conditions can cause black stool, though they are less common. They include:

• Variceal bleeding, which is bleeding from veins in the esophagus that can be from advanced liver disease (cirrhosis).
• Mallory-Weiss tear, a tear in the mucous membrane of the esophagus, particularly after bouts of heavy coughing or repetitive vomiting.

When to call the doctor

Dr. Rx

Black stool can have a lot of causes. They can be uninteresting (iron supplementation, various foods, even alcohol) or more dangerous (bleeding). The biggest consideration is your health status and underlying conditions. If you have black stool, it’s important to discuss with your doctor. —Dr. Kumar

• You are pregnant.
• You recently started a new medication.
• You are experiencing abdominal pain.
• You are taking blood thinners, like warfarin (Coumadin).

Should I go to the ER for black stool?

You should go to the ER if you’re having any of the following symptoms:

• You’re vomiting blood
• You’re in severe pain
• The bleeding is uncontrolled
• You’re experiencing confusion or difficulty thinking
• You feel lightheaded, faint, or dizzy
• You’re having chest pain or shortness of breath
• You are feeling dizzy and lightheaded

Treatments

Don’t assume your dark stool is from your diet or constipation until you confirm it with your doctor. In some cases, your doctor may need to do an endoscopy or a colonoscopy (looking into your esophagus and stomach or your colon with a tube) or another procedure to check for tears, polyps, or bleeding in the colon or intestines.

Shria Kumar, MD.

Therapeutic Endoscopy Fellow, MD Anderson Cancer Center, Houston, TX

Dr. Kumar is a gastroenterologist, who completed her fellowship at the Hospital of the University of Pennsylvania in Philadelphia. She received her undergraduate degrees in Religious Studies and Chemistry from New York University (2010) and graduated from the Albert Einstein College of Medicine (2014), where she was inducted into the Alpha Omega Alpha Honor Medical Society. She is completing her t…

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Melena – causes, diagnosis and treatment

Melena are black tar-like stools that form with heavy (more than 60 ml) acute or chronic bleeding from different parts of the gastrointestinal tract. The cause of the pathological condition may be primary lesions of the digestive system, violations of the hemostasis system, some infectious diseases. In order to detect the source and cause of hemorrhage, endoscopic, radiological and laboratory research methods are used. With a characteristic change in the appearance of feces, you should immediately consult a doctor.

General characteristics

In the case of melena, the patient notices a sharp change in the consistency and color of the feces – they become more liquid, “sticky”, turn black (tarry stools). It is necessary to distinguish between melena and physiological changes in the color of feces due to medication – feces after the use of iron and bismuth preparations are formed, solid. Bleeding is accompanied by pain in the abdomen of varying intensity and other dyspeptic disorders, the severity of which depends on the level and degree of damage to the digestive system.

In some cases, with the appearance of blood in the feces, the pain syndrome subsides. Simultaneously with the onset of melena, vomiting of “coffee grounds” develops, general well-being is disturbed: the skin and mucous membranes become pale, dizziness, weakness, and fainting are noted. With massive blood loss, collapse is possible, which is characterized by a frequent weak pulse, a sharp drop in blood pressure, and loss of consciousness. Bleeding from the gastrointestinal tract is a symptom of serious pathological conditions and requires emergency qualified medical care.

Causes of melena

Most often, heavy bleeding, leading to the release of black tarry feces from the rectum, complicates the course of gastroduodenal pathology. A rarer factor causing the development of melena are abundant nasal and pulmonary hemorrhages, accompanied by the ingestion of blood. Violation of the color and consistency of feces is observed in acute erosive esophagitis, periarteritis nodosa, which occurs with the involvement of small vessels of the gastrointestinal tract in the process. Altered blood that appears in the stool in the general serious condition of the patient may indicate a rupture of the aortic aneurysm into the lumen of the small intestine.

Gastrointestinal bleeding

The main cause of melena is the development of acute or profuse chronic hemorrhages from the upper segments of the gastrointestinal tract, associated mainly with ulcerative-destructive processes in the mucous membrane. The dark color of feces appears when whole blood interacts with hydrochloric acid of the stomach and the conversion of hemoglobin into hematin hydrochloride. The appearance of melena is also caused by bleeding from the small or initial sections of the large intestine, subject to a slowdown in peristalsis and a violation of the passage of feces. Tar-like stools are a symptom of such diseases of the gastrointestinal tract as:

• Gastritis . Melena is often found in the erosive variant of acute gastritis, which is manifested by extensive superficial lesions of the mucous membrane of the organ. Bleeding occurs against the background of severe pain in the epigastric region, nausea and vomiting, changes in the nature and frequency of stools. The condition develops after poisoning with chemicals, taking drugs that irritate the mucous membrane.
• Peptic ulcer . With a deep lesion by the ulcerative process of the wall of the stomach or duodenum, the vessels are destroyed, hemorrhage occurs. Bleeding can be minor or massive with signs of melena. A pathognomonic sign indicating the presence of an ulcer is a decrease or complete disappearance of the pain syndrome after the onset of hemorrhage.
• Mallory-Weiss syndrome . A detailed clinical picture of the disorder often develops against the background of recurrent vomiting, intense coughing, and indomitable hiccups. For the disease, repeated vomiting with impurities of scarlet blood is more characteristic, but sometimes blood accumulates in the stomach and is destroyed by hydrochloric acid, which causes the appearance of tarry stools 6-8 hours after the first symptoms.
• Stomach cancer . For tumors of the stomach, the combination of coffee grounds vomiting and melena is pathognomonic. The condition appears in the late stages of neoplasm development, when the tumor tissue grows deep into the wall of the organ and destroys the blood vessels. Typical is a persistent pain syndrome, frequent nausea, vomiting after eating, symptoms of cancer intoxication (weight loss, general weakness, lack of appetite).
• Erosive bulbite . Hemorrhage and melena are more often observed in the acute variant of the lesion of the duodenal bulb. Other symptoms – dull epigastric pain, periodic nausea and vomiting, stool instability with a tendency to constipation – are of little specificity and occur with any lesions of the upper digestive system. Bleeding can be provoked by chemical damage, taking NSAIDs.
• Mesenteric artery occlusion . Due to thrombosis and vascular embolism, there is a sharp cessation of the blood supply to the intestine with ischemic and destructive changes in its wall. The first sign of occlusion is severe abdominal pain, accompanied by reflex repeated vomiting with bile impurities. The color and texture of the feces change several hours after the onset of symptoms.
• Neonatal necrotizing enterocolitis . The disease manifests itself mainly in premature babies 1-2 weeks after birth. Melena develops as a result of extensive ischemic and necrotic changes in the intestinal wall due to intrauterine hypoxia or asphyxia during childbirth. The disease is very difficult, bleeding from the gastrointestinal tract is complicated by DIC, multiple organ failure.

Infectious pathologies

Melena in viral or bacterial lesions is potentiated both by the direct action of microorganisms on the walls of the digestive tract, and by indirect influence through disturbances in the mechanisms of vascular permeability and hemostasis. The appearance of black fetid feces is accompanied by a general infectious syndrome: febrile fever, headaches, myalgia and arthralgia. Gradually develop pathognomonic symptoms for each pathogen. Of the infectious diseases, chalk is most often complicated by:

• Hemorrhagic fever . Viral damage to the organs of the reticuloendothelial system causes a pronounced lack of platelets, which, combined with pathological changes in the vascular wall, provokes melena, hematuria, nosebleeds. In addition to the allocation of black feces, a hemorrhagic rash on the skin and mucous membranes is determined. In severe situations, hypovolemic shock may develop.
• Typhoid fever . At the stage of necrotic changes and cleansing of typhoid ulcers of the intestine, bleeding from damaged intestinal arteries may occur. Such a complication usually occurs at 3-4 weeks of typhoid fever with a typical staging of the process. Also characteristic is the discrepancy between changes in the pulse and the degree of increase in body temperature – heart rate of normal frequency with high febrile fever.
• Dengue fever . Melena is detected in the hemorrhagic form of the infectious process. At the initial stages, patients complain of fever, malaise. Spontaneous bleeding from the digestive tract occurs 2-3 days after the onset of symptoms, due to the predominant lesion of the capillaries in combination with changes in the rheological properties of the blood, a decrease in the number of coagulation factors.

Blood clotting disorders

Hemorrhage in the upper digestive tract may be associated with systemic hematological diseases, which develop a tendency to hypocoagulation, insufficiency of coagulation factors, and a pathological increase in the permeability of the vascular wall. In such diseases, melena is accompanied by nasal, uterine and pulmonary bleeding. Hemorrhages in the cavity of the joints and pericardium are possible, which leads to the appearance of the corresponding symptoms. The main causes of tarry stools are the following hemorrhagic diseases:

• Hemophilia . Massive bleeding, manifested by melena, is observed in moderate and severe forms of pathology, in which the level of clotting factors is not more than 5% of the norm. In most cases, the manifestation of hemophilia occurs in early childhood. The main symptom, which occurs in 80% of patients, is hemorrhages in the joint cavity, extensive hematomas after impact, hematuria are also characteristic.
• Rendu-Osler-Weber disease . Blood staining of the feces indicates a severe course of the process with diffuse damage to the small vessels of the digestive tract. With this disease, in addition to melena, nosebleeds often begin for no reason, which are extremely difficult to stop. A characteristic feature is hemorrhagic telangiectasia on the skin of the face, mucous membrane of the lips and cheeks.
• Thrombocytopenias . Hemorrhagic syndrome is provoked by a sharp decrease in the number of platelets, which may be autoimmune in nature or develop secondary to other hematological disorders. Patients complain of the causeless appearance of bruises and bruises, bleeding from the nasal passages. For thrombocytopenia, a combination of melena and pain in the left hypochondrium is typical, which is due to an increase in the spleen.

Liver pathology

Gastric bleeding with black “sticky” stools is caused by chronic liver diseases (fibrosis, cirrhosis), leading to portal hypertension. Due to a violation of the outflow of blood, the collateral vessels of the lower third of the esophagus and stomach expand, and then rupture with an increase in pressure in the abdominal cavity, which is accompanied by massive blood loss. In primary lesions of the liver, melena, as a rule, is combined with hematemesis, specific “liver signs”: palmar erythema, spider veins on the skin of the abdomen.

Examination

The patient is examined by a gastroenterologist, in case of massive hemorrhage, consultation with a surgeon is obligatory. Diagnostic search in the presence of melena is aimed at the rapid detection of the source of bleeding, and, if possible, its elimination. A complex of instrumental and laboratory methods is used, which are necessary to study the state of the digestive tract, assess the severity of the patient’s condition and the degree of hemodynamic disorders. The most valuable for diagnosis are:

• X-ray examination . A series of radiographs with oral contrasting of the gastrointestinal tract with barium sulfate is an alternative to the endoscopic examination method. With the help of radiography in 80-85% of cases it is possible to determine the localization of damage, but the technique is not always informative for establishing the etiology.
• Endoscopy . EGDS using a flexible probe is used not only to detect the site of hemorrhage, but also as a therapeutic method – special tools allow you to “burn” a bleeding vessel. In doubtful cases, to verify the causes of melena, a biopsy of the altered sections of the mucosa is performed.
• Fecal analysis . In order to confirm the presence of blood in the feces, a triple Gregersen reaction is performed, which reveals even a small amount of blood pigments. Be sure to perform a standard coprogram, according to indications, a bacteriological examination of feces is prescribed.
• Coagulogram. The results of the analysis of clotting ability, activity of the internal and external links of hemostasis are indicative of suspected hereditary hemorrhagic pathologies with clotting disorders. To control the dynamics of the patient’s condition, the study is done several times.
• Blood tests . All patients with melena are recommended a complete blood count, which provides an approximate assessment of the degree of blood loss for the development of further treatment tactics. To exclude concomitant diseases, a biochemical blood test, liver tests are necessary.

Selective mesenteric arteriography is prescribed in case of massive bleeding and the impossibility of performing a qualitative endoscopic examination to visualize the exact location of the vessel injury. Radionuclide scanning with labeled erythrocytes is used as a screening test for unclear etiology of melena.

To detect traces of blood in the feces, a stool test for occult blood is prescribed.

Symptomatic therapy. Such a pathological condition cannot be eliminated on its own at home. With the appearance of tarry dark feces, it is necessary to immediately seek qualified medical help, since untimely diagnosis and treatment are fraught with massive blood loss, severe disturbances in the activity of all body systems.

Melena – causes, diagnosis and treatment

Melena are black tarry stools that form with heavy (more than 60 ml) acute or chronic bleeding from different parts of the gastrointestinal tract. The cause of the pathological condition may be primary lesions of the digestive system, violations of the hemostasis system, some infectious diseases. In order to detect the source and cause of hemorrhage, endoscopic, radiological and laboratory research methods are used. With a characteristic change in the appearance of feces, you should immediately consult a doctor.

General characteristics

In the case of melena, the patient notices a sharp change in the consistency and color of the feces – they become more liquid, “sticky”, turn black (tarry stools). It is necessary to distinguish between melena and physiological changes in the color of feces due to medication – feces after the use of iron and bismuth preparations are formed, solid. Bleeding is accompanied by pain in the abdomen of varying intensity and other dyspeptic disorders, the severity of which depends on the level and degree of damage to the digestive system.

In some cases, with the appearance of blood in the feces, the pain syndrome subsides. Simultaneously with the onset of melena, vomiting of “coffee grounds” develops, general well-being is disturbed: the skin and mucous membranes become pale, dizziness, weakness, and fainting are noted. With massive blood loss, collapse is possible, which is characterized by a frequent weak pulse, a sharp drop in blood pressure, and loss of consciousness. Bleeding from the gastrointestinal tract is a symptom of serious pathological conditions and requires emergency qualified medical care.

Causes of melena

Most often, heavy bleeding, leading to the release of black tarry feces from the rectum, complicates the course of gastroduodenal pathology. A rarer factor causing the development of melena are abundant nasal and pulmonary hemorrhages, accompanied by the ingestion of blood. Violation of the color and consistency of feces is observed in acute erosive esophagitis, periarteritis nodosa, which occurs with the involvement of small vessels of the gastrointestinal tract in the process. Altered blood that appears in the stool in the general serious condition of the patient may indicate a rupture of the aortic aneurysm into the lumen of the small intestine.

Gastrointestinal bleeding

The main cause of melena is the development of acute or profuse chronic hemorrhages from the upper segments of the gastrointestinal tract, associated mainly with ulcerative-destructive processes in the mucous membrane. The dark color of feces appears when whole blood interacts with hydrochloric acid of the stomach and the conversion of hemoglobin into hematin hydrochloride. The appearance of melena is also caused by bleeding from the small or initial sections of the large intestine, subject to a slowdown in peristalsis and a violation of the passage of feces. Tar-like stools are a symptom of such diseases of the gastrointestinal tract as:

• Gastritis . Melena is often found in the erosive variant of acute gastritis, which is manifested by extensive superficial lesions of the mucous membrane of the organ. Bleeding occurs against the background of severe pain in the epigastric region, nausea and vomiting, changes in the nature and frequency of stools. The condition develops after poisoning with chemicals, taking drugs that irritate the mucous membrane.
• Peptic ulcer . With a deep lesion by the ulcerative process of the wall of the stomach or duodenum, the vessels are destroyed, hemorrhage occurs. Bleeding can be minor or massive with signs of melena. A pathognomonic sign indicating the presence of an ulcer is a decrease or complete disappearance of the pain syndrome after the onset of hemorrhage.
• Mallory-Weiss syndrome . A detailed clinical picture of the disorder often develops against the background of recurrent vomiting, intense coughing, and indomitable hiccups. For the disease, repeated vomiting with impurities of scarlet blood is more characteristic, but sometimes blood accumulates in the stomach and is destroyed by hydrochloric acid, which causes the appearance of tarry stools 6-8 hours after the first symptoms.
• Stomach cancer . For tumors of the stomach, the combination of coffee grounds vomiting and melena is pathognomonic. The condition appears in the late stages of neoplasm development, when the tumor tissue grows deep into the wall of the organ and destroys the blood vessels. Typical is a persistent pain syndrome, frequent nausea, vomiting after eating, symptoms of cancer intoxication (weight loss, general weakness, lack of appetite).
• Erosive bulbite . Hemorrhage and melena are more often observed in the acute variant of the lesion of the duodenal bulb. Other symptoms – dull epigastric pain, periodic nausea and vomiting, stool instability with a tendency to constipation – are of little specificity and occur with any lesions of the upper digestive system. Bleeding can be provoked by chemical damage, taking NSAIDs.
• Mesenteric artery occlusion . Due to thrombosis and vascular embolism, there is a sharp cessation of the blood supply to the intestine with ischemic and destructive changes in its wall. The first sign of occlusion is severe abdominal pain, accompanied by reflex repeated vomiting with bile impurities. The color and texture of the feces change several hours after the onset of symptoms.
• Neonatal necrotizing enterocolitis . The disease manifests itself mainly in premature babies 1-2 weeks after birth. Melena develops as a result of extensive ischemic and necrotic changes in the intestinal wall due to intrauterine hypoxia or asphyxia during childbirth. The disease is very difficult, bleeding from the gastrointestinal tract is complicated by DIC, multiple organ failure.

Infectious pathologies

Melena in viral or bacterial lesions is potentiated both by the direct action of microorganisms on the walls of the digestive tract, and by indirect influence through disturbances in the mechanisms of vascular permeability and hemostasis. The appearance of black fetid feces is accompanied by a general infectious syndrome: febrile fever, headaches, myalgia and arthralgia. Gradually develop pathognomonic symptoms for each pathogen. Of the infectious diseases, chalk is most often complicated by:

• Hemorrhagic fever . Viral damage to the organs of the reticuloendothelial system causes a pronounced lack of platelets, which, combined with pathological changes in the vascular wall, provokes melena, hematuria, nosebleeds. In addition to the allocation of black feces, a hemorrhagic rash on the skin and mucous membranes is determined. In severe situations, hypovolemic shock may develop.
• Typhoid fever . At the stage of necrotic changes and cleansing of typhoid ulcers of the intestine, bleeding from damaged intestinal arteries may occur. Such a complication usually occurs at 3-4 weeks of typhoid fever with a typical staging of the process. Also characteristic is the discrepancy between changes in the pulse and the degree of increase in body temperature – heart rate of normal frequency with high febrile fever.
• Dengue fever . Melena is detected in the hemorrhagic form of the infectious process. At the initial stages, patients complain of fever, malaise. Spontaneous bleeding from the digestive tract occurs 2-3 days after the onset of symptoms, due to the predominant lesion of the capillaries in combination with changes in the rheological properties of the blood, a decrease in the number of coagulation factors.

Blood clotting disorders

Hemorrhage in the upper digestive tract may be associated with systemic hematological diseases, which develop a tendency to hypocoagulation, insufficiency of coagulation factors, and a pathological increase in the permeability of the vascular wall. In such diseases, melena is accompanied by nasal, uterine and pulmonary bleeding. Hemorrhages in the cavity of the joints and pericardium are possible, which leads to the appearance of the corresponding symptoms. The main causes of tarry stools are the following hemorrhagic diseases:

• Hemophilia . Massive bleeding, manifested by melena, is observed in moderate and severe forms of pathology, in which the level of clotting factors is not more than 5% of the norm. In most cases, the manifestation of hemophilia occurs in early childhood. The main symptom, which occurs in 80% of patients, is hemorrhages in the joint cavity, extensive hematomas after impact, hematuria are also characteristic.
• Rendu-Osler-Weber disease . Blood staining of the feces indicates a severe course of the process with diffuse damage to the small vessels of the digestive tract. With this disease, in addition to melena, nosebleeds often begin for no reason, which are extremely difficult to stop. A characteristic feature is hemorrhagic telangiectasia on the skin of the face, mucous membrane of the lips and cheeks.
• Thrombocytopenias . Hemorrhagic syndrome is provoked by a sharp decrease in the number of platelets, which may be autoimmune in nature or develop secondary to other hematological disorders. Patients complain of the causeless appearance of bruises and bruises, bleeding from the nasal passages. For thrombocytopenia, a combination of melena and pain in the left hypochondrium is typical, which is due to an increase in the spleen.

Liver pathology

Gastric bleeding with black “sticky” stools is caused by chronic liver diseases (fibrosis, cirrhosis), leading to portal hypertension. Due to a violation of the outflow of blood, the collateral vessels of the lower third of the esophagus and stomach expand, and then rupture with an increase in pressure in the abdominal cavity, which is accompanied by massive blood loss. In primary lesions of the liver, melena, as a rule, is combined with hematemesis, specific “liver signs”: palmar erythema, spider veins on the skin of the abdomen.

Examination

The patient is examined by a gastroenterologist, in case of massive hemorrhage, consultation with a surgeon is obligatory. Diagnostic search in the presence of melena is aimed at the rapid detection of the source of bleeding, and, if possible, its elimination. A complex of instrumental and laboratory methods is used, which are necessary to study the state of the digestive tract, assess the severity of the patient’s condition and the degree of hemodynamic disorders. The most valuable for diagnosis are:

• X-ray examination . A series of radiographs with oral contrasting of the gastrointestinal tract with barium sulfate is an alternative to the endoscopic examination method. With the help of radiography in 80-85% of cases it is possible to determine the localization of damage, but the technique is not always informative for establishing the etiology.
• Endoscopy . EGDS using a flexible probe is used not only to detect the site of hemorrhage, but also as a therapeutic method – special tools allow you to “burn” a bleeding vessel. In doubtful cases, to verify the causes of melena, a biopsy of the altered sections of the mucosa is performed.
• Fecal analysis . In order to confirm the presence of blood in the feces, a triple Gregersen reaction is performed, which reveals even a small amount of blood pigments. Be sure to perform a standard coprogram, according to indications, a bacteriological examination of feces is prescribed.
• Coagulogram. The results of the analysis of clotting ability, activity of the internal and external links of hemostasis are indicative of suspected hereditary hemorrhagic pathologies with clotting disorders. To control the dynamics of the patient’s condition, the study is done several times.
• Blood tests . All patients with melena are recommended a complete blood count, which provides an approximate assessment of the degree of blood loss for the development of further treatment tactics. To exclude concomitant diseases, a biochemical blood test, liver tests are necessary.

Selective mesenteric arteriography is prescribed in case of massive bleeding and the impossibility of performing a qualitative endoscopic examination to visualize the exact location of the vessel injury. Radionuclide scanning with labeled erythrocytes is used as a screening test for unclear etiology of melena.

To detect traces of blood in the feces, a stool test for occult blood is prescribed.