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Bloody or tarry stools
Definition
Bloody stools often are a sign of an injury or disorder in the digestive tract. Your doctor may use the term "melena" to describe black, tarry, and foul-smelling stools or "hematochezia" to describe red- or maroon-colored stools.
Alternative Names
Stools - bloody; Hematochezia; Melena; Stools - black or tarry
Considerations
Blood in the stool may come from anywhere along your digestive tract, from mouth to anus. It may be present in such small amounts that you cannot actually see it, and it is only detectable by a fecal occult blood test.
When there is enough blood to change the appearance of your stools, the doctor will want to know the exact color to help find the site of bleeding. To make a diagnosis, your doctor may use endoscopy or special x-ray studies.
Black stool usually means that the blood is coming from the upper part of the gastrointestinal (GI) tract. This includes the esophagus, stomach, and the first part of the small intestine. Blood will typically look like tar after it has been exposed to the body's digestive juices as it passes through the intestines.
Maroon-colored stools or bright red blood usually suggests that the blood is coming from the lower part of the GI tract (large bowel, rectum, or anus). However, sometimes massive or rapid bleeding in the stomach causes bright red stools.
Eating black licorice, lead, iron pills, bismuth medicines like Pepto-Bismol, or blueberries can also cause black stools. Beets and tomatoes can sometimes make stools appear reddish. In these cases, your doctor can test the stool with a chemical to rule out the presence of blood.
Bleeding in the esophagus or stomach (such as with peptic ulcer disease) can also cause you to vomit blood.
Causes
The upper part of the GI tract will usually cause black stools due to:
- Abnormal blood vessels (vascular malformation)
- A tear in the esophagus from violent vomiting (Mallory-Weiss tear)
- Bleeding stomach or duodenal ulcer
- Inflammation of the stomach lining (gastritis)
- Lack of proper blood flow to the intestines (bowel ischemia)
- Trauma or foreign body
- Widened, overgrown veins (called varices) in the esophagus and stomach
The lower part of the GI tract will usually cause maroon or bright red, bloody stools due to:
- Anal fissures
- Bowel ischemia (when blood supply is cut off to part of the intestines)
- Colon polyps or colon cancer
- Diverticulosis (abnormal pouches in the colon)
- Hemorrhoids (common cause)
- Inflammatory bowel disease (such as Crohn's disease or ulcerative colitis)
- Intestinal infection (such as bacterial enterocolitis)
- Small bowel tumor
- Trauma or foreign body
- Vascular malformation (abnormal collections of blood vessels called arteriovenous malformations or AVMs)
When to Contact a Medical Professional
Call your doctor immediately if you notice blood or changes in the color of your stool. Even if you think that hemorrhoids are causing the blood in your stool, your doctor should examine you to make sure that there is no other, more serious cause present.
In children, a small amount of blood in the stool is usually not serious. The most common causes are constipation and milk allergies. However, it is still worth reporting to your doctor, even if no evaluation is needed.
What to Expect at Your Office Visit
Your doctor will take a medical history and perform a physical examination, focusing on your abdomen and rectum.
The following questions may be included in the history to better understand the possible causes of your bloody or dark stools:
- Are you taking blood thinners (aspirin, warfarin, clopidogrel, Aggrenox) or NSAIDs (ibuprofen, naproxen)?
- Have you had any trauma to the abdomen or rectum, or have you swallowed a foreign object accidentally?
- Have you eaten black licorice, lead, Pepto-Bismol, or blueberries?
- Have you had more than one episode of blood in your stool? Is every stool this way?
- Have you lost any weight recently?
- Is there blood on the toilet paper only?
- What color is the stool?
- When did it develop?
- What other symptoms are present -- abdominal pain, vomiting blood, bloating, excessive gas, diarrhea, or fever?
Treatment depends on the cause and severity of the bleeding. For serious bleeding, you may be admitted to a hospital for monitoring and evaluation. If there is massive bleeding, you will be monitored in an intensive care unit. Emergency treatment may include a blood transfusion.
The following diagnostic tests may be performed:
- Angiography
- Barium studies
- Bleeding scan (nuclear medicine)
- Blood studies, including a complete blood count ( CBC) and differential, serum chemistries, clotting studies
- Colonoscopy
- Esophagogastroduodenoscopy or EGD
- Stool culture
- Tests for the presence of Helicobacter pylori infection
- X-rays of the abdomen
TREATMENT
If you have passed a lot of blood, you may need emergency treatment, which can include:
- Blood transfusions
- Fluids through a vein
- Interventional radiography embolization (a procedure to block the blood vessels that may be bleeding)
- Medications to decrease stomach acid
- Possible surgery if bleeding does not stop
Prevention
For information about preventing the different causes of bloody or tarry stools, see:
References
Henneman PL. Gastrointestinal bleeding. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 22.
Garcia-Tsap G, Sanyal AJ, Grace ND, Carey WD: Practice Guidelines Committee of American Association for Study of Liver Diseases: Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007; 102:2086-2102.
Lieberman Da. Clinical practice. Screening for colorectal cancer. N Engl J Med. 2009;361:1179-1187.
Lanza FL, Chan FK, Quigley EM: Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
