Lower digestive anatomy
Lower digestive anatomy

Stools - bloody

Definition:

Bloody stools often indicate an injury or disorder in the digestive tract. Your health care provider may use the term "melena" to describe black, tarry, and foul-smelling stools or "hematochezia" to describe red or maroon-colored stools.



Alternative Names:
Blood in the stool; Hematochezia; Melena; Stools - black or tarry

Considerations:

Blood seen in the stool can originate anywhere along the intestinal tract.

A black stool usually means that the blood is coming from the upper part of the gastrointestinal (GI) tract. At least 6 tablespoons (or 200 milliliters) of blood must have been lost in order to cause passage of melena. Passing maroon-colored stools or bright red blood (hematochezia) usually suggests that the blood is coming from the large bowel or the rectum. However, sometimes hematochezia can be caused by massive upper GI bleeding.

The ingestion of black licorice, lead, iron pills, Pepto-Bismol (or similar medications containing bismuth subsalicylate) or blueberries can all cause black stools, or false melena. If a problem is suspected, stools should be tested for the presence of hidden blood.

Some upper GI causes of bloody stools, such as peptic ulcer disease, can also cause vomiting blood.

Common Causes:

GI bleeding is the most serious source of bloody stools. The color of the stool can suggest the location of the bleeding. However, this is not always reliableand any diagnosis should be confirmed with radiographic and/or endoscopic investigation.

Black color:

  • Bleeding ulcer
  • Gastritis
  • Esophageal varices
  • Mallory-Weiss tear (a tear in the esophagus from violent vomiting)

Maroon color:

Bright red color:

Home Care:
Contact your health care provider immediately if you notice any signs of bloody stools.
Call your health care provider if:

Do not take this lightly. Make an appointment to see your health care provider right away if you notice ANY of the following:

  • Any evidence of GI bleeding occurs.
  • There is any change in the color of the stool.
  • There is blood in the stool.

Do not rely on visual impressions -- always test the stool or have it tested. Home kits can be purchased at the drugstore or online, or you can send a specimen to the doctor.

If you have ongoing digestive problems, ask to see a gastroenterologist (a doctor specializing in diseases of the digestive tract). The gastroenterologist will decide on the appropriate tests to determine the cause of blood in stool.

What to expect at your health care provider's office:
Your health care provider will obtain your medical history and will perform a physical examination.

Medical history questions documenting bloody or dark stools may include the following:
  • Quality
    • Is there blood on the toilet paper only?
    • Is there bright red blood in the stool (hematochezia)?
    • Is there maroon colored stool?
    • Are there black or tarry bowel movements (melena)?
  • Time pattern
    • When did it develop?
    • Is every stool this way?
    • Has there been more than one episode (repeated)?
  • Aggravating and related factors
    • Does bloody stool occur with menstruation?
    • Have you ingested black licorice, lead, Pepto-Bismol, or blueberries?
    • Have you eaten a lot of meat lately?
  • What other symptoms are also present?

The physical examination will probably include emphasis on the abdomen and rectum.

Your health care provider will manage your condition depending on the nature of the bleeding. Mild bleeding from hemorrhoids or mild GI infections can be managed on an outpatient basis. However, for more serious bleeding, you may need to be admitted to a hospital for monitoring and workup.

If there is evidence of massive bleeding, you will need to be monitored in an intensive care unit; emergency treatment including blood transfusion may be necessary.

Diagnostic tests that may be performed include:


Review Date: 11/9/2002
Reviewed By: Andrew J. Muir, M.D., M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.
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