Bloody or tarry stools Health Article

Common Causes

Upper GI tract (usually black stools):

• 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 blood vesels (esophageal and stomach varices)

Lower GI tract (usually maroon or bright red, bloody stools):

• Anal fissures
• Bowel ischemia
• Colon polyps or colon cancer
• Diverticulosis
• Hemorrhoids
• 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

Call your health care provider if

Call your doctor immediately if you notice blood or changes in the color of your stool. Even if you think that hemorrhoids are causing blood in your stool, your doctor should examine you in order to make sure that there is no other, more serious cause present at the same time.

In children, a small amount of blood in the stool is usually not serious. The most common causes are constipation and milk allergies. But it is still worth reporting to your doctor, even if no evaluation is necessary.

What to expect at your health care provider's office

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 or NSAIDs (ibuprofen, naproxen, aspirin)
• 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
• Blood studies, including a 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