Table of ContentsView AllTable of ContentsCausesOther CausesAppearanceOther SymptomsDiagnosisTreatmentWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Causes
Other Causes
Appearance
Other Symptoms
Diagnosis
Treatment
When to See a Provider
Melena is when blood causes stools to appear black, tarry, and foul-smelling. The blood is dark because it is coming from somewhere in the upper digestive system, including the esophagus (food tube), stomach, and small intestine. Melena is not a disease itself but rather a symptom of a condition that’s causing the bleeding.
Blood in the stool is never normal, so when melena is present, it is important to see a healthcare provider for an evaluation.
This article will describe some of the possible reasons for melena, when it might be an emergency, and the testing that might be done to determine the cause.
Kevin Brine / Getty Images
What Causes Melena?
Stools maylook black and appear tarrybecause they contain blood. The blood is dark because it is coming from somewhere in the upper digestive tract. This means that there is a medical condition present that is causing bleeding.
The amount of blood in the upper intestinal tract needs to be somewhere between 100 to 200 milliliters (about 7 to 13 tablespoons) to turn stool black. The black stools could continue for even a few days after the bleeding stops.
Peptic Ulcer (Gastric or Duodenal Ulcer)
Apeptic ulceris the most common cause of bleeding in the upper digestive tract. The stomach and small intestine have a lining, and if it wears away beyond the mucosal layers, bleeding can occur.
An ulcer in the stomach is called a gastric ulcer, and an ulcer in the first section of thesmall intestine(the duodenum) is called aduodenal ulcer.
Some people with an ulcer have no symptoms. But when there are symptoms, they can include gnawing or burning pain in the upper chest. This pain might get better after eating or taking antacids, but sometimes when the stomach is involved, the pain doesn’t follow a pattern.
Cirrhosis with Esophageal or Gastric Varices
Varicesoccur when a vein in the esophagus or stomach becomes dilated from too much pressure in theportal vein, which returns blood to the liver from the stomach, intestines, spleen, and pancreas. They are most commonly related to severe scarring in the liver, calledcirrhosis.
Varices may have no symptoms except bleeding. The blood loss can be sudden and severe (acute). More commonly, however, the bleeding is chronic (long-lasting).
Mallory-Weiss Syndrome
Erosive Esophagitis
Irritation or inflammation in theesophaguscould lead to bleeding in some cases. Some of the symptoms could include trouble swallowing, feeling like something is caught in the throat, and a burning sensation.
There are a number of potential causes ofesophagitis, including infection, vomiting, injury,gastroesophageal reflux disease (GERD), or a stuck pill.
Vascular Gastrointestinal Lesions
Vascular gastrointestinal lesions are rare. They are abnormalities in blood vessels that may cause bleeding.
These lesions can be present at birth or develop over time because of an associated condition such askidney disease, cardiac disease, or mechanical heart valves (due to a condition called Heyde syndrome). The cecum andascending colonare common places where these lesions might occur.
Tumors
What Else Could Cause Black Stool?
Some foods that turn stool dark are black licorice, chocolate sandwich cookies, beets, and artificial black, blue, or red food coloring. This discoloration is usually harmless and will go away after the food is digested.
What Does Melena Look Like?
Melenic stool is alsodifferent in texturefrom normal stools. It is often described as tarry, meaning it is sticky and dense.
The third part of melena is the smell. Stool that contains blood has what is usually termed a “foul” smell, which is strong and unmistakable.
What’s the Difference Between Hematochezia and Melena?
Other Symptoms With Melena
There may not be any other symptoms when melena starts. When there are symptoms, they will vary based on the condition that is causing it.
How Do I Know If My Black Stool Is Melena?
When a black stool is melena, it will look tarry and smell offensive. Having other symptoms in the digestive tract may also signal blood in the stool.
However, when it’s not clear that blood is in the stool, consider recent foods that you’ve eaten and supplements that you’ve taken. If any of the foods were dark in color, or if the supplements or medications could cause a dark stool, the stool might not contain blood.
Also, if the color changes back to that of a typical bowel movement and doesn’t become black again, the cause likely was not blood.
If there is a true concern that blood is in the stool, contact a healthcare provider. A stool test called a fecal occult blood test might be used to detect the presence of blood.
Melena is a symptom of a problem, so there will be a need to determine the cause. The tests that might be used to find the cause of the bleeding might include:
What Is the Treatment for Melena?
The treatment for melena is based on what is causing the bleeding. In general, the goals will be as follows:
Intravenous fluids and a blood transfusion may be needed if blood loss is significant.
Less common causes of bleeding may require treatments that include surgery and medications to help manage ulcers and inflammation.
When to Contact a Healthcare Provider
When melena is suspected, it’s important to seek medical care. Sometimes blood in the stool is clear, but if there’s any doubt, ask a healthcare provider for guidance. Blood in the stool is never normal and is always a sign to see a healthcare provider.
Seek care immediately for the following symptoms that signal a large amount of blood has been lost:
Other signs requiring emergency care are:
Severe pain and blood loss need care immediately and could bereasons to go to the emergency departmentor call 911 for an ambulance.
Summary
If there is any concern that blood is in the stool, it’s important to consult a healthcare provider. Bleeding higher up in the digestive tract can result from several different conditions. It’s important to receive a diagnosis so that treatment can begin.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ansari P.Overview of gastrointestinal bleeding. Merck Manual.Vakil N.Peptic ulcer disease. Merck Manual.Ansari P.Varices. Merck Manual.Lynch KL.Mallory-Weiss syndrome. Merck Manual.Grossi L, Ciccaglione AF, Marzio L.Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?World J Gastroenterol. 2017;23:3011-3016. doi:10.3748/wjg.v23.i17.3011Ansari P.Vascular gastrointestinal lesions. Merck Manual.Sakai E, Ohata K, Nakajima A, Matsuhashi N.Diagnosis and therapeutic strategies for small bowel vascular lesions.World J Gastroenterol. 2019;25:2720-2733. doi:10.3748/wjg.v25.i22.2720Villano A.Gastrointestinal stromal tumors (GISTs). Merck Manual.Gupta A, Shetty S, Mutalik S, et al.Treatment ofH. pyloriinfection and gastric ulcer: need for novel pharmaceutical formulation.Heliyon. 2023;9(10):e20406. doi:10.1016/j.heliyon.2023.e20406MedlinePlus.Black or tarry stools.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ansari P.Overview of gastrointestinal bleeding. Merck Manual.Vakil N.Peptic ulcer disease. Merck Manual.Ansari P.Varices. Merck Manual.Lynch KL.Mallory-Weiss syndrome. Merck Manual.Grossi L, Ciccaglione AF, Marzio L.Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?World J Gastroenterol. 2017;23:3011-3016. doi:10.3748/wjg.v23.i17.3011Ansari P.Vascular gastrointestinal lesions. Merck Manual.Sakai E, Ohata K, Nakajima A, Matsuhashi N.Diagnosis and therapeutic strategies for small bowel vascular lesions.World J Gastroenterol. 2019;25:2720-2733. doi:10.3748/wjg.v25.i22.2720Villano A.Gastrointestinal stromal tumors (GISTs). Merck Manual.Gupta A, Shetty S, Mutalik S, et al.Treatment ofH. pyloriinfection and gastric ulcer: need for novel pharmaceutical formulation.Heliyon. 2023;9(10):e20406. doi:10.1016/j.heliyon.2023.e20406MedlinePlus.Black or tarry stools.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ansari P.Overview of gastrointestinal bleeding. Merck Manual.Vakil N.Peptic ulcer disease. Merck Manual.Ansari P.Varices. Merck Manual.Lynch KL.Mallory-Weiss syndrome. Merck Manual.Grossi L, Ciccaglione AF, Marzio L.Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?World J Gastroenterol. 2017;23:3011-3016. doi:10.3748/wjg.v23.i17.3011Ansari P.Vascular gastrointestinal lesions. Merck Manual.Sakai E, Ohata K, Nakajima A, Matsuhashi N.Diagnosis and therapeutic strategies for small bowel vascular lesions.World J Gastroenterol. 2019;25:2720-2733. doi:10.3748/wjg.v25.i22.2720Villano A.Gastrointestinal stromal tumors (GISTs). Merck Manual.Gupta A, Shetty S, Mutalik S, et al.Treatment ofH. pyloriinfection and gastric ulcer: need for novel pharmaceutical formulation.Heliyon. 2023;9(10):e20406. doi:10.1016/j.heliyon.2023.e20406MedlinePlus.Black or tarry stools.
Ansari P.Overview of gastrointestinal bleeding. Merck Manual.
Vakil N.Peptic ulcer disease. Merck Manual.
Ansari P.Varices. Merck Manual.
Lynch KL.Mallory-Weiss syndrome. Merck Manual.
Grossi L, Ciccaglione AF, Marzio L.Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?World J Gastroenterol. 2017;23:3011-3016. doi:10.3748/wjg.v23.i17.3011
Ansari P.Vascular gastrointestinal lesions. Merck Manual.
Sakai E, Ohata K, Nakajima A, Matsuhashi N.Diagnosis and therapeutic strategies for small bowel vascular lesions.World J Gastroenterol. 2019;25:2720-2733. doi:10.3748/wjg.v25.i22.2720
Villano A.Gastrointestinal stromal tumors (GISTs). Merck Manual.
Gupta A, Shetty S, Mutalik S, et al.Treatment ofH. pyloriinfection and gastric ulcer: need for novel pharmaceutical formulation.Heliyon. 2023;9(10):e20406. doi:10.1016/j.heliyon.2023.e20406
MedlinePlus.Black or tarry stools.
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