Black Stool: Causes and When to Seek Medical Attention - Gastroenterology and Hepatology

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Black stool


Hello, doctor.
Yesterday, during bowel movement, the first two-thirds of the stool was black, well-formed, and of normal thickness, but it had a shiny surface! It was also more difficult to flush than usual (was it sticky?).
The remaining part was a normal coffee color.
I checked some information, and it says that gastrointestinal bleeding can result in tarry stools, which also have a shiny surface.
So I would like to ask the doctor if my situation qualifies as tarry stools and whether it could indicate gastrointestinal bleeding.
Six months ago, I vomited something resembling red bean porridge, but about a month ago, I had an endoscopy that showed only mild gastroesophageal reflux.

L, 20~29 year old female. Ask Date: 2020/04/09

Dr. Chen Shidian reply Gastroenterology and Hepatology


If there are no symptoms (such as abdominal pain), observation can be considered.
If there are concerns, a fecal occult blood test can be performed.

Reply Date: 2020/04/09

More Info


Black stool, or melena, can be a concerning symptom that often indicates gastrointestinal bleeding. Understanding its causes and when to seek medical attention is crucial for your health.

Causes of Black Stool
1. Upper Gastrointestinal Bleeding: The most common cause of black stool is bleeding in the upper gastrointestinal tract, which includes the esophagus, stomach, and the first part of the small intestine. When blood from these areas is digested, it can turn black and tarry. Conditions that can cause this include:
- Peptic Ulcers: Sores that develop on the lining of the stomach or the first part of the small intestine.

- Gastritis: Inflammation of the stomach lining.

- Esophageal Varices: Swollen veins in the esophagus that can rupture and bleed.

- Malignancies: Tumors in the gastrointestinal tract can also lead to bleeding.

2. Medications: Certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, can irritate the stomach lining and lead to bleeding.

3. Dietary Factors: Foods such as black licorice, blueberries, or foods with dark coloring can sometimes cause stool to appear black. Iron supplements can also lead to dark stools.

4. Other Conditions: Conditions like liver disease can lead to changes in stool color due to altered blood flow and bile production.


When to Seek Medical Attention
Given your description of the stool being black, shiny, and difficult to flush, it is essential to consider the possibility of gastrointestinal bleeding. Here are some guidelines on when to seek medical attention:
- Persistent Symptoms: If you notice black stools consistently over several days, it is crucial to consult a healthcare provider.

- Accompanying Symptoms: If you experience other symptoms such as abdominal pain, dizziness, weakness, or fainting, seek immediate medical attention.

- History of GI Issues: Given your previous experience of vomiting what appeared to be "red bean porridge," which may indicate a significant upper GI bleed, it is vital to discuss this with your doctor. Even though you had a gastroscopy a month ago that showed only mild gastroesophageal reflux, changes in your stool color warrant further investigation.


Diagnostic Steps
If you decide to seek medical attention, your healthcare provider may recommend several diagnostic tests, including:
- Stool Tests: To check for the presence of blood.

- Endoscopy: To visualize the upper gastrointestinal tract and identify any sources of bleeding.

- Imaging Studies: Such as a CT scan, to evaluate the abdomen for any abnormalities.


Conclusion
In summary, while black stool can sometimes be attributed to dietary factors or medications, it is often a sign of gastrointestinal bleeding, especially when accompanied by other concerning symptoms. Given your history and the characteristics of your stool, it is advisable to consult a healthcare professional promptly for a thorough evaluation. Early diagnosis and treatment are essential to address any underlying issues effectively.

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