| Subject | Contents |
| Definition | "Melena" is the passage of black, tarry and foul-smelling stools. ";Hematochezia"; is the passage of red, or maroon-colored stools. |
| Alternative Names | Blood in the stool; Hematochezia; Melena; Stools - black or tarry |
| Considerations | Blood, as 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 GI tract. At least 6 Tablespoons (or 200 milliliters) of blood must have been lost in order to cause passage of melena. Maroon-colored stools or bright red blood usually suggest that the blood is coming from large bowel or rectum. However, sometimes hematochezia can be caused by massive upper GI tract bleeding, See also GI bleeding . The ingestion of black licorice, lead, iron pills, Pepto-Bismol, or blueberries can all cause black stools or false melena. Stools should be tested for the presence of hidden blood. Some upper GI causes of bloody stools can also cause vomiting blood such as in peptic ulcer disease. |
| Common Causes | bleeding '>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 reliable. A definitive diagnosis will require radiographic and/or endoscopic investigation. Black color: bleeding ulcergastritis esophageal varices Mallory-Weiss tear (a tear in the esophagus from violent vomiting) Maroon color: all the causes of black color stool diverticular bleeding vascular malformation intestinal infection (such as bacterial enterocolitis) inflammatory bowel diseasetumor colon polyps or colon cancer Bright red color: all the causes of black or maroon color stool hemorrhoids anal fissures ("cracks" in the anal area) |
| Home Care | Immediate medical management under the doctor's direction is required. |
| Call your health care provider if | Any evidence of GI bleeding occurs. There is any change in the color of the stool. Don't rely on visual impressions; always test it or have it tested. Home kits can be purchased at the drugstore, online, or you can send a specimen to the doctor. There is blood in the stool. DO NOT take it lightly. Make an appointment to see the doctor right away. Ask to see a gastroenterologist, a doctor that specializes in diseases of the digestive tract. The doctor will decide on the appropriate tests to determine the cause of blood in stool. |
| What to expect at your health care provider's office | The medical history will be obtained and a physical examination performed. Medical history questions documenting bloody or dark stools in detail may include: 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? Is there abdominal pain ? Are you vomiting blood ? Is there bloating ? Is there excessive gas (flatus) ? Is there diarrhea ? The physical examination will probably include emphasis on the abdominal and rectal regions. Depending on the nature of the bleeding, your doctor will manage the bleeding differently. Mild bleeding from hemorrhoids or mild GI infections can be managed on an outpatient basis. However, for other more serious bleeding, you may need to be admitted to a hospital for monitoring and workup. If there is evidence of massive bleeding, the patient 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: blood studies including a CBC and blood differentialcolonoscopygastroscopy or EGD bleeding scan angiography barium studies stool cultureX-rays of the abdomen After seeing your health care provider: If a diagnosis was made by your health care provider related to bloody or dark stools, you should note that diagnosis in your personal medical record. |
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