What Causes Black or Tarry Stool?

Black stool refers to a condition in which your stool is an unusually dark color. Stool is the bodily waste left over after digestion. Stool is also known as poop, bowel movements, or feces.

You may have black poop because of certain foods, medications and supplements, or underlying medical problems.

Black stool isn't always something to worry about, but it can sometimes be a sign of a serious health condition. To rule out a life-threatening condition, contact your healthcare provider right away if:

• You have a history of gastrointestinal (GI) bleeding
• Your stool has an especially foul smell
• The problem lasts longer than a few days

This article explores the causes of black or tarry stool. It explains some of the more serious health problems associated with it and outlines common treatments for black stool caused by medical conditions.

Food and Supplements

Black stools could be caused by food, supplements, medication, or minerals. Iron supplements, taken alone or as part of a multivitamin for iron-deficiency anemia, may cause black stools or green stools.

Foods that are dark blue, black, or green may darken your bowel movements. The following foods and substances can lead to black stool:

• Black licorice
• Blueberries
• Blood sausage
• Lead
• Bismuth subsalicylate (Pepto-Bismol)

If you can't trace your black stool to something you ate, talk to your doctor to find other possible causes.

If there's no obvious reason for a black stool, it could be time to look for blood in the stool. Various medical reasons can cause tarry, black stools with a foul smell.

Blood in the Stool (Melena)

Blood that comes from the upper GI tract—such as the esophagus or the stomach—may turn the stool black. This is a condition called melena. If you have melena, you may also notice that your stool has a tarry texture or is similar to coffee grounds.

Blood changes from red to black as it passes through the body and interacts with enzymes, substances that help digest food in the GI tract.

This makes it a bit more difficult to tell if there is red blood in or on the stool.

Bright red blood in or on the stool is typically blood from the lower GI tract, such as the rectum or the colon. This is a condition called hematochezia. Blood stemming from this region will be redder in appearance because it will be exposed to less of the digestive process.

Some people are more likely to develop bleeding in the GI tract. Talk to your doctor if any of these risk factors apply to you:

• Liver disease
• Cancer
• Dieulafoy lesion (a rare condition of the stomach)
• Erosive esophagitis (inflammation in the esophagus)
• Erosive gastritis (inflammation in the stomach)
• Intestinal ischemia (when blood supply to the intestines is cut off)
• Peptic ulcers (sores in the stomach lining or upper part of small intestine)
• Tear in the esophagus (Mallory-Weiss tear)
• Varices (abnormally large veins) in the esophagus or stomach

Diagnosis

Seeing the black color is not enough to determine whether or not there's blood in your stool. Remember, it could be caused by food or iron supplements. A healthcare provider needs to confirm if there's blood. That requires several types of tests.

Your doctor will have you collect a small stool sample at home using a special kit. The sample is then sent to a lab for evaluation.

If you're diagnosed with melena, doctors may order further diagnostic tests to determine the cause and the exact location of the bleeding.

Specifically, your doctor may conduct an esophagogastroduodenoscopy (EGD, or upper endoscopy). This procedure involves inserting a flexible tube with a camera down your throat so that your healthcare provider can inspect the lining of the esophagus, stomach, and upper intestine.

Causes of Blood in Stool

Black, tarry stool typically indicates the presence of an acute condition in the upper GI tract. After the bleeding has stopped, stool may continue to appear black and tarry for several days.

Possible causes of blood in the stool include:

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

Ulcer

An ulcer is a type of sore on the stomach lining that can cause bleeding and melena. Contrary to popular belief, stomach ulcers are not usually caused by stress or spicy food, although these can aggravate an already existing ulcer.

In fact, stomach ulcers are usually caused by an infection with bacteria called Helicobacter pylori (H. pylori). Long-term use of pain medications, known as nonsteroidal anti-inflammatory drugs (NSAIDs), is another cause of stomach ulcers.

NSAIDs include common over-the-counter drugs, such as ibuprofen, naproxen sodium, and aspirin. Some NSAIDs are prescribed by healthcare providers.

NSAIDs can irritate the stomach by weakening the lining's ability to resist acid made in the stomach. For this same reason, NSAIDs have an adverse effect on Crohn's disease and ulcerative colitis—conditions that cause ulcers and inflammation of the GI tract.

Gastritis

Gastritis is inflammation of the stomach lining. This inflammation can be caused by too much alcohol, eating spicy foods, smoking, infection with bacteria, or prolonged use of NSAIDs. Gastritis can also develop after surgery or trauma or may be associated with already existing medical conditions.

Gastritis left untreated can lead to stomach ulcers and other complications. Some people have no symptoms. Acute, suddenly occurring cases of gastritis may only result in tarry, black stool.

Persistent bleeding can lead to more severe symptoms like:

• Abdominal pain
• Lightheadedness
• Nausea
• Vomiting
• Indigestion
  

Esophageal Varices

Esophageal varices are enlarged veins in the wall of the lower esophagus or upper stomach. When these veins rupture, they may cause bleeding and lead to blood in the stool or in vomit.

Esophageal varices are serious complications resulting from high blood pressure brought on by cirrhosis of the liver.

Most people with esophageal varices experience no symptoms unless the veins rupture. Symptoms of bleeding esophageal varices include:

• Melena
• Vomiting blood
• Lightheadedness
• Fainting

Mallory-Weiss Tear

Mallory-Weiss tear is a tear in the mucous membrane that joins the esophagus and the stomach. If this tear bleeds, it can result in melena.

This condition is fairly rare. It only only occurs in about seven out of 100,000 people in the US and may be caused by violent vomiting, coughing, or epileptic convulsions. About 5% of people with a Mallory-Weiss tear do not survive.

Like other conditions that cause melena, symptoms of a Mallory-Weiss tear may not be obvious. Along with tarry, black stool, some people may experience any of the following:

• Vomiting tarry blood
• Lightheadedness (presyncope)
• Shortness of breath (dyspnea)
• Diarrhea
• Abdominal pain
• Chest pain
  

Treatment

Treatment of black stool depends on the cause. It can include both medications and procedures to stop the bleeding.

Stomach Ulcers

Stomach ulcers caused by an infection may be treated with antibiotics. Your healthcare provider may also recommend an acid reducer. Ulcers from NSAIDs usually heal after you stop taking the drug.

Gastritis

If your doctor suspects gastritis, they may prescribe:

• Antacids or proton pump inhibitors
• Antibiotics that treat H. pylori infection
• Sucralfate (a drug that helps the stomach heal by soothing irritation)

If these treatments fail to resolve your symptoms, your healthcare provider may order an upper endoscopy to take a closer look at your stomach and small intestine.

Esophageal Varices

Esophageal varices requires immediate medical care to help stop the bleeding.

Elastic bands may be wrapped around the varices to stop the flow of blood. Stents, tubes inserted to manage blood flow, may be used to lower blood pressure. That can reduce the amount of bleeding.

Mallory-Weiss Tear

In the case of a Mallory-Weiss tear, the tear heals on its own for most people.

If it doesn't resolve itself, you may need treatment to seal the lesion. This may either take the form of a medication injected internally, or a heat therapy known as electrocoagulation.

Summary

Black stool isn't always a sign of a bigger health problem. Your poop may look black as a result of food you ate or iron supplements you took. If that's the case, the color of your poop will return to normal within a day or so.

If it doesn't, and if you cannot trace it back to something you have eaten, ask yourself:

• Does the stool have a tarry appearance, somewhat like coffee grounds?
• Is there an especially foul smell that has not gone away?
• Does my medical history place me at risk for gastrointestinal bleeding?

If you answered yes to one or more of these questions, or if you're experiencing symptoms like nausea, vomiting, or lightheadedness, you should contact your doctor.