Black stools may signal serious internal bleeding, warns surgeon

Black, tarry stools can be a critical warning sign of serious internal bleeding in the upper digestive tract, a condition that requires immediate medical attention. If left untreated, this bleeding can cause a sudden drop in blood pressure, leading to shock and potentially fatal outcomes.

Dr. Quek Yeow Ling, a general surgeon at Oriental Melaka Straits Medical Centre, explained that upper gastrointestinal (GI) bleeding, affecting the esophagus, stomach, or duodenum, is a medical emergency. She noted that while certain foods like black seaweed, black sesame, and blueberries, along with iron supplements, can darken stools, a distinction can be made. "However, if the stool is dark black like tar, sticky, and has a foul odor, it is likely a sign of internal bleeding," she stated. Other alarming symptoms include vomiting blood, dizziness, fainting, rapid heartbeat, shortness of breath, cold and clammy skin, and upper abdominal pain.

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However, if the stool is dark black like tar, sticky, and has a foul odor, it is likely a sign of internal bleeding.

Common causes of upper GI bleeding include stomach and duodenal ulcers, gastritis, and Mallory-Weiss tears from severe vomiting. Less common but serious causes include esophageal or stomach cancer. Individuals who regularly take painkillers, aspirin, blood thinners, consume excessive alcohol, smoke, are elderly, or have a history of untreated ulcers or liver disease are at higher risk.

Dr. Quek stressed the importance of seeking immediate medical help if unsure about the cause of black stools. "Do not wait at home or try to treat yourself. Go to the nearest hospital emergency department immediately," she advised. The primary diagnostic method is an upper GI endoscopy (OGDS), where a flexible tube with a camera is inserted through the mouth to locate the bleeding source. In many cases, bleeding can be stopped during the endoscopy using clips, injections, or heat therapy. Intravenous fluids, blood transfusions, acid-reducing medications, and radiological procedures are also part of the treatment, with surgery considered only in severe, unresponsive cases.

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Do not wait at home or try to treat yourself. Go to the nearest hospital emergency department immediately.