Melena (Black Stool): Cause, Symptoms and Treatment Options

• Ulcers
• Gastritis and
• Bleeding

Early detection and treatment are crucial in treatming Melena (black stool). Learn more about Melena symptoms, causes, and treatment options.

What Are the Common Causes of Melena?

Although hematochezia and Melena cause bloody stools, they each have different possible causes. It is caused by bleeding higher up in your digestive tract. Reasons for melena include:

• Peptic ulcers
• Gastric or esophageal varices
• Gastritis
• Stomach cancer or Gastric cancer
• Mallory-Weiss syndrome

Conditions that Cause Melena

• Gastrinoma (gastrin excess): gastric acid hypersecretion and ulcer formation.
• Gastrointestinal Stromal Tumor (GIST): A mesenchymal tumor of the GI tract that can ulcerate and bleed
• Gastric Antral Vascular Ectasia (GAVE or Watermelon Stomach): Dilated small blood vessels in the stomach lining that can be a chronic source of bleeding.
• Portal Hypertensive Gastropathy: Mucosal changes in the stomach seen in patients with portal hypertension, leading to bleeding.
• Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu syndrome): A genetic disorder, characterized by the presence of multiple, fragile blood vessels that bleed easily. This can occur throughout the entire GI tract.
• Dieulafoy's Lesion: a large-caliber arterial vessel in the wall of the stomach, can bleed tremendously and does so without a corresponding ulcer.
• Aortoenteric Fistula: It's a rare yet potentially life-threatening condition in which an abnormal connection is created between the aorta and the digestive tract, sometimes post aortic surgery.
• HIV/AIDS: Kaposi Sarcoma (GI involvement) it may cause bleeding in immunocompromised patients.
• Crohn's Disease (Upper GI involvement): Although infrequent, Crohn's can impact the upper GI tract and cause bleeding.
• Hemobilia: Bleeding into the biliary tract (e.g., due to trauma or tumor), which can then go into the GI tract and cause melena.
• Hemosuccus Pancreaticus: Bleeding from the pancreatic duct into the duodenum, usually secondary to chronic pancreatitis or pancreatic tumor

What Are the Symptoms of Melena?

• Black, tarry stools
• Foul-smelling stools
• Blood in stool
• Abdominal pain or discomfort
• Fatigue or weakness due to potential blood loss
• Nausea or vomiting (less common)
• Dizziness or lightheadedness (less common)

When to Visit a Melena Specialist?

Severe rectal bleeding can constitute a medical emergency. Visit the emergency department if you experience one of the following symptoms:

• Cold, clammy skin
• Confusion
• Continuous rectal bleeding
• Fainting
• Painful abdominal cramping
• Rapid breathing
• Severe anal pain
• Severe nausea

How Does a Specialist Diagnose Melena?

Here are a few melena diagnosis steps that doctors follow;

• Medical history: Including symptoms, past medical conditions, and medications.
• Physical examination: Checking for signs of bleeding and abdominal tenderness.
• Stool tests: Analyzing a sample of stool for the presence of blood.
• Endoscopy: Upper endoscopy or colonoscopy allows direct visualization of the gastrointestinal tract. This helps to identify the source of bleeding.
• Imaging tests: In some cases, imaging tests, such as abdominal ultrasound, CT scan, or angiography, may be necessary to locate the bleeding site.
• Laboratory Tests: Complete blood count (CBC) and coagulation studies, help assess the extent of blood loss and evaluate clotting function.

Treatment and Management of Melena

Melaena treatment depends on the underlying cause of blood in stool. Options may include;

• Medications to reduce stomach acid
• Endoscopic procedures to stop bleeding
• Surgery in severe cases

In cases of melena, patients are commonly admitted for observation and stabilization. Doctors will keep close track of vital signs, hemoglobin levels, and the color of his stool.

Fluid and Blood Replacement

• Dehydration is treated with intravenous (IV) fluids that help maintain blood pressure.
• You may need blood transfusions in the event of substantial blood loss.

Endoscopic Intervention

• Upper GI endoscopy (EGD) is done to identify and treat the source of bleeding.
• During endoscopy, treatments may also include:
• Injection therapy (i.e., epinephrine)
• Thermal coagulation
• Hemostatic clips or variceal banding

Treatment of Underlying Cause

• Ulcers: Treat with PPIs and H. pylori eradication if positive.
• Varices: Treated with endoscopic band ligation and medication for portal hypertension.
• Tumors or lesions: Possible need for biopsy, surgery or oncology referral.
• Surgical or Radiological Intervention
• If bleeding isn't able to be controlled with endoscopy, surgical intervention or interventional radiology (embolization) may be required.

How Can Melena Be Prevented?

To help prevent melena (black, tarry stool from GI bleeding):

• Use Medications Carefully: Limit NSAIDs and aspirin, as they can irritate your stomach.
• Limit Alcohol: Drinking too much can damage your stomach lining.
• Manage Stomach Issues: Treat ulcers, GERD, or other GI conditions as advised.
• Quit Smoking: Smoking increases stomach acid and ulcer risk.
• Treat Infections: Get treatment for H. pylori infections, a common ulcer cause.

These steps can help keep your stomach healthy and lower the risk of melena.

Lifestyle Changes for People with Melena

• Adopt a Soft, Non-Irritating Diet: Eat bland, easy-to-digest foods to reduce stress on the upper GI tract during recovery.
• Avoid Smoking and Alcohol: Both can irritate the GI lining and worsen bleeding or delay healing.
• Monitor and Limit NSAID Use: Only take anti-inflammatory drugs (like ibuprofen) under medical supervision, as they can worsen GI bleeding.
• Follow Medication Schedule Strictly: If prescribed acid suppressors (e.g., PPIs or H2 blockers), take them regularly to help heal the GI lining.
• Eat Smaller, Frequent Meals: This can reduce acid buildup and decrease pressure in the stomach, aiding recovery.
• Stay Hydrated with Non-Irritating Fluids: Choose water or electrolyte solutions to maintain hydration without aggravating the stomach.
• Manage Stress Levels: Psychological stress can increase stomach acid production and delay healing; techniques like mindfulness, therapy, or gentle exercise can help.
• Avoid Heavy Lifting or Straining: Straining may increase intra-abdominal pressure and raise the risk of rebleeding.
• Keep a Symptom Diary: Record any signs of recurrent black stools, fatigue, or dizziness to share with your doctor promptly.
• Attend All Follow-up Appointments: Regular monitoring is crucial to track healing and adjust treatment if needed.

Home Remedies for Melena (Post-Medical Treatment Support Only)

Melena (black, tarry stools) is often a sign of serious internal bleeding, especially from the upper gastrointestinal (GI) tract. Home remedies are not a substitute for medical treatment. However, once you've received medical care and your doctor approves, certain supportive remedies may help promote healing.

• Drink coconut water to soothe the stomach and stay hydrated.
• Consume aloe vera juice in moderation to support digestive health.
• Use turmeric milk (haldi doodh) for its mild anti-inflammatory effects.
• Eat boiled or steamed foods to reduce GI irritation.
• Add probiotics like curd or yogurt to help balance gut bacteria.
• Drink chamomile tea to calm the digestive system.
• Avoid spicy, oily, or acidic foods that can aggravate the GI tract.
• Use honey in warm water for a gentle soothing effect on the stomach.
• Rest and avoid physical strain to allow internal healing.