Melena (black stool) is a symptom of internal bleeding, usually in your upper gastrointestinal (GI) tract. The blood turns black as it travels through your digestive system before coming out in your poop.
“Melena” is the medical term for the black, tarry stool that comes from bleeding in your upper gastrointestinal (GI) tract. Black stool is a sign of older blood in your stool. The blood turns black and tarry while traveling through your GI tract from higher up, where it started — usually in your stomach or upper small intestine. Digestive chemicals interact with the blood during its journey, changing its color and texture.
Healthcare providers diagnose melena when they’ve confirmed that the color of your poop is, in fact, from internal bleeding. Black stool is often a sign of gastrointestinal bleeding, but not always. Certain medications, supplements and foods may also turn your poop black. In that case, it’s not called melena.
Melena is a sign of bleeding in your upper GI tract. But not all gastrointestinal bleeding turns black. If you’re bleeding from lower down, like in your large intestine, it’s more likely to come out looking red. Lower GI bleeding is fresher and has less distance to travel before it comes out in your poop.
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Melena comes from bleeding in your upper GI tract — usually your stomach or the upper part of your small intestine (duodenum). It could also be from your lower esophagus if you swallowed the blood. Rarely, it might be from your lower small bowel or upper large bowel, if your bowels move very slowly.
Causes of upper GI bleeding and melena may include:
Certain medicines, supplements and foods may stain your stool black, including:
A healthcare provider can test your stool to determine if it has blood in it. A provider will also ask you questions about your health history, your symptoms and the nature of your poop. They might ask:
Classic melena is jet black with a tarry, sticky consistency. This can be one way of distinguishing melena from stained-black stool. However, some causes of upper GI bleeding and melena can also cause diarrhea, making it wetter. A small amount of bleeding may look more dark brown than black.
Melena is known for its particularly strong, offensive odor. The smell is a byproduct of blood being broken down and digested in your GI tract. The longer it’s traveled, the darker and smellier it is. You won’t notice the same distinctive smell with stained-black poop, which doesn’t have blood in it.
Other symptoms can be a clue to what’s causing the bleeding or where it’s coming from. For example:
Abdominal pain may signal a stomach condition, like an ulcer, gastritis or gastropathy. Chest pain may be from your esophagus. Pancreatic conditions can cause either upper abdominal pain or back pain. If you feel no pain, you might have a silent ulcer, a tumor or a ruptured blood vessel in your GI tract.
Some people with upper GI bleeding also vomit blood. Blood in your vomit, and what it looks like, can be other clues. Fresh, red blood in your vomit suggests an active bleed in your stomach or esophagus. Dark brown, textured blood that looks like coffee grounds is older and suggests the bleeding has stopped.
If your healthcare provider suspects you have melena, they’ll start by testing your stool. A fecal occult blood test can determine if there’s blood in your stool that you can’t clearly see. But diagnosing melena is just the beginning. Your provider will then need to diagnose and address the cause of your bleeding.
Tests may include:
Treatment for melena involves:
Your healthcare provider will assess your overall condition to determine the treatment you need. Depending on how much blood you’ve lost, you may need IV fluids or a blood transfusion to restore your blood volume. Some people may even need intensive care before further testing or treatment.
Your provider can often stop active bleeding and prevent new bleeding with endoscopic therapies. During an upper endoscopy, they might seal the wound with electrocautery or by injecting medication into it. Sometimes, they place a clip or band on the blood vessel. Sometimes, stitches are needed.
Acid-blocking medications called proton pump inhibitors (PPIs) are often prescribed for ulcers, inflammation or erosion in your gastrointestinal lining. They promote healing and help protect the tissues from chemical damage. Some of the causes of melena will need more comprehensive treatment.
If your black stool looks tarry or sticky and has a strong smell, it might be melena. Melena means you’re bleeding somewhere inside. Internal bleeding is always serious, especially when you can’t tell if it’s stopped. The blood that turns your stool black has traveled some distance. By the time you notice melena, that blood may be a few days old. But you may still be bleeding and losing blood.
Go to urgent care or an ER if you have symptoms of severe bleeding, such as:
A note from Cleveland Clinic
Black stool (melena) is an odd thing to find, and you might not associate it with bleeding at first. Learning that there’s actually blood in your stool might be upsetting, and rightly so. While red blood is more recognizable, it also has more benign causes. The black blood that causes melena, however, comes from deep inside your body. Internal bleeding requires attention and care from a skilled healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 06/08/2023.
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