What to Tell a Patient with Black Stool (Melena)
You need to go to the hospital immediately for evaluation, as black tarry stools indicate bleeding in your digestive tract that requires urgent medical assessment and potentially life-saving treatment. 1
Why Hospital Evaluation is Critical
- Mortality risk is significant for patients with gastrointestinal bleeding, and early specialist intervention in a hospital setting reduces death rates compared to delayed treatment 1
- Hospital admission allows for immediate assessment of your blood pressure and heart rate, intravenous fluid resuscitation, blood transfusion if needed, and urgent endoscopy to both diagnose and potentially stop the bleeding 1
- Elderly patients (over 65 years) and those with heart, kidney, or liver disease face significantly higher mortality rates and require more aggressive management 1
What Will Happen at the Hospital
Immediate Assessment
- The medical team will check your vital signs and blood counts to determine bleeding severity 2
- Blood typing and cross-matching will be performed in case transfusion is needed 2
- You'll receive intravenous fluids and blood transfusions to maintain your hemoglobin above 7 g/dL (or 9 g/dL if you have massive bleeding or heart disease) 1, 2
Diagnostic Testing
- An upper endoscopy (EGD) will be performed within 24 hours as the first-line procedure, since the upper gastrointestinal tract is the most common source of melena 1, 3
- The most common causes include peptic ulcers, stomach erosions, esophagitis, varices, and tears in the esophagus 1
- If the upper endoscopy doesn't find the source, a colonoscopy may be performed, though the diagnostic yield is low (4.8%) after a negative upper endoscopy 4
Treatment
- If an ulcer is found and treated during endoscopy, you'll receive high-dose proton pump inhibitor therapy 1
- The endoscopy can often stop the bleeding through therapeutic interventions 1
Important Distinctions
Not all black stools are melena. Black stools that lack the sticky, tar-like consistency and characteristic foul odor typically do not represent blood and generally don't require urgent evaluation unless other concerning features are present 1. However, when in doubt, seek immediate evaluation rather than waiting.
Common Pitfalls to Avoid
- Don't delay seeking care hoping the problem will resolve on its own—early intervention saves lives 1
- Don't assume it's just hemorrhoids or something minor without medical evaluation 2
- Inform your doctors about all medications (especially blood thinners, aspirin, or anti-inflammatory drugs) and any recent dietary changes 1