Answers
Vomiting blood or black stools: what should I do?
Short answer
Vomiting blood, or passing black, sticky, tar-like stools, usually means bleeding from the food pipe, stomach or duodenum. It is a medical emergency. Call 112 or go to the nearest emergency department. Most bleeding can be found and stopped by an endoscopy, ideally within 24 hours.
Signs of bleeding
Iron tablets and some stomach medicines can turn stools dark grey or black, but those stools are firm and not sticky or foul-smelling. If unsure, get checked.
- Vomiting fresh red blood, or dark 'coffee-ground' material
- Black, sticky, foul-smelling stools (melaena)
- Dizziness, fainting, sweating, a fast heartbeat or breathlessness
Common causes
- Ulcers in the stomach or duodenum, often from painkillers or H. pylori
- Varices: swollen veins in the food pipe from cirrhosis
- A tear in the food pipe after repeated vomiting, often after alcohol
- Severe inflammation of the food pipe or stomach
- Less often, a cancer
What to do right now
- Call 112 or go to the nearest emergency department; do not drive yourself
- Lie on your side if vomiting, and do not eat or drink
- Take a list of all your medicines, especially blood thinners, aspirin and painkillers
- Tell the doctors if you have liver disease or drink alcohol
What happens in hospital
Fluids, blood transfusion if needed, and medicines to reduce acid or, in liver disease, to lower pressure in the veins. An endoscopy finds the source and treats it: clips, injections or heat for ulcers, and banding for varices. Most people stop bleeding with this treatment. Afterwards, the cause is treated to prevent it happening again.
Eating after a bleed
Eat more
- Nothing by mouth until the doctors allow it, often after the endoscopy
- Then sips of water, followed by soft food such as khichdi, dal-rice and curd
- Iron-rich foods as you recover: dal, green leafy vegetables, eggs, meat
Cut down
- Alcohol, completely
- Painkillers for body pain without your doctor's advice
- Very hot, spicy or fried food in the first days
Good to know
- Iron tablets after a bleed turn stools black; that is expected and different from melaena.
- With varices, a low-salt diet and regular banding sessions prevent repeat bleeding.
Common questions
Does every bleed need an endoscopy?
Almost always. It finds the cause, stops ongoing bleeding and shows the risk of it happening again.
Can it happen again?
It can, if the cause continues. Treating H. pylori, avoiding painkillers, stopping alcohol and regular banding for varices greatly lower the risk.
Should I stop my blood thinner?
Never stop it on your own. The doctors treating the bleed and your heart doctor decide together when it is safe to restart.