What causes black stools and abdominal pain

Blood in the stool - what does the esophagus have to do with it?

The shock is great when you discover blood in the bowl after using the toilet. Out of shame or fear, many sufferers withhold their complaint from their doctor. But you shouldn't do that: because the blood in the stool is usually a warning signal from the body. The causes can be very diverse: ulcers, hemorrhoids or even chronic heartburn. It is important that the trigger is recognized and treated quickly.

The color of the bloody stool reveals the cause

If you notice that your stool looks reddish or black after going to the toilet, your body will in most cases lose blood somewhere in the digestive tract. The coloration will differ depending on what is causing the blood in the stool. Knows the bowel movement light red speckles (hematochezia), the trigger is usually in the middle or lower digestive tract. The following diseases, among others, can be responsible for this:

  • Gastrointestinal infection
  • hemorrhoids
  • Crohn's disease or ulcerative colitis (inflammatory bowel disease of unknown cause)
  • Intestinal polyps (protrusions of the mucous membrane that protrude from the lining of the intestine into the inside of the intestine)
  • Colon cancer

Black looking bowel movements (Melena or tarry stool), on the other hand, usually has its origin in the upper digestive tract. These diseases can be triggers:

  • Stomach ulcers
  • Stomach cancer
  • Mallory-Weiss syndrome (tears in the lining of the esophagus)
  • Inflammation of the stomach lining
  • Inflammation of the esophagus
This is how the black color of the stool is created

The black, shiny discoloration of the stool comes about because blood that escapes above the small intestine (i.e. into the mouth, esophagus or stomach) comes into contact with the acid in the stomach during the digestive process. Because the red pigment in the blood (hemoglobin) is broken down by stomach acid and bacteria, the stool takes on a black color and a tough consistency reminiscent of coffee grounds. An extremely foul odor is also characteristic of tarry stools.

Black stools - reflux can be to blame

A common cause of black bowel movements is reflux. Why this? In reflux disease, the acidic stomach contents enter the esophagus and irritate it. Since this is not an acute but a chronic condition, the esophagus can be severely damaged by the aggressive stomach acid: Due to the constant irritation, inflammation of the esophagus (esophagitis) is not uncommon. If this lasts longer, it can quickly happen that the irritated areas start to bleed - the result: black stools. In addition to the discolored excretion, those affected can recognize inflammation by the following signs:

Varicose veins in the esophagus can also be responsible for the blood in the stool. The thin-skinned veins that are located in the esophagus are only protected by the mucous membrane - they can therefore tear quickly, which then leads to bleeding.


Not every dark discoloration of your stool automatically means that you have blood in your stool. Do you consume iron supplements regularly or have you recently taken charcoal tablets? These can also be causes of a dark stool. Likewise, intensely red foods are like beetroot, red wine or blueberries responsible for a black coloration of the stool.

Blood in the stool: when is a doctor's visit necessary?

If food coloring or medication can be ruled out as the cause, it is important that those affected see a doctor immediately if they discover dark blood in the stool. Especially when accompanying symptoms like

  • Nausea,
  • Stomach pain,
  • Dizziness,
  • pale skin as well
  • Ringing in the ears and palpitations occur,

Rapid treatment is necessary as this may be a sign of severe blood loss.

Treatment options if the stool looks black

Usually there is one first at the doctor thorough questioning of the patient at. He then gives a stool sample, which the laboratory analyzes for changes in appearance, consistency, weight and smell. If the blood is not directly visible, there are other methods that can make it visible. With the precise analysis, it is then gradually deciphered which disease is possibly behind the black stool.

A gastroscopy is also typical, in which the doctor inserts a thin tube with a small camera into the end of the patient's mouth into the esophagus and stomach. The doctor can use the camera images to locate the cause of the bleeding very quickly. Under certain circumstances, he can also take tissue samples directly, remove possible ulcers and stop the bleeding.

Treatment options differ depending on the cause of the dark blood in your stool. If, for example, the esophagus is inflamed, acid inhibitors help to neutralize the stomach acid and thus relieve the esophagus. If it is found that stomach ulcers caused by bacteria are responsible for the black stool, the doctor usually prescribes antibiotics.


In addition to causes such as inflammation or ulcers in the upper digestive tract, the blood in the stool can also be caused by a serious illness such as stomach cancer. It is therefore important that you keep your cancer screening appointments on a regular basis. The earlier cancer is detected, the better the chances of being able to fight it. From the age of 50, a test for hidden blood in the stool is scheduled once a year, and from the age of 55, a colonoscopy every two years to prevent colon cancer.1

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