Melena (Black Stool): Symptoms, Causes, Treatment

What are the symptoms of melena?

Melena is a condition characterized by the passage of black, tarry stools or feces, which is a sign of gastrointestinal bleeding. The symptoms of melena may vary depending on the severity and location of the bleeding. Common symptoms of melena include:

1. Black or tarry stools: The most common symptom of melena is the passage of black or tarry stools, which may be soft and sticky.
2. Abdominal pain: Abdominal pain or discomfort is common in individuals with melena, especially in the upper left quadrant.
3. Nausea and vomiting: Some individuals may experience nausea and vomiting, which can be due to the presence of blood in the stomach or small intestine.
4. Fatigue: Fatigue is a common symptom of melena, which may be due to blood loss or anemia.
5. Pale or yellowish skin: As a result of blood loss, the skin may appear pale or yellowish due to decreased blood circulation.
6. Lightheadedness or dizziness: Blood loss can cause lightheadedness or dizziness, especially when standing up quickly.
7. Rapid heart rate: A rapid heart rate can occur due to blood loss and decreased blood volume.
8. Low blood pressure: Blood pressure may decrease due to blood loss, which can lead to dizziness or fainting.
9. Darkening of urine: As a result of blood loss, the urine may appear dark yellow or cola-colored.
10. Decreased appetite: Loss of appetite is common in individuals with melena, especially if they are experiencing abdominal pain or nausea.

In severe cases of melena, individuals may also experience:

• Bloody diarrhea
• Abdominal tenderness
• Fever
• Chills
• Shock (in severe cases)

If you experience any of these symptoms, it’s essential to seek medical attention immediately as melena can be a sign of a serious underlying condition that requires prompt treatment.

What are the causes of melena?

Melena is a condition characterized by the passage of black, tarry stools or feces, which is a sign of gastrointestinal bleeding. The causes of melena can be broadly classified into three categories:

1. Upper gastrointestinal tract bleeding:
   • Peptic ulcer disease: Bleeding from peptic ulcers in the stomach or duodenum (the first part of the small intestine).
   • Gastroesophageal reflux disease (GERD): Bleeding from the esophagus due to acid reflux.
   • Esophagitis: Inflammation of the esophagus, which can cause bleeding.
   • Zollinger-Ellison syndrome: A rare condition characterized by a tumor in the pancreas that produces excessive gastrin, leading to hypergastrinemia and peptic ulcer disease.
2. Lower gastrointestinal tract bleeding:
   • Hemorrhoids: Bleeding from swollen veins in the rectum or anus.
   • Diverticulosis: Bleeding from small pouches in the wall of the colon.
   • Colorectal cancer: Bleeding from cancerous tumors in the colon or rectum.
   • Inflammatory bowel disease (IBD): Chronic inflammation of the colon, which can cause bleeding.
3. Other causes:
   • Gastrointestinal infections: Bacterial or viral infections such as Salmonella, Campylobacter, or Norovirus can cause bleeding.
   • Irritable bowel syndrome (IBS): A chronic condition characterized by abdominal pain, bloating, and changes in bowel habits, which can cause bleeding.
   • Gastrointestinal angiodysplasia: Abnormal blood vessels in the gastrointestinal tract that can cause bleeding.
   • Celiac disease: An autoimmune disorder that causes damage to the small intestine and can lead to bleeding.

It’s essential to note that melena can be a symptom of an underlying condition that requires prompt medical attention. If you experience symptoms of melena, it’s crucial to seek medical help to determine the underlying cause and initiate appropriate treatment.

What is the treatment for melena?

The treatment for melena depends on the underlying cause of the bleeding. The goal of treatment is to stop the bleeding, manage symptoms, and prevent complications. Here are some common treatments for melena:

1. Blood transfusion: In severe cases of melena, blood transfusions may be necessary to replace lost blood and prevent anemia.
2. Medications:
   • Antacids or acid reducers: To reduce stomach acid production and help heal peptic ulcers or esophagitis.
   • Histamine-2 (H2) blockers: To reduce stomach acid production and help heal peptic ulcers or esophagitis.
   • Proton pump inhibitors (PPIs): To reduce stomach acid production and help heal peptic ulcers or esophagitis.
   • Anti-inflammatory medications: To reduce inflammation and alleviate symptoms in cases of inflammatory bowel disease.
3. Endoscopy: A procedure where a flexible tube with a camera and light is inserted through the mouth or anus to visualize the inside of the digestive tract and identify the source of bleeding.
4. Colonoscopy: A procedure where a flexible tube with a camera and light is inserted through the rectum to visualize the inside of the colon and identify the source of bleeding.
5. Surgery: In cases where bleeding is severe or persistent, surgery may be necessary to remove damaged or cancerous tissue.
6. Vasopressin injection: A medication that helps constrict blood vessels and reduce bleeding.
7. Octreotide injection: A medication that helps slow down gastric emptying and reduce bleeding from peptic ulcers or tumors.
8. Nutritional support: In severe cases of malnutrition or anemia, nutritional support may be necessary to help restore nutritional balance.

In addition to these treatments, other measures can be taken to manage symptoms and prevent complications:

• Rest: Avoid strenuous activities to prevent further bleeding.
• Fluid replacement: Drink plenty of fluids to prevent dehydration.
• Electrolyte replacement: Replace lost electrolytes with electrolyte-rich fluids or supplements.
• Pain management: Manage pain with medications such as acetaminophen or ibuprofen.

It’s essential to work closely with a healthcare provider to determine the best course of treatment for melena.