Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- Vomiting blood or coffee-ground vomit, and black, tarry stools, need emergency assessment.
- Fresh blood in the stool is not always “piles”; persistent bleeding needs checking.
- Endoscopy usually finds the source and can often treat it at the same time.
- Slow bleeding can cause anaemia over time without visible blood.
Overview
Upper GI bleeding comes from the food pipe, stomach or duodenum (for example ulcers, gastritis, swollen veins in the food pipe called varices in liver disease). Lower GI bleeding comes from the bowel or back passage (for example piles, polyps, colitis, diverticula and, less commonly, cancer).
Black stools usually mean blood from the upper gut has been digested. Bright red blood usually comes from the lower bowel or back passage, but heavy upper bleeding can also look red.
Causes and risk factors
- Peptic ulcers and gastritis, often related to H. pylori or painkillers
- Varices in people with cirrhosis
- Piles (haemorrhoids), anal fissures, polyps, colitis, diverticular disease, tumours
Symptoms
- Vomiting blood, or vomit that looks like coffee grounds
- Black, sticky, foul-smelling stools
- Bright red or maroon blood in the stool
- Dizziness, weakness, pale skin or a racing heartbeat
When to seek urgent medical care
- All of the above need urgent medical assessment. Go to an emergency department; do not wait for an appointment
- Repeated small blood loss can cause anaemia and should be investigated
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- Urgent assessment of blood pressure and blood count; fluids or blood transfusion if needed
- Endoscopy (upper endoscopy or colonoscopy) to find the source and, in many cases, treat it at the same time
Treatment
General approach
- Treatment depends on the cause and may include medicines, endoscopic treatment, or other procedures
- Do not take aspirin or anti-inflammatory painkillers unless a doctor has advised you to
- Bleeding from the back passage should not be assumed to be piles without assessment, especially if it persists or comes with weight loss, change in bowel habit or anaemia
What you can do
Common questions
Is black stool always dangerous?
Black, tarry, foul-smelling stool usually means bleeding in the upper digestive tract and needs urgent assessment. Iron tablets, bismuth and some foods can also darken stools, but if you are unsure, get checked.
اردو خلاصہ
خون کی قے، کالا چپچپا پاخانہ یا پاخانے میں تازہ خون فوری طبی توجہ کا تقاضا کرتا ہے۔ چکر، کمزوری یا دل کی تیز دھڑکن ہو تو بلاتاخیر ایمرجنسی جائیں۔ پاخانے میں خون کو ہمیشہ بواسیر نہ سمجھیں۔
Videos on this topic
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Black Stool & Blood Vomiting: Signs of Severe Liver Disease Explained
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.