Ebony Diarrhea
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Ebony Diarrhea
Black Watery Diarrhea: 5 Causes & When To Worry.
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MD, Associate Lecturer of Gastroenterology and hepatology. An IBS sufferer, gut health enthusiast and witer.
Copyright © 2022 Oh My Gut | IBS and Gut Health Blog | By Dr. I. Farahat
Common causes of black watery diarrhea include:
Apparently, we are talking today about “black” and “watery diarrhea” and not “black stool”. So, what can cause both watery diarrhea and black stool?
From my experience dealing with hundreds of patients complaining of “black diarrhea”. A majority of them refer to the “dark” as “black”.
So, the first thing to make sure of the color of your diarrhea before you dive into the causes below.
“Dark brown” or “dark green” stools are different from black stools. So, notice the stool under sufficient light to make sure it is true black.
Black stool is a potentially serious condition that may reflect bleeding inside your gut tract. The amount of black diarrhea may reflect the “severity” of bleeding. If you have sudden massive black watery diarrhea, consult your health care provider immediately.
Black watery diarrhea due to bleeding inside your gut is a life-threatening condition, seek medical help if you have any of the below signs or symptoms.
peptic ulcer refers to a breakdown in the lining of your stomach or duodenum, which in turn can bleed and cause black watery diarrhea in server causes.
People usually have peptic ulcers due to the abuse of “Non-Steroidal Anti-Inflammatory Drugs” or due to H. Pylori infection.
In the United States, up to 73% of patients with Peptic ulcer disease (PUD) suffer from bleeding ulcers (causing vomiting of blood or black watery diarrhea) ( ref ).
How to suspect Peptic Ulcers (as a cause of black watery diarrhea).
How to deal if you suspect a Peptic ulcer as a cause of black watery diarrhea?
The active ingredient of Pepto-Bismol is called bismuth subsalicylate. it is used to treat:
Pepto-Bismol turns black inside your body. And it is common for people taking Pepto-Bismol to experience black stool, and even black tongue.
Black diarrhea starting after taking Pepto-Bismol is common, and you don’t have to worry.
If you took Pepto-Bismol for watery diarrhea, watery diarrhea can turn black after being yellow or brown.
If you are unsure, please consult your doctor or nurse.
Sudden black watery diarrhea in patients with chronic liver diseases (especially liver cirrhosis) usually indicates bleeding varices.
A varix is a dilated vessel in the wall of your esophagus (esophageal varix) or stomach (gastric varix). it is caused by failure of the liver to properly receive blood from your digestive tract, A condition called “portal hypertension”.
The condition is not confined to liver cirrhosis, other causes that can cause variceal bleeding include:
How to deal if you suspect bleeding esophageal varices:
As with any bleeding inside your digestive tract, you have to seek emergency medical help. time is critical, especially if you experience both vomitings of blood and black stool.
Another overlooked cause of gastrointestinal bleeding is medications that cause blood thinning.
Over-dosing or the wrong combination of the blood-thinning medication with other medication (such as antibiotics) without medical supervision can lead to bleeding.
Common blood-thinning drugs that can cause bleeding:
Any misuse of the above medications can result in bleeding from multiple sites of your body such as:
So, having black watery diarrhea while taking one of the blood-thinning medications mentioned above may indicate bleeding inside your gut.
The black watery diarrhea is more likely to be due to these medications if you experience bleeding from other sites such as under the skin, mouth, nose, …etc.
Get immediate help from your doctor if you experience black watery diarrhea while taking a blood-thinning medication.
Benign or malignant masses (tumors) inside your gastrointestinal tract can easily bleed.
This is more common with malignant forms such as cancer stomach or cancer esophagus. The mass usually ulcerates and causes bleeding which leads to black diarrhea in severe cases of massive bleeding.
The symptoms of gastrointestinal tumors vary according to the type and the side of the tumors, for example:
The condition is usually diagnosed by taking a biopsy from the bleeding lesion. Bleeding from gastric or intestinal cancer is considered more in older ages.
In rare cases, you may experience bleeding from abnormal “malformed” blood vessels inside your stomach or intestine.
The Problem with this type of bleeding is it almost has no symptoms. It presents with sudden massive bleeding, which in turn can cause black watery diarrhea and loss of large amounts of blood.
blood loss can range from mild undetectable bleeding to massive life-threatening blood loss with black to red stools.
Coincidences happen. you may get diarrhea at the same time you were eating black foods that causes blackish stools. And the result is “black watery stool”
Black foods that can cause blackish stool to include:
Another case that we frequently see in our practice is the swallowing of blood coming from the nose, mouth, or throat.
people with massive epistaxis or severe flooding per gum or mouth for any cause may swallow a large amount of blood.
This blood passes into the stool and turns its color black. Having black stool or black diarrhea after one or two days after an epistaxis attack ( ref ), tooth bleeding, or bleeding after a tonsillectomy operation may be a result of swallowed blood.
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"Is one episode of black diarrhea something to be concerned about?" "Is it serious?" The answer in most cases is yes. The biggest cause of black, tar like, loose stools or melena as medical people call it is bleeding from the upper gastrointestinal tract. This is dangerous and can be life threatening. Between 6% and 13% of cases lead to death.
Black feces can be caused by certain medicines and foods like iron tablets and seafood ink (false melena) but if you have diarrhea which is black, tarry and sticky, the most likely cause is your own blood.
This type of bowel movement will also have a very characteristic strong smell which is almost metallic, due to the hemoglobin in it which contains iron.
Bleeding from the upper gastrointestinal tract (the gullet/esophagus, stomach and first part of the small intestine) is four times more likely than from lower down and this is the bleeding which causes black diarrhea.
If this happens to you, you will be scared and will probably be asking yourself " why is my diarrhea black ? " but read on to find out what the cause might be and what action to take.
Photo (cropped) courtesy of Shriram Rajagopalan
As blood moves down through the intestinal tract enzymes start to digest it and this is why it turns from the bright red color of normal blood, to the black of partly digested blood.
This normally only happens when the blood has been in transit for some time and so points to bleeding higher up in the gastrointestinal system.
This is why if you are bleeding in the esophagus, the stomach or the small intestine you may have black diarrhea.
In rare cases the blood could be coming from lower down, if the bowels are functioning very slowly.
There are many different things that can cause the bleeding that leads to black tarry diarrhea. The most common causes
are peptic ulcers and varices (dilated veins in the esophagus or stomach).
Peptic ulcers occur in the stomach and the duodenum (the first part of the small intestine). They can cause erosion of large blood vessels leading to hemorrhage.
Most of these ulcers are caused by an infection with Helicobacter pylori.
This can be treated with medication to reduce the production of acid in the stomach and a course of antibiotics. However, any bleeding point must be found and stopped first.
Varices are associated with chronic liver disease. These dilated veins can rupture and cause severe life threatening bleeding.
Other black diarrhea causes from bleeding can include:
If there are no other reasons for your black diarrhea such as eating lots of false melena causing things then you should get medical attention quickly. Either go to ER or if you have other symptoms call an ambulance.
If you are bleeding then the quicker you receive treatment the higher your chance of having a good outcome.
If you are bleeding profusely then you can go into shock. This is when there is not enough blood circulating to keep your normal body systems working properly.
You may feel faint or dizzy, with pale, cold and clammy skin. You could have rapid breathing, a racing heart and even chest pain. You could feel confused or agitated, and you could even lose consciousness.
If you have any of these symptoms alongside your black diarrhea then you need to summon help urgently and you should lie flat and call 911 in the USA, 999 in the UK or the number in your area. You can elevate your legs if you do not have any injuries. Do not drink anything.
When you get to ER they will take a history as usual but they will principally be trying to work out how much blood you have lost and then they will look for the underlying cause of your problem and any related problem. For example people with cancer are more likely to have ulcers.
You will be put on a drip immediately and given replacement fluids. If your hemoglobin levels are low and you have signs of shock then you will be given a blood transfusion or plasma.
The main test that you will have is an endoscopy which is done under sedation. This means that a camera will be introduced into your gastrointestinal tract to look for the source of the bleeding that is causing your black diarrhea.
There are different types. A gastroscope is used to look at the food pipe and the stomach, a colonoscope is used to look at the large bowel and a new instrument called an enteroscope can now be used to look at the small bowel. For more information about how a colonoscopy is done see here .
In patients who are unstable this will be done immediately and other people should have this test within 24 hours. Sometimes an angiogram (a special x-ray which looks at blood vessels) is used where endoscopy fails to find the bleeding point.
Other tests will include blood tests, x-rays and scans.
Often the bleeding from an ulcer or caused by other things like medications can be stopped during endoscopy. This is done either mechanically with clips or using a heat probe and often in conjunction with blood clotting injections. If this method fails surgery may be needed.
The treatment of varices is slightly different. Sometimes a balloon is inflated in the esophagus as a temporary measure. The bleeding is stemmed during endoscopy using tiny elastic bands to tie off the ruptured veins. If this band ligation does not work then shunts called TIPS may be used. The drug Terlipressin or similar is usually given to raise blood pressure, and a course of antibiotics is started.
The thought of having these tests can be scary and people also feel embarrassed but remember the medical staff are used to this kind of thing.
When they see or hear about black tarry diarrhea they don't think 'yuck!' they immediately think about what it could mean, what tests are needed and how they can help you get over your problem and in some cases save your life!
So if you have black diarrhea, unless you have been gorging on black pudding or Guinness and feel perfectly well, then you have an urgent situation on your hands and should get help straight away.
The more quickly you act the more likely it is that you will have a happy outcome.
If you find yourself in this situation, then you are going to live through a few scary moments. Although it is hard to do, try and keep calm and get to the people who can sort you out. This is not a wait and see scenario.
If you feel well and suspect that the black color of your feces is caused by something you have ingested please see this article on black poop .
Whatever your problem turns out to be DiarrheaNurse wishes you a speedy recovery.
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People who have watery, black diarrhea may be suffering from an infection, pancreatitis, irritable bowel disease or colon cancer, according to WebMD. Black stools are often accompanied by abdominal or rectal pain, fever, and signs of dehydration.
Chronic diarrhea can result from exposure to parasites or bacteria when people ingest contaminated food or water, explains Mayo Clinic. Certain medications such as antibiotics or viral infections also cause chronic diarrhea that can appear black and watery. People who are lactose intolerant yet consume dairy products often struggle with diarrhea.
Diarrhea is commonly accompanied by bloating in the stomach, cramps, an urgent feeling to have a bowel movement, and nausea or vomiting, according to WebMD.
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