Black Stool (Melena): Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 2, 2026.
What kind of doctor treats Black Stool (Melena)?
A primary care doctor is often the first person to see and can order tests and start treatment, referring to a gastroenterologist, a specialist who performs endoscopy, if upper digestive bleeding is suspected. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is black stool or melena?
Melena is the medical word for black, sticky, tar-like stool. It happens because of blood that has traveled through the digestive tract and often signals bleeding in the stomach or first part of the small intestine, so it deserves a prompt medical visit.
Melena is not a disease itself but a sign of blood in the stool, usually from the esophagus, stomach, or small intestine. As the blood breaks down in the bowel, it turns the stool black and gives it a strong, foul smell.
Symptoms
The main sign is black, sticky, tar-like stool with a strong, foul smell. Other signs include belly pain, dizziness, tiredness, or vomiting blood or material that looks like coffee grounds.
Causes and who gets it
Common causes include stomach ulcers, irritation of the stomach lining, and torn blood vessels in the esophagus. People who take NSAIDs like aspirin or ibuprofen regularly, drink heavily, or have H. pylori are at higher risk, as are older adults.
How doctors diagnose it
Doctors ask about symptoms, medicines, and diet, then check blood counts and test the stool for blood. Endoscopy, a thin camera passed into the stomach, often finds the bleeding source.
Treatment
Treatment depends on the cause and how bad the bleeding is. Doctors may give IV fluids or blood transfusions if much blood was lost. Acid-lowering medicines help ulcers heal, and endoscopy can stop bleeding directly.
When to see a doctor
See a doctor promptly if your stool is black, sticky, and tar-like and you cannot explain it by iron supplements or Pepto-Bismol. Go to the emergency room right away if you also feel weak or dizzy, vomit blood or coffee-ground material, or have severe belly pain.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either type can spend extra time on problems like black stool and refer to a specialist when needed.
Common questions
Can certain foods or medicines make stool black without bleeding?
Yes. Iron supplements, bismuth medicines such as Pepto-Bismol, blueberries, and licorice can all turn stool dark or black. This is harmless and goes away after the item is stopped.
Is black stool always an emergency?
It always needs a medical visit, but not always an emergency room trip. If a person feels well and took iron or Pepto-Bismol, a routine visit may be enough. Weakness, dizziness, vomiting blood, or severe pain call for urgent care.
What does melena look and smell like?
Melena is black, shiny, sticky, and tar-like, often with a very strong, foul smell. Dark stool from food is usually more solid and less sticky.
Can ulcers come back after treatment?
They can, especially if a person keeps taking NSAIDs or H. pylori was not fully cleared. Doctors may retest for the germ, and long-term acid-lowering medicine sometimes lowers the chance of return.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
