Black bowel movements - causes and treatment

Black bowel movements - causes and treatment

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The chair can turn black in color for various reasons, with various serious illnesses being possible triggers. Certain food or medication may also cause black bowel movements. We explain symptoms, causes and therapies in an understandable way.


In the broadest sense, a black chair is to be understood as all black discoloration of the feces. If the stool is deep black, foul-smelling and slightly shiny, it falls under the name of the so-called tar chair, which is usually caused by bleeding in the upper digestive tract. Black stool, without the typical optical and olfactory characteristics (olfactory characteristics), must be clearly differentiated from the tar stool, since the use of medication or certain foods can also cause the color to change here. The same applies to chairs whose color is slightly brownish. The deep black first excretions to be observed in every newborn (so-called child's pitch or meconium) are not a digestive product and therefore cannot be equated with black bowel movements.

Symptom: black stool

Black stool in the form of a tar chair is caused by hematin in the stool. When the red blood pigment hemoglobin comes into contact with stomach acid, the hematin is formed by the oxidation of the iron it contains. Accordingly, the black discoloration of the tar chair is mostly the result of bleeding in the upper digestive tract. However, the haematin may be formed by bleeding in the small or large intestine even when the digestive process is very slow. If the released hemoglobin remains in the intestine long enough (five hours or more), bacterial decomposition to hematin begins. The tar chair is often accompanied by symptoms such as stinging abdominal pain, nausea and vomiting of blood (hematemesis). However, in the course of blood loss, other health impairments such as anemia (anemia) with a corresponding undersupply of oxygen in the entire organism as well as headaches, ringing in the ears, fatigue and loss of performance can occur. The tarry stool in late-stage stomach cancer is sometimes accompanied by a persistent feeling of fullness.

In contrast to the so-called tar stool, medication- or nutritional-related black or black-brown bowel movements often occur without further symptoms.

Causes of black bowel movements

The black stool in the form of the tar stool can in principle be caused by any disease that causes bleeding in the (upper) digestive tract. Gastric ulcers, gastritis (gastritis), varicose veins in the area of ​​the esophagus (esophageal varices) and stomach (gastric varices), inflammation of the esophagus, chronic inflammatory bowel diseases, bacterial intestinal infections or cancers in the gastrointestinal area can be mentioned as possible triggers of the bleeding. The bleeding is therefore often the result of serious illnesses and urgently requires medical care.

Stomach ulcers and inflammation of the stomach

If the black bowel movement is the result of a stomach ulcer, it is based on so-called ulcer bleeding. As complications in the course of a gastric ulcer, these are not uncommon and can cause vomiting of blood or so-called coffee grounds (vomit that appears like coffee grounds due to the hematin) in addition to the tarry stool. Since acute bleeding from a stomach ulcer can have life-threatening consequences, it must be stopped immediately.

In gastritis, the tar stool is an expression of bleeding from the inflamed mucosa. These usually only appear in an advanced stage of gastric mucosal inflammation and urgently require medical treatment. In the case of inflammation of the stomach, the tarry stool is often accompanied by pain in the abdominal area, but also behind the sternum, which is occasionally mistaken for heart pain. In rare cases, inflammation of the esophagus (esophagitis) also causes bleeding, which causes the stool to turn black. Both bleeding from inflammation of the stomach and blood loss from inflammation of the esophagus can cause anemia over time.

Varicose veins in the esophagus and stomach

Bleeding from varicose veins in the area of ​​the esophagus (esophageal varices) also sometimes causes black stool to be excreted. The veins in the area of ​​the esophagus are sometimes extremely thin-walled and can tear easily in the case of a varicose vein, which can result in heavy bleeding. At worst, blood loss is so serious that it can result in life-threatening shock. The vomiting of blood can also be observed relatively frequently here. Bleeding from varicose veins must be treated immediately as a medical emergency. Similar symptoms as with the bleeding of the esophageal varices can be expected if varicose veins tear in the stomach area.

If digestion is significantly slowed down, bleeding due to intestinal inflammation may also be the cause of the tar stool. The intestinal inflammation is usually caused by infections with bacteria or viruses. But parasites can also cause bleeding in the intestinal area. Gastric cancer is one of the most serious diseases that can cause bleeding in the upper digestive tract and black stool. This is favored by various risk factors, whereby in addition to gastric ulcers and gastric mucosal infections, bacterial infections with Helicobacter pylori, nutritional influences (e.g. too much nitrate or contaminated drinking water) and hereditary predisposition are to be mentioned.

Other causes of black stool

Black or black-brown stools do not necessarily have to indicate bleeding in the digestive tract, but can also be caused by certain foods. However, the appearance of the droppings in such cases does not correspond to the tar chair already mentioned. For example, eating large amounts of meat, black cherries, blackberries or blueberries also causes the stool to turn black. The same can be observed under certain circumstances after the intake of red wine. Taking coal tablets, iron supplements or other metal-containing medicines also often results in black bowel movements. Both the nutritionally related and most drug-induced dark stool discoloration is a harmless side effect. However, nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastric bleeding, which poses a significant health risk. In this case, however, the bowel movement shows the typical consistency and color as well as the foul smell of the tar chair.

Stool exams for diagnosis

In order to determine the cause of black bowel movements, in addition to a thorough questioning of the patient after eating in the past few days, taking medication and other complaints, a bowel examination is recommended. As part of a more extensive examination, bowel movements can be observed over a certain period of time and examined for consistency (solid, liquid), color (reddish-brown, green-brown, black or light-colored bowel movements), smell, quantity and ingredients. However, it is also possible to use a so-called hemoccult test to detect any blood that may be contained in a stool sample within a relatively short time. The test can be carried out at the doctor's, but can theoretically also be carried out at home using the appropriate test strips.

If blood cannot be detected in the stool, a large part of the more serious illnesses can be excluded from the outset as the cause of the black stool. In such cases, certain foods or medications usually trigger the discoloration of the feces. However, if the test is positive, further examinations in the sense of a clear diagnosis are urgently required. In addition to the stool examination, the accompanying symptoms can sometimes provide important information in the medical diagnosis. Furthermore, gastroscopy and taking tissue samples can be used to diagnose diseases such as gastric mucosal inflammation, stomach ulcers and stomach cancer. However, special ultrasound examinations, as well as imaging methods of computer tomography and magnetic resonance therapy are sometimes used in the course of the diagnosis. Blood tests can also provide information about possible infections in the intestine.

Therapy for black bowel movements

If bleeding in the digestive tract is the cause of black bowel movements, therapeutic measures are urgently needed. With bleeding in the stomach, esophagus or duodenum, these can often be remedied during gastroscopy using special procedures (so-called endoscopic hemostasis). If hemostasis is not successful in this way, an operation may be necessary. As soon as the bleeding has stopped, the underlying disease should be treated immediately. Different treatment methods are available depending on the different causes of black bowel movements. If, for example, an inflammation of the stomach has developed in the course of an infection with Helicobacter pylori, antibiotics are mostly used in conventional medicine. So-called acid inhibitors (antacids) are also used more often for inflammation of the esophagus and gastric mucosal infections in order to prevent further irritation of the tissue by gastric acid.

Treating the causes

In naturopathy, inflammation of the gastric mucosa and inflammation of the esophagus is often worked with healing earth or base powder, and with mucous, anti-inflammatory and tannin-rich medicinal plants to protect the mucous membrane. Acupuncture, aromatherapy and nutritional therapies are also often part of naturopathic treatment for gastric ulcers. In the course of therapy, particular attention is paid to the acid-base household. Schüssler salt therapy and homeopathy offer further naturopathic treatment approaches for gastritis or esophagitis. Measures of osteopathy are also sometimes used to mechanically influence the function of the esophagus and stomach. Naturopathy may have only limited treatment options for diseases that may cause bleeding in the digestive tract with a corresponding black stool. In case of doubt, conventional therapeutic measures cannot be avoided. (fp)

Photo 1: Evgen /

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Jörn Reckel, Wolfgang Bauer: Intestinal illness - everything sick: help with holistic therapy, Verlagshaus der Ärzte, 2016
  • Irmtraut Koop: Gastroenterology compact - Everything for clinic and practice, Thieme Verlag, 3rd edition, 2013
  • John Henry Clarke: Diseases of the Digestive Organs, Ahlbrecht Verlag, 1st edition, 2013
  • Nimish Vakil: Helicobacter pylori infection, MSD Manual, (accessed September 13, 2019), MSD

Video: Irritable Bowel Syndrome Symptoms, Treatment, Research (September 2022).


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