Melena is black or dark stools caused by bleeding in the upper digestive tract. Melena is a sign of a medical condition that needs to be treated immediately.

Melena occurs due to bleeding in one of the organs in the upper digestive tract, namely the esophagus, stomach, and duodenum (duodenum). In most cases, the cause of bleeding there is a stomach ulcer, bleeding from varicose veins in the esophagus (oesophagus), and tumors in the esophagus.

Causes of Melena

Blood in the stool can be red, like the normal color of blood. This condition can be caused by bleeding in the large intestine. Blood in the stool is red due to the close proximity of the large intestine to the anus.

Whereas in melena, blood in the stool is black. This is because blood has mixed with enzymes and stomach acid in the digestive tract.

Melena can be a sign of certain medical conditions, including:

1. Gastric ulcer or duodenal ulcer

Gastric ulcers are sores that form on the stomach wall. Meanwhile , duodenal ulcers are sores that appear in the duodenum. Injuries to both organs can cause melena if they bleed.

Gastric and duodenal ulcers are the most common causes of melena.

2. Mallory-Weiss syndrome

Mallory-Weiss syndrome is a condition characterized by tearing of the inner lining of the esophagus that borders the stomach. Melena occurs when this tear bleeds.

3. Rupture of esophageal varices

Esophageal varices are enlarged veins in the esophagus in people with cirrhosis . These esophageal varices can rupture so that they bleed and cause melena.

4. Esophagitis

Esophagitis is an inflammation of the esophagus that can be experienced by people with stomach acid or gastroesophageal reflux disease ( GERD ). This condition can cause bleeding, one of which is marked by melena.

5. Tumors

Melena is also a symptom of a benign tumor or a malignant tumor that grows in the esophagus or stomach.

In addition to the several medical conditions above, a person is at risk of developing melena if he takes drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), in the long term, or undergoes radiotherapy.

Symptoms of Melena

The main symptom of melena is blood in the stool, which causes tar-colored stools and a foul odor. Melena can also be accompanied by other symptoms, such as:

  • Abdominal pain
  • Dizzy
  • Nauseous
  • pale skin
  • Vomiting blood (hematemesis)

When to see a doctor

Immediately consult a doctor if you experience the above symptoms. Examination is also recommended if the symptoms get worse which is marked by breathing faster than usual, the skin feels cold, and restlessness.

Melena's diagnosis

The doctor will conduct a question and answer regarding symptoms and medical history, as well as the drugs the patient last consumed, followed by a physical examination. After that, the doctor will recommend further examinations, such as:

  • Stool test, to confirm the presence of blood in the stool
  • Blood tests, to check levels of oxygen, iron, and blood clotting function
  • Endoscopy , to see the condition of the upper digestive tract
  • X-rays or CT scans, to look for sources of bleeding in the upper digestive tract

Treatment of Melena

The treatment method for melena will be adjusted to the cause and severity. If the bleeding is quite a lot and occurs quickly, the doctor will first stabilize the patient's condition by giving an infusion and blood transfusion .

If the patient's condition has stabilized, the doctor will carry out further treatment, including:

1. Drugs

The doctor will give proton pump inhibitors , such as esomeprazole or pantoprazole , to reduce stomach acid production. Thus, bleeding due to stomach ulcers can be stopped.

2. Endoscopy

Endoscopic procedures may be performed to treat melena caused by ruptured esophageal varices.

3. Embolization

Embolization is done by injecting a special substance to close leaky or burst blood vessels.

4. Operation

Surgery is performed in cases of melena where no source of bleeding is found or when other treatments fail to resolve the bleeding. The aim of the operation is to repair the torn wall of the stomach or duodenum, so that the bleeding stops. Surgery may also be performed to remove a tumor that is causing bleeding.

Melena complications

Melena can cause serious complications if not treated immediately. Some of these complications are:

  • Anemia , if melena lasts a long time
  • Shock, if the cause of the bleeding is not treated immediately and gets worse

Prevention of Melena

Melena can be prevented by avoiding various causes of gastrointestinal bleeding. Various efforts that can be done to prevent bleeding are:

  • Quit smoking
  • Drink enough water
  • Check with your doctor if you have a stomach ulcer or GERD , so you can get the right treatment
  • Avoid taking NSAIDs or aspirin without a doctor's prescription, especially in the long term
  • Avoid excessive consumption of alcoholic and caffeinated drinks
  • Eat a complete and balanced nutritious diet
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