Common Causes of Red or Black Stool
Having red stools or black stools can cause a shock when you don’t know why it’s happening. Common reasons for a change in stool color include eating certain foods—especially those with artificial colors—and taking dietary supplements, such as iron.
The cause of red stools or black stools could be nothing to worry about, such as those that are caused by food coloring. It’s important to keep in mind, however, that red or black in the stool could be from bleeding in the gastrointestinal tract (stomach, small intestine, or large intestine).
Blood is a warning sign for both serious digestive problems, such as colon cancer, and relatively common and easily treated problems, like hemorrhoids. Find out if the change in your stool color could be from something you ate or if you actually do need to call your doctor.
Inflammatory Bowel Disease (IBD) as a Cause for Red or Black Stool
Some people with inflammatory bowel disease (IBD), especially those who’ve had surgery to remove part or all of the large intestine, may notice that they don’t digest food in the same way as before their surgery. This isn’t always a problem; it could be part of the “new normal” after having surgery.
Sometimes (a lot of times, in fact) foods with strong coloring (especially artificial coloring) can mean having stools that come out having those colors. The color will stop when that food is digested and leaves the body.
Medical Causes for Black Stool
Let’s take a look at some common causes of black stool. The medical term for stools that are black and foul-smelling because they contain blood is “melena.” To figure out how much blood is present in a black stool, a physician may order a fecal occult blood test.
Melena can be caused by 200 milliliters (or more) of blood being passed in the stool, which is also equivalent to a quarter of a cup or four tablespoons. The darkened color of the blood is a sign that the bleeding is coming from somewhere higher up in the digestive tract (the stomach or the small intestine) and not from the lower part, the colon.
If you think there is blood in your stool, contact your doctor immediately to have the cause checked out. This type of bleeding might be caused by:
- Medical conditions causing bleeding that results in acidified blood (blood from higher in the digestive tract)
- Bleeding ulcer
- Esophageal varices
- Tear in the esophagus from violent vomiting (Mallory-Weiss tear)
An ulcer is a sore on the lining of the stomach which can cause bleeding. Stomach ulcers are typically caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of over-the-counter or prescription pain medications called NSAIDs (nonsteroidal anti-inflammatory drugs).
Gastritis is the inflammation of the stomach lining and can be caused by overindulging in alcohol or food, eating spicy foods, smoking, infection with bacteria, or prolonged use of NSAIDs. Conditions that can lead to gastritis include pernicious anemia, autoimmune diseases, and chronic bile reflux.
A black stool caused by food, supplements, medication, or minerals (but not blood) might be called “false melena.” The stool might be black, but it doesn’t actually contain any blood.
Iron supplements, taken by many women to combat iron-deficient anemia, may cause stools to be black or even greenish in color. Multivitamins that contain iron may also have the same effect.
In addition, foods that are dark blue or black in color may cause black stools. Food and supplements that can cause black stool include:
- Black licorice
- Iron supplements or foods high in iron
- Pepto-Bismol (bismuth subsalicylate).
- Other foods dark in color
Medical Causes of Red or Maroon Stool
Now let’s discuss some causes of red stool. Stool that is red or maroon colored because it contains blood is called hematochezia. The brighter color of the blood is because it is coming from somewhere lower in the digestive tract, like the colon or the rectum.
If you see blood in the stool, it should always be checked out by a doctor. Causes of red blood in the stool can include:
- Anal fissures
- Colon polyps or colon cancer
- Diverticular bleeding
- Inflammatory bowel disease (IBD)
A common source of bright red blood in the stool or on toilet paper is hemorrhoids. Hemorrhoids are enlarged veins in the rectal area that may burst and bleed. Hemorrhoids are not usually serious and can often be treated effectively with OTC medications. Troublesome hemorrhoids that won’t heal may need to be evaluated by a physician to see if prescription medication is needed.
A fissure is a tear or ulcer in the lining of the anal canal (the last part of the rectum before the anus). Fissures can occur in anyone, but are more common in middle age or young adults and can cause bright red bleeding. Acute fissures generally heal with non-invasive treatments that are done at home.
Colon polyps can also cause red blood to appear in the stool. Polyps are growths on the inside of the colon that are believed to be the start of colon cancer. Blood that may be from polyps or colon cancer is not always visible in or on the stool. This type of blood is called “occult blood” and can be discovered with a simple stool test. The fecal occult blood test may be done as a screening tool for colon cancer.
IBD and diverticular disease are also sources of bleeding from the digestive tract.2 Both Crohn’s disease of the colon and ulcerative colitis can result in blood passed in the stool, frequently along with diarrhea. Pouches in the colon wall (known as diverticula) caused by diverticular disease may produce considerable amounts of blood in the stool.
Several different types of food with natural or artificial coloring may also cause red colored stools. These can include:
- Red gelatin, popsicles, or Kool-Aid
- Tomato juice or soup
- Large amounts of beets
Blood in the stool may not always be the result of a serious or chronic condition, but it should always be checked out by a physician.
Any change in bowel habits, such as color, odor, frequency, or consistency (constipation or diarrhea) that does not clear up within a few days, is a reason to make an appointment with a family practitioner or a gastroenterologist.
This is true even in the setting of IBD or other chronic illnesses because treatments might need to be changed.
In most cases, a change in stool color is caused by something in the diet and is not something to worry about. Thinking back over the past few days and the food eaten or supplements taken might give some clues as to why your stool might have an unusual color.
If a change in stool color cannot be explained for a dietary reason, goes on for a few days, or is accompanied by any other symptoms (such as diarrhea, constipation, weakness, or dizziness), talking to a doctor should be the next step.
Frank blood in the stool or passing blood with no stool should be reported to a physician as soon as possible. If there are extreme pain and blood loss, it may be necessary to go to the emergency room.
- Roath MC, Di palma JA. Correspondence: cefdinir and red stool. Gastroenterol Hepatol (N Y). 2013;9(6):338.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of GI Bleeding. Updated July 2016.
- Kim BS, Li BT, Engel A, et al. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467
- Boyle JT. Gastrointestinal bleeding in infants and children. Pediatr Rev. 2008;29(2):39-52. doi:10.1542/pir.29-2-39
- Ghassemi KA, Jensen DM. Lower GI bleeding: epidemiology and management. Curr Gastroenterol Rep. 2013;15(7):333. doi:10.1007/s11894-013-0333-5