GI Bleeding in Guwahati: Black Stool, Vomiting Blood

Go to the nearest emergency department now if you have:

Vomited blood — red, or dark like coffee grounds
Black, sticky, foul-smelling stools (melaena), or a large amount of red or maroon blood from below
Dizziness or fainting on standing, a racing heartbeat, cold sweaty skin or unusual paleness
Breathlessness, chest pain or confusion with any bleeding
Any bleeding if you have cirrhosis or liver disease, or take blood thinners

Do not wait for an OPD appointment, and do not drive yourself. Lie down, do not eat or drink, and take the list of your medicines with you.

What does the blood tell us?

The colour and the way blood appears point to where it is coming from. Upper bleeding (food pipe, stomach, first part of the intestine) is usually more dangerous than bleeding from the lower bowel, but both can be serious.

What you see	Usually means	Common causes
Vomiting blood (red or coffee-ground)	Upper GI bleed	Stomach or duodenal ulcer, swollen veins in the food pipe (varices), tear after severe retching, gastritis, tumour
Black, tarry, sticky, foul stool	Upper GI bleed (blood has been digested)	Same as above
Bright red blood on the paper, in the pan, or coating the stool	Usually lower bowel or anus	Piles, anal fissure, polyps, colitis, bowel cancer; a very brisk upper bleed can also look like this
Maroon stool mixed with blood	Either; needs urgent assessment	Colon or small bowel bleeding, or a heavy upper bleed
No visible blood, but tiredness, breathlessness or a low blood count	Slow, hidden bleeding	Ulcers, tumours, polyps, erosions, worm infection (hookworm)

Not every dark stool is a bleed. Iron tablets, bismuth medicines, and some foods and charcoal can turn stool dark. Iron stool is usually dark green-black and formed. Bleeding stool is tarry, sticky, shiny and has a distinct foul smell. If you are unsure, or feel unwell, get checked. Beetroot can also make stool look reddish.

What causes GI bleeding?

Upper GI bleeding

Peptic ulcers — most often from H. pylori infection or from painkillers (NSAIDs such as diclofenac, ibuprofen, aceclofenac, naproxen, or aspirin). Many people buy these over the counter and take them for months.
Varices — swollen veins in the food pipe or stomach in people with cirrhosis, from hepatitis B, alcohol or fatty liver scarring. Variceal bleeding is among the most serious digestive emergencies and needs urgent hospital care.
Gastritis and erosions — from alcohol, painkillers or severe illness.
Mallory-Weiss tear — a tear at the lower food pipe after forceful vomiting or retching.
Oesophagitis, tumours of the food pipe or stomach — Northeast India has high rates of both, and tobacco and areca nut add to the risk.

Lower GI bleeding

Piles (haemorrhoids) and anal fissure — the commonest causes of small amounts of bright red blood. They are common, but a diagnosis of piles should not be assumed when other features are present (see below).
Polyps and colorectal cancer
Colitis — ulcerative colitis, Crohn's disease, or infection
Fragile blood vessels (angiodysplasia) and diverticula, mainly in older people

Do not assume it is piles if you also have a change in bowel habit, weight loss, anaemia, a family history of bowel cancer, or if you are over 45–50 and have never had a colonoscopy. A colonoscopy is advised in these situations.

What happens in hospital

Stabilise first. Drips, blood tests and, when needed, a blood transfusion. Guidelines recommend a restrictive transfusion policy — usually transfusing when haemoglobin falls below about 7 g/dL (a higher threshold is used for people with heart disease) — because transfusing more than needed can raise the risk of re-bleeding, particularly in cirrhosis.
Risk assessment. Scoring systems help decide who needs admission and how urgently the scope is needed. Some low-risk patients can be managed safely as outpatients.
Medicines before the scope. An acid-reducing medicine is commonly started. If a cirrhosis-related (variceal) bleed is suspected, a drug that lowers pressure in the veins (such as terlipressin or octreotide) and an antibiotic are started at once.
Endoscopy. After resuscitation, upper endoscopy (gastroscopy) is generally done within 24 hours, and within 12 hours if varices are suspected. Bleeding is controlled during the same procedure with clips, heat treatment, injection, a haemostatic powder, or band ligation for varices.
After the scope. For a high-risk ulcer, high-dose acid suppression is given for about 3 days, then continued twice a day for 2 weeks or longer depending on the finding. H. pylori is tested for and treated.
If bleeding continues after endoscopic treatment, options include a repeat endoscopy, a procedure by an interventional radiologist to block the bleeding vessel (embolisation), a pressure-lowering procedure for varices, or surgery.

Lower GI bleeding: most stop on their own. Once stable, a colonoscopy after bowel preparation finds the source. If the bleeding is heavy or ongoing, a CT scan with contrast can locate it and guide treatment. See the preparation guide.

How safe is endoscopy during a bleed?

Emergency endoscopy is the main treatment for upper GI bleeding, and its risks (aspiration, perforation, re-bleeding, reactions to sedatives) are small compared with the risk of untreated bleeding. Even after successful treatment of a high-risk ulcer, roughly 1 in 10 re-bleed, mostly within the first 3 days, which is why people are watched in hospital. These figures are approximate and vary with the cause and the patient's health.

Had a bleed, or told you are anaemic?

After you are stable, send your discharge summary, endoscopy report and blood reports on WhatsApp before your visit. Follow-up consultations at Hayat Hospital and Apollo Clinic, Ulubari, and at outreach OPDs in Dimapur, Hojai, Tinsukia and Dibrugarh. This page is not for emergencies.

Call to book WhatsApp your reports

Preventing another bleed

Cause	What prevents a repeat
Ulcer from H. pylori	Treatment for 14 days, then a test at least 4 weeks later to confirm it is gone. Cured infection removes most of the risk of the ulcer returning.
Ulcer from painkillers (NSAIDs)	Stop the NSAID. Use paracetamol instead. If an NSAID is unavoidable, the lowest dose for the shortest time, together with a PPI. Be wary of unlabelled "joint pain" powders and remedies that may contain hidden steroids or NSAIDs.
Aspirin or clopidogrel for the heart or a stent	Do not stop on your own — the cardiologist and gastroenterologist decide together. Aspirin taken for heart protection is usually restarted within days once bleeding is controlled, with a PPI.
Blood thinners (warfarin, DOACs)	The decision to pause and restart is individual. Never stop or restart without advice.
Varices (cirrhosis)	Repeat band ligation every few weeks until the veins are gone, plus a beta-blocker (propranolol or carvedilol). Treat the cause of cirrhosis, stop alcohol completely, and see a hepatologist regularly. People with cirrhosis who have not bled should have a screening endoscopy — unless FibroScan and platelet count show a very low risk.
Piles	Fibre (isabgol), enough water, no straining or long sitting on the toilet. Banding or other procedures if bleeding continues. See a doctor if bleeding persists or other features appear.
Polyps	Removed at colonoscopy. A follow-up colonoscopy is scheduled by what was found.
Alcohol, gastritis	Stop or cut alcohol. Treat the underlying cause.

Anaemia with no visible bleeding

A low haemoglobin with low iron (iron-deficiency anaemia) in a man of any age, or a woman after menopause, should be assumed to be from slow bleeding in the gut until proven otherwise. Guidelines advise both a gastroscopy and a colonoscopy, plus a blood test for coeliac disease. Taking iron tablets for months without finding the cause can hide a treatable problem — or an early cancer.

In younger women, heavy periods are the commonest cause, but gut investigation is still advised if there are digestive symptoms, a family history of bowel cancer, or if the anaemia does not improve with iron. Hookworm and poor diet add to anaemia in many parts of Northeast India.

Common questions

I have black stools. Is it an emergency?

It can be. Black, sticky, foul-smelling (tarry) stool usually means bleeding from the food pipe, stomach or first part of the intestine, particularly if you also feel dizzy, weak or breathless — go to an emergency department. Iron tablets, bismuth, charcoal and some foods can darken stool too, but that stool is usually formed and not sticky or foul-smelling. If in doubt, get checked.

I see bright red blood on the toilet paper. Is it piles?

Often, yes — piles and anal fissure are the commonest causes. But blood with a change in bowel habit, weight loss, anaemia, a family history of bowel cancer, or in anyone over 45–50 who has not had a colonoscopy should be investigated rather than assumed to be piles.

I vomited a little blood after retching hard. Should I still go to hospital?

Yes. A tear in the lower food pipe (Mallory-Weiss tear) after forceful vomiting is a common, usually mild cause and often stops by itself, but blood in vomit can also come from an ulcer or varices. It needs a medical assessment.

Can painkillers cause stomach bleeding?

Yes. Diclofenac, ibuprofen, aceclofenac, naproxen and aspirin are among the commonest causes of ulcer bleeding, especially with long use, higher doses, older age or steroids. Paracetamol is safer for the stomach. If you must take an NSAID, ask about taking a PPI with it.

I have cirrhosis. Will I bleed from varices?

Not everyone does. Varices are checked for with an endoscopy (unless tests show a very low risk), and if they are large or high-risk, a beta-blocker or band ligation lowers the chance of a first bleed considerably. Any vomiting of blood or black stool in cirrhosis needs emergency hospital care.

Is endoscopy safe when I am bleeding? Can it be avoided?

For upper GI bleeding, endoscopy is both the test and the treatment, and it is recommended for nearly everyone. Its risks are small compared with continuing to bleed. It is done in hospital with monitoring, after you have been stabilised.

Can an ulcer bleed again?

Yes, particularly in the first few days, which is why you are monitored in hospital. Long-term, the risk is lowered by curing <i>H. pylori</i> (and confirming it is gone), avoiding NSAIDs, and completing the PPI course.

I am on aspirin or a blood thinner and I bled. Should I stop it?

Do not stop it on your own. For aspirin taken to protect the heart or a stent, stopping carries its own risk, so it is usually restarted within days once bleeding is controlled. For blood thinners, the decision depends on why you take them. Your gastroenterologist and cardiologist or physician decide together.

I am anaemic but see no blood. Could it be from the gut?

Yes. Slow, hidden bleeding is a common cause of iron-deficiency anaemia. In a man, or a woman after menopause, a gastroscopy and colonoscopy are generally advised to find the source, along with a coeliac blood test. Taking iron alone without finding the cause is not enough.

Written and medically reviewed by Dr. Mayank Agarwal, MBBS, MD (Medicine), DM (Gastroenterology) · Assam Medical Council Reg. No. 19633 · Last reviewed: 14 October 2026

This page gives general information about gastrointestinal bleeding. It does not replace urgent medical care or a consultation. If you are bleeding now, go to the nearest emergency department. Please do not start or stop any medicine — especially blood thinners or aspirin — without advice.

Based on:

Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol 2021;116:899–917. PMID 33929377.
Gralnek IM, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): ESGE Guideline – Update 2021. Endoscopy 2021;53:300–332. doi:10.1055/a-1369-5274.
de Franchis R, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2022;76:959–974. PMID 35120736.
Kaplan DE, et al. AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology 2024;79:1180–1211.
Sengupta N, et al. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol 2023;118:208–231.
Snook J, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021;70:2030–2051.

GI bleeding in Guwahati — black stools, vomiting blood, rectal bleeding