Fitness and health 20.2.2017 07:26 am

Gastrointestinal: Bleeding where you shouldn’t

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Signs to watch for include bloody bowel movements, or black, tarry stools.

Gastrointestinal (GI) bleeding is when bleeding occurs in any part of the gastrointestinal tract. GI bleeding itself is not a disease, but a symptom of any number of conditions. The GI tract includes your oesophagus, stomach, small intestine, large intestine (colon), rectum, and anus.

Any presence of blood in the stool (faeces) or in vomit is significant and needs to be evaluated in the emergency department. Black or dark stools may represent slow bleeding into the GI tract and should be treated by a doctor.

You may initially be diagnosed with gastrointestinal (GI) bleeding by your primary care provider (PCP), such as a family practitioner, an internist, or child’s paediatrician. You will likely be referred to a gastroenterologist, a specialist in the digestive tract, for further treatment.

The outcome of treatment for gastrointestinal bleeding greatly depends on several factors including:

  • The cause and location of the bleeding.
  • The rate of bleeding when the person sees a doctor.
  • Prior health problems and conditions.

Maintain a proper diet and take the medications prescribed as directed. The causes and risk factors for (GI) bleeding are classified into upper or lower, depending on their location in the GI tract.

Causes of upper GI bleeding include:

  • Peptic ulcers,
  • Gastritis (bleeding in the stomach).
  • Oesophageal varices.
  • Cancers, and inflammation of the GI lining from ingested materials.

Causes of lower GI bleeding include:

  • Diverticular disease (diverticulitis)
  • Gastrointestinal cancers.
  • Inflammatory bowel disease (IBD, Crohn’s disease, ulcerative colitis).
  • Infectious diarrhoea.
  • Angiodysplasia.
  • Polyps.
  • Haemorrhoids.
  • Anal fissures.


Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black, tarry stools. Vomited blood from bleeding in the stomach may look like coffee grounds.

Symptoms associated with blood loss can include:

  • Fatigue.
  • Weakness.
  • Shortness of breath.
  • Abdominal pain.
  • Pale appearance.

Vomiting of blood usually originates from an upper GI source. Bright red or maroon stool can be from either a lower GI source or from brisk bleeding from an upper GI source. Long-term GI bleeding may go unnoticed or may cause fatigue, anaemia, black stools, or a positive test for microscopic blood.


  • Peptic ulcer disease: peptic ulcers are localised erosions of the mucosal lining of the digestive tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, causing abdominal bleeding.
  • Gastritis: general inflammation of the stomach lining, which can result in bleeding in the stomach. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces. Causes of gastritis include drugs such as nonsteroidal anti-inflammatory drugs, for example.
  • Oesophageal varices: swelling of the veins of the oesophagus or stomach usually resulting from liver disease. Varices most commonly occur in alcoholic liver cirrhosis. When varices bleed, the bleeding can be massive, catastrophic and occur without warning.
  • Mallory-Weiss tear: a tear in the oesophageal or stomach lining, often as a result of severe vomiting or retching. Mucosal tears also can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth.
  • Cancer: one of the earliest signs of oesophageal or stomach cancers may be in the vomit or stool. v Inflammation: when the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid.
  • Diverticulosis: one of the most common causes of lower GI bleeding. Small out-pockets, or diverticula, form in the wall of the colon, usually in a weakened area of the bowel wall.


  • Cancers: one of the early signs of colon or rectal cancers may be blood in the stool.
  • Inflammatory bowel disease (IBD): flares of inflammation from IBD (Crohn’s disease and ulcerative colitis) often cause mucousy stool that has blood mixed in it.
  • Infectious diarrhoea: some viruses or bacteria can cause damage to the inner lining of the intestines, which can lead to bleeding.
  • Angiodysplasia: along with diverticulosis, this is one of the most common causes of lower GI bleeding. Angiodysplasia is a malformation of the blood vessels in the wall of the GI tract.
  • Polyps: intestinal polyps are noncancerous tumours of the GI tract, occurring mostly in people older than 40. A small proportion of these polyps may transform into cancer.
  • Haemorrhoids and fissures: haemorrhoids are swollen veins in and around the anus. Repeated stretching from straining during bowel movements causes them to bleed.

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