Change in Bowel Habit

[031013]

I have HCC.  Over the past few weeks my condition has shown  signs of deterioration.  Ten days ago - coincidentally the same day I was soliciting a second medical opinion - I suffered severe muscle spasms and cramping in the lower back.  Until that day my stool pattern was normal and predicatable.  The next day, and every day since, my stool has been black.  It is not foul smelling, though, and I'm not sure what "tarry" means.  For the first three days I was taking Prednisone since I was being premedicated for CT scans and I'm allergic to the dye.  Since then low level morphine by pill has been added - average 10 mg per day as needed.  There are no other medications I take except Senicot for constipation.

I have a miserable constant stomach ache and slight ascites.  Since I find myself between doctors - my original oncologist, the new one who just ran all the latest tests, and a third facility considering me for TheraSpheres in conjunction with the new one, I'm not even sure who to contact or if I even need to contact someone about this change in bowl habit.

I am worrying myself to distraction over this and heaven knows I need to keep my immune system focused on the cancer and not other stresses.  Your advice is most welcome.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Black stools suggest an upper GI bleed.  Of course, there are other causes of black stools including eating black licorice, lead, iron pills, Pepto-Bismol (or similar medications containing bismuth subsalicylate) or blueberries.  

"Tarry" stools resemble tar - black and curdy.  Again, it is suggestive of an upper GI bleed.  

You have several risk factors for an upper GI bleed including your cancer and steroid use.  If your cancer is compromising your liver function to the point of failure, varicies can result in a upper GI bleed.  Other causes would include gastritis or esophagitis or a peptic ulcer.

In any case, an upper endoscopy should be considered to evaluate the source of the bleed.  This can be arrainged by your gastroenterologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

Black stool, unless you started taking iron or certain other things, likely means blood. When it's black instead of red, it means the blood is probably getting there from the stomach area, giving it time to be chemically changed before passing through. Tarry means sticky and black, like tar. You need to check in with your doctors and have it evaluated!

[031013]

Just as FYI - this turned out to be a major GI bleed.  We called the oncology nurse on call on Saturday after reading the response to my post and she said it did not necessitate a weekend response since the blood was not fresh.  On Monday we called my oncology case manager who discussed with the oncologist who said to get with my primary physician.  

By Tuesday I was in the Emergency Room and considered extremely critical.  I had lost over half my total hemoglobin; I spent the next two days in ICU and had a procedure that "band-aided" five varices that had been bleeding.  Then two days in a regular room and was released from the hospital yesterday.

Don't ever ignore black stools!