Medical Oncologist
CION Cancer Clinics
Vomiting blood or passing black stools: go to hospital now | CION Cancer Clinics
If you have vomited blood, brought up vomit that looks like coffee grounds, or passed black, tarry stools, go to a hospital emergency department today. Most of the time the cause is an ulcer or a tear, not cancer. If you have cirrhosis, hepatitis or liver cancer, it may be bleeding varices, which needs urgent treatment. This page explains what to do now, the usual causes and what the hospital will do. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- I have vomited blood or passed black stools. What should I do?
- What can cause vomiting blood or black stools?
- What will the hospital do when I arrive?
- Is my stool black from blood, or from something I took?
- What families often think, and what is actually true
- What this page cannot tell you
- Common questions about vomiting blood and black stools
The short answer
I have vomited blood or passed black stools. What should I do?
Go to the nearest hospital emergency department now. Do not wait for a clinic appointment, and do not wait to see whether it happens again. Vomiting blood, vomit that looks like coffee grounds, or black, sticky, foul-smelling stools can all mean bleeding inside the gut, and that needs a doctor today.
Most of the time, the cause is not cancer
The commonest causes are a stomach or duodenal ulcer, an irritated stomach lining, or a small tear in the food pipe after hard retching. Painkillers such as ibuprofen, blood thinners and alcohol all make these more likely. Most people who bleed like this do not have liver cancer.
Why a liver condition makes it more urgent
If you have cirrhosis, hepatitis B or C, a fatty liver that has scarred, or liver cancer, the bleeding may come from varices. These are swollen veins in the food pipe or stomach that form when blood cannot flow easily through a scarred liver. You can read how they form on our page about varices. A variceal bleed can be heavy and fast. It is treatable, and early treatment matters.
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Go to hospital today, and call an ambulance if any of these apply
Call an ambulance, or have someone drive you straight to an emergency department, if you vomit fresh red blood or a large amount of dark material, feel faint or dizzy when you stand, look pale and sweaty, have a racing heart, or become confused or very drowsy. Do not drive yourself. Do not eat or drink while you travel. Take your medicine list and any recent liver reports with you, and tell the team at once if you have cirrhosis, hepatitis or liver cancer. Black stools on their own, with no faintness, still mean hospital today.
Not sure whether this applies to you?
Ask an oncologistWhat it usually turns out to be
What can cause vomiting blood or black stools?
Doctors find the cause with a camera test. Here are the usual answers, the commonest first. None of these can be sorted out at home.
Ulcers and an irritated stomach
An ulcer in the stomach or the first part of the small bowel is the most frequent cause. Long-term painkillers, a common stomach infection and heavy drinking all raise the chance. Ulcers can bleed heavily, so they need hospital care too.
A tear after retching
Repeated hard vomiting, often after drinking, can tear the lining where the food pipe meets the stomach. The first vomit is clear and a later one has blood in it. Many settle on their own, but a doctor must decide that.
Varices from liver scarring
In someone with cirrhosis or a liver tumour pressing on the main liver vein, pressure builds in the veins of the food pipe. That is called portal hypertension. The swollen veins can burst without warning.
More likely if you have
- Known cirrhosis or long-standing hepatitis B or C
- Fluid in the abdomen, called ascites
- Yellow eyes or a low platelet count
- Liver cancer that involves the portal vein
Less common causes
Inflammation of the food pipe, a bleeding blood vessel in the stomach wall, and growths in the stomach or bowel. A swallowed nosebleed can also come back up as dark vomit. Each one is found on the same camera test.
What happens next
What will the hospital do when I arrive?
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They steady you first
The team checks your pulse and blood pressure, puts in a drip, and sends blood tests for your blood count, clotting and liver function. If you have lost a lot of blood, they may give a transfusion.
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They start medicines early if the liver is involved
If cirrhosis or varices are suspected, doctors usually start a medicine that lowers pressure in the gut veins, and antibiotics to prevent infection, before the camera test.
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A camera test finds the bleeding point
An endoscopy passes a thin flexible tube through the mouth into the food pipe and stomach. It is usually done as soon as you are stable. If varices are bleeding, the doctor places small rubber bands around them to seal them. An ulcer is treated through the same tube.
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If bleeding does not stop
A small number of people need a second procedure, such as a TIPS. That is a shunt placed inside the liver to lower the pressure, done by an interventional radiologist.
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Before you go home
Varices often come back, so many people need repeat banding and a tablet called a beta-blocker. Read more about beta-blockers to prevent bleeding. If you have cirrhosis, ask whether your liver has been scanned recently, because a bleed sometimes leads to finding a tumour.
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Side by side
Is my stool black from blood, or from something I took?
Likely to be blood: go to hospital today
Often harmless: still mention it to a doctor
Jet black, shiny and sticky, like tar
Dark green-black and formed, while taking iron tablets
A strong, unusual foul smell
Dark after some stomach-settling medicines that contain bismuth
Comes with dizziness, weakness or a fast heartbeat
Dark after a large serving of dark foods, with no other symptoms
You have cirrhosis, hepatitis or liver cancer
You feel completely well and the colour returns quickly
Commonly believed
What families often think, and what is actually true
"It was only a little blood, so it can wait till morning."
The amount you see says little about the amount lost. Much of the blood can stay inside the gut, and a variceal bleed can restart without warning. Go today.
"Vomiting blood means the cancer has spread."
Usually it does not. Ulcers and tears are far more common, and even in people with liver disease the cause is most often varices, which can be treated. Only the camera test and scans can say what is going on.
"Cold water, buttermilk or a home remedy will settle it."
Nothing taken by mouth stops internal bleeding, and eating or drinking can delay the endoscopy. Keep the person still, lying on their side if they are drowsy, and get them to hospital.
"We should not tell the doctor how much he drinks."
Doctors need to know about alcohol to treat the bleed safely and to watch for withdrawal in hospital. It is medical information, not a judgement, and hiding it can put him at risk.
Being straight with you
What this page cannot tell you
It cannot tell you where the blood is coming from, how much has been lost, or whether you are safe to stay at home. Nobody can judge that from a description. Only an examination, blood tests and an endoscopy can, and that is why the advice on this page is always the same: go today.
It cannot tell you whether you have liver cancer
A bleed is not a diagnosis of cancer. If doctors find varices, they will look for the liver disease behind them. In someone with cirrhosis, that usually includes a liver scan. If a scan shows something in the liver, the next steps are explained on our page about who needs an endoscopy to check for varices and the wider liver pages.
Who this page does not apply to
It is not for streaks of bright red blood on toilet paper after a hard stool, which usually come from piles near the back passage and need a routine doctor visit. It is not for children, who need a paediatric emergency team. And it is not for someone already being treated in hospital, whose own team should be told straight away.
CION's oncologists can help plan care after the emergency is over, once the bleeding has been treated.Questions we are asked
Common questions about vomiting blood and black stools
Should I call an ambulance or go by car?
Call an ambulance if the person is vomiting large amounts of blood, feels faint, is confused or cannot stand. If they are alert and steady, a family member can drive them straight to the nearest emergency department. Never let the person drive themselves, and go to the closest hospital rather than a distant favourite.
Should I go to a clinic or a hospital?
A hospital with an emergency department. A clinic appointment, including an oncology clinic, is the wrong place for active bleeding because the person may need blood, drips and an urgent endoscopy. If the person is a CION patient, call the helpline after you are on your way so their team knows.
What does coffee-ground vomit mean?
It usually means blood that has sat in the stomach for a while and been darkened by stomach acid. It is still bleeding, even though it does not look red. Treat it exactly like vomiting fresh blood and go to hospital today.
Can iron tablets make stools black?
Yes. Iron tablets and some stomach-settling medicines can turn stools dark, often green-black and formed rather than sticky. If you are unsure, or the stool is tarry and smells unusually foul, or you feel weak or dizzy, assume it is blood and go to hospital.
I have cirrhosis. Is every bleed from varices?
No. People with cirrhosis also get ulcers and tears. But varices are common enough in cirrhosis that doctors treat the bleed as if it could be variceal until the endoscopy shows otherwise. That is why telling the team about your liver at once matters so much.
Does a variceal bleed mean liver cancer?
Not by itself. Varices usually come from cirrhosis. A liver tumour can raise pressure in the portal vein and cause them, so after a first bleed doctors often check the liver with a scan. Ask about this before discharge if nobody mentions it.
Can it be prevented next time?
Often the risk can be lowered. Repeat banding, beta-blocker tablets, treating the liver disease behind it and avoiding alcohol and painkillers like ibuprofen all help. A hepatologist or gastroenterologist will plan this. It lowers the risk rather than removing it.
I am on cancer treatment. Does that change anything?
Go to hospital first and tell the emergency team which treatment you are on. Some cancer medicines raise bleeding risk, which is why an endoscopy is often done before they start. Then call the CION helpline so your oncologist can review your plan once you are safe.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Sources
- NHS — Vomiting blood
- MedlinePlus — Bleeding esophageal varices
- Cleveland Clinic — Esophageal Varices: Symptoms, Causes & Treatment
- Merck Manual Consumer Version — Portal Hypertension
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
What happens in hospital during a variceal bleedEach step of the admission, in more detailBlack tarry stools and what they meanTelling blood from iron tablets and foodVarices explainedWhy swollen veins form in the food pipeConfusion, drowsiness and odd behaviourThe other liver emergency that cannot wait
Talk to us
Had a bleed and now worried about your liver?
Once the emergency has been treated, tell us what the endoscopy and scans found. We can help you understand the next steps and arrange an oncology opinion if it is needed. One helpline serves every CION centre.