Black Specks in Stool: When Should You Worry?

Your stool can serve as a good indicator of your general state of physical health. Discovering black specks in the stool can be a distressing experience for anyone. Without any knowledge about the possible causes of these strange dark spots, you are likely to start speculating wildly. A lot of ideas regarding possible causes might come to mind—ranging from a fatal disease to aliens laying their eggs in your gastrointestinal tract. But before you start begging your physician to order a stool exam, stat, consider the fact that the spots in your stool may be due to any one of many harmless causes.

Dietary Causes of Black Specks in Stool

Certain foods in your diet or certain ingredients in your food may cause black spots in your stool when they are not digested properly.

• Certain spices: e.g., black pepper and paprika
• Certain fruits: e.g., bananas, dark-colored fruits (blueberries, cherries, figs, plums), or undigested seeds of fruits like strawberries
• Dark pudding
• Green leafy vegetables: Once digested and eliminated, green leafy veggies turn from dark green to black in the stool. Thus, it’s normal to see black flecks in your poop after you’ve eaten a salad.
• Dark beverages: e.g., red wine, grape juice, cranberry juice, all of which can bring about a reddish-black tint in your poo.
• Undercooked meat: The dark pigments you may see in your stool are due to the blood content in the raw meat.
• Foods rich in iron such as beets and spinach may also lend a blackish tinge to your stool, especially when consumed in large quantities. Other examples of these foods include oysters, kidney beans, beef, and molasses.
• Junk food consumption is another common cause of the blackening of the stool. Snacks that are high in sugar, salt, and fats darken the product of your bowel movement by inducing mild symptoms of diarrhea. The alkaline fluid which aids in digestion is referred to as bile. The natural color of bile is greenish-brown. When a person suffers from diarrhea, bile is expelled from the system hurriedly and way before it has had a chance to break down properly. As a result, the bowel movement ends up having dark-greenish or blackish areas. To put things plainly, the black dots in your stool may, in fact, just be bile.
• Too much fiber consumption can also bring about dark specks in the stool as it can induce rapid bowel movement. As mentioned, this could lead to the presence of bile in the feces. To solve this problem, combine fiber-rich foods with protein and carbohydrate sources. This will moderate your fiber intake per meal and will help keep you full for longer periods. Example: Eat your spinach salad with chicken fillet and an oven-baked sweet potato.

So before you freak out about the weird black stuff in your bowel movement, it would be wise to recall the meals that you’ve consumed over the past several hours. Perform the process of elimination to determine which foods in your diet are causing the dark specks in your waste. For instance, if you suspect that bananas are causing the black flecks in your stool, refrain from eating them and see if the color of your feces improves over time. If not, then that’s the time you should consider other causes.

Black Spots in Stool Caused by Medication

• Certain pharmaceuticals may bring about a dark discoloration of the stool. It's common to find black specks in the stool if you're taking iron supplements. It is, in fact, a positive sign that the iron is being properly absorbed by your body. If you suspect that your iron supplements are giving you diarrhea, consuming the supplements with a bit of food might help.
• Certain prescribed antibiotics or antifungals may be the explanation behind the black spots in your bowel movement. The dark specks in your waste may actually be the dead bacteria or parasites being eliminated from your gastrointestinal tract.

• Certain over-the-counter (OTC) drugs that cause micro-bleeding in the GI may also be the culprit behind the dark spots in your bowel movement. Aspirin, non-steroidal anti-inflammatory drugs, ibuprofen, and even Pepto Bismol all contain an active ingredient known as salicylic acid. One common side-effect of this acid is gastric irritation and ulceration in the sensitive stomach mucosa. This is frequently accompanied by minor bleeding. In other words, the black flecks in your stool may be blood. But don't panic just yet! This type of bleeding is minor and can be stopped by simply discontinuing the meds.
• Supplements that contain vanadium may also cause minor internal bleeding in the GI and thus, bring about the presence of black spots in the stool. Vanadium supplements are often taken by muscle-builders and athletes.

What About GI Bleeding?

But isn't black specks in stool a sign of serious GI bleeding?

The list of possible causes mentioned above may seem to go against everything you've read online about the possible reasons behind black dots in the stool. Most people and even some medical practitioners immediately associate dark flecks in the stool with severe gastrointestinal bleeding. While this is possible, it's not always the case. To understand more clearly, view the table below.

Signs That Are Concerning

Generally, black specks in stool do not warrant emergency medical care. That is unless the spots have been showing up in your poop for a prolonged period or are accompanied by other abnormal symptoms. So, what are the signs that you should look out for?

What to Look For

• Stomach pain
• Abdominal cramping
• Diarrhea
• Loss of appetite
• Unusually foul-smelling stools

Such symptoms indicate a more severe underlying condition such as a digestive disorder which may or may not be a precursor of cancer.

Digestive Disorders Causing Black Flecks in Stool

Inflammatory digestive disorders include IBS, Crohn's disease, and ulcerative colitis. The inflammation caused by these conditions leads to tiny amounts of bleeding which may or may not show up as black flecks in the stool.

Crohn's Disease

In Crohn's disease, certain parts of the digestive tract's lining, from the mouth to the rectum, become inflamed. The type of inflammation suffered by the affected individual is deep enough to affect the normal functions of the bowel tissue. This condition can pave the way for life-threatening complications such as an increased risk of developing colorectal cancer. If black specks in stool are accompanied by nausea, vomiting, formation of fistula, bloody or mucus-tinged feces, weight loss, fever, fatigue, and sores in the mouth, seek medical assistance promptly.

Unfortunately, there is still no known cure for this condition. So far, the aim of medical treatment is to manage the symptoms and to arrest the inflammation. The primary treatment of Crohn's disease includes prescription corticosteroids. If these are not enough, then immunosuppressive drugs may be given so as to help lessen the inflammation. The last resort would be a surgical procedure where the inflamed areas of the intestine are removed. This is known as bowel resection.

Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory bowel disease that specifically affects the internal linings of the colon and the rectum. The black specks in the stool may be associated with ulcerative colitis if you're also experiencing any of the following symptoms: recurrent bloody or mucus-filled or pus-filled diarrhea, pain in the abdomen, and the frequent urge to empty the bowels.

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Note that the symptoms associated with this condition may diminish and then intensify in turn. In other words, affected individuals find themselves in an endless cycle of remission and exacerbation. Symptoms of flare-ups include oral ulcers, arthritic joints, inflamed dermis, and eye irritation.

Ulcerative colitis may cause colorectal cancer. That's because each time the damaged GIT tissue attempts to repair itself, the newly formed tissue that develops has a different structure from the old, normal ones.

In its severe form, individuals with ulcerative colitis experience BMs (bowel movements) up to six times daily or more. They suffer from extremely high temperatures, shortness of breath, abnormal cardiac rate, and more evident blood in the stools.

Ulcerative colitis is believed to be an auto-immune condition. In this case, the body's immune system goes haywire and ends up attacking normal tissues. One theory is that in people with ulcerative colitis, the immune system views the normal bacteria in the gut as a threat and ends up attacking them, causing the gut to become inflamed.

Like Crohn's disease, the treatment of ulcerative colitis is centered on managing the symptoms and preventing outbreaks. The doctor may prescribe aminosalicylates, corticosteroids, and drugs to suppress the immune system.

Irritable Bowel Syndrome

Crohn's disease and ulcerative colitis are both forms of IBD (inflammatory bowel disease) but IBS (irritable bowel syndrome) is a completely different animal altogether. IBS is a lifelong condition marked by rapid bowel activity with no evident causes. In this condition, the bowels are also inflamed. However, unlike Crohn's disease and ulcerative colitis, IBS is less likely to cause cancer. That's because, unlike IBD, IBS does not eventually lead to the modification of tissues in the bowel.

Individuals suffering from irritable bowel syndrome experience it in different degrees of severity. In other words, some are luckier than others. The symptoms tend to appear and disappear in periods that range from six days to six months at one time. This condition tends to worsen during periods of stress or after consuming certain food triggers. IBD, on the other hand, may worsen regardless of the absence or presence of these factors.

Like the previous conditions, IBS is accompanied by episodes of diarrhea, abdominal cramping, bloating, stomach pain, and rectal bleeding. The affected individual suffers from fever, chronic fatigue, diminished appetite, and loss of weight. However, one way to ascertain that the black specks in stool are caused by IBS and not by IBDs is the presence of these unique symptoms: inability to empty the bladder, backache, prolonged constipation, the need to move bowels immediately after a BM, a sensation of incomplete emptying of the bowels, and pain during sexual intercourse. It is also important to note that the abdominal cramping associated with irritable bowel syndrome tends to go away after the passage of stools.

Possible dietary causes of irritable bowel syndrome include dairy, alcohol, wheat, artificial sugar substitutes, and caffeine. It may also be brought about by a poor immune system, hormonal changes, high levels of stress, or a current medical condition. Because the exact cause of IBS remains obscure, the treatment rarely involves pharmaceuticals.

Regardless of whether you're suffering from IBS or an IBD, immediate medical attention is required. Expect the treatment process to involve modifications in your diet and in your lifestyle.

Physical injury to the GIT may be another reason that you have black dots in your stool. This micro-bleeding due to trauma may be brought about by a variety of causes from a viral infection to lacerations in the lower esophageal lining.

Mallory-Weiss Tear

These cuts along the lower part of the esophagus develop over time after prolonged and vigorous coughing or vomiting. Sometimes, these tears are caused by seizures. To assess whether the black specks in stool are due to this condition, a CBC may be ordered. However, while a low hematocrit will point towards a positive diagnosis, a more definitive diagnosis can be made through an esophagogastroduodenoscopy. That is, the surgeon will pass a tube through your esophagus, your stomach, and your duodenum to visually check for the presence of tears.

The black-spotted stools associated with Mallory-Weiss tears are temporary and the prognosis tends to be quite good. A tear can heal on its own even without treatment. Or it can be held together with clips during an esophagogastroduodenoscopy. In some cases, the physician may prescribe H2 blockers and other meds that inhibit the production of gastric acid.

H. pylori Infection

Initially, the Helicobacter pylori bacteria is quite harmless. This spiral-shaped microorganism has resided in your stomach since your childhood, learning to thrive in its naturally acidic environment. However, extreme overgrowth of this bacteria enables it to attack your gastric lining.

These bacteria are spiral-shaped and it is because of this that they're able to drill their way through your GIT lining. Once they are blanketed by your gut's mucus, your body's immune cells are unable to recognize and attack them. Moreover, these bacteria have the ability to neutralize stomach acids. As a result, your stomach cells become unusually sensitive to stomach acid. Add to that the irritation caused by the H. pylori itself. This leads to ulcers both in the stomach and the small intestine.

H. pylori infections may be transmitted through person-to-person contact or fecal-oral contact. The latter occurs when one neglects to wash his hands after using the toilet. You may also get H. pylori infection after ingesting contaminated food or water.

The black specks in stool are possibly due to an H. pylori infection if they are accompanied by too much burping, bloating, anorexia, weight loss, nausea, and vomiting. The affected individual may also notice an unusually foul odor in his breath.

It is necessary to treat an existing H. pylori infection to prevent fatal complications such as obstruction and perforation in the bowel. The former happens when an ulcer impedes the passage of food through the stomach. Meanwhile, the latter results when an ulcer breaks through the gastric wall. Other serious complications associated with H. pylori infections include internal hemorrhage due to the rupture of an ulcer through a blood vessel and peritonitis wherein the lining of the abdominal cavity becomes infected as well.

Triple therapy is the treatment of choice for this condition. This includes the intake of at least two types of prescribed antibiotics such as clarithromycin and amoxicillin along with medication to reduce stomach acid such as PPIs (proton pump inhibitors).

Other Possible Causes of Black Spots in Stool

Giardiasis

Parasites that cause giardiasis may appear as black flecks in the stool. These harmful organisms are usually found in infected bodies of water such as backwater lakes and streams. However, it's also possible for them to find their way in urban water supplies, public pools, and even spas. While giardiasis may be contracted through the ingestion of contaminated water or food, it's also possible for it to be transmitted from person to person. To determine whether the black specks in stool are caused by the Giardia lamblia protozoa, check for the presence of associated signs and symptoms such as watery and foul-smelling stools which may sometimes be greasy, extreme exhaustion, pain in the abdomen, a bloated tummy, flatulence, loss of weight, and nausea. These symptoms may kick in less than one month after exposure to the causative agent and may be experienced by the infected individual from two to six weeks.

If you're experiencing these symptoms along with dark spots in your stool, seek emergency care. Otherwise, you'll place yourself at risk for dehydration. Recall whether you or any other person in your household has traveled recently or has gone swimming as these facts will aid greatly in the diagnosis. That said, the definitive diagnosis is done after a stool examination and possibly after an enteroscopy procedure. In the latter, a tube will be passed down the throat toward the small intestine and a tissue sample will be obtained.

Giardiasis may or may not go away on its own. Even so, your physician is likely to recommend the use of an antiparasitic drug as opposed to going through the disease process unaided. When not sufficiently treated, the symptoms of giardiasis may recur. Pharmaceutical treatment of giardiasis includes metronidazole or a single dose of tinidazole. For children, liquid nitazoxanide is a more popular choice.

Liver Damage

Liver damage is another probable culprit. Though the liver is not necessarily a part of your GIT, it plays a vital role in digestion. As mentioned, bile is essential for the breakdown of food and this stuff happens to be produced in the liver. Liver disease which causes inflammation and scarring (such as in cases of hepatitis and liver cirrhosis) can eventually cause black spots in the stool. Visit your physician if the dark flecks in your stool are accompanied by symptoms such as generalized fatigue, unexplained weight loss, and an abnormal yellowish discoloration of the skin or the eyes (jaundice).

Listen to Your Body

All in all, black specks in stool can be due to a broad variety of causes ranging from the potentially fatal to the not-so-serious. However, if there's one thing that they have in common, it's the fact that they can all be avoided by maintaining a healthy lifestyle. This means observing a balanced diet and proper hygiene. This also means getting in tune with your body and paying attention to how it reacts to certain foods and medications.

Resources

• "Crohn's disease". NHS Choices. Retrieved Jan. 5, 2017.
• "Irritable bowel syndrome (IBS)". NHS Choices. Retrieved Jan. 5, 2017.
• "Giardiasis". HealthLine. Retrieved Jan. 5, 2017.
• "Mallory-Weiss tear". U.S. National Library of Medicine. Retrieved Jan. 5, 2017.
• "Ulcerative colitis". Mayo Clinic. Retrieved Jan. 5, 2017.
• "H. pylori Infection". HealthLine. Retrieved Jan. 5, 2017.
• "Best Impacted Stool Home Remedy". HealDove. Retrieved Jan. 5, 2017.
• "White Spots in Stool and Why You May Be Having Them". HealDove. Retrieved Jan. 5, 2017.