Vomiting blood – the causes and when to see a doctor

Overview

Vomiting (being sick) is your body’s way of getting rid of harmful things in your stomach (tummy). It can also happen because something has irritated your gut. But vomiting blood (medically known as haematemesis) is usually caused by bleeding somewhere in your food pipe (oesophagus), tummy or small intestine.

If you vomit blood, it will look different depending on where it’s coming from and how long it’s been in your tummy. It may be bright red, look like small streaks of blood, or it may be dark like coffee grounds, which means it’s been in your tummy for a few hours. Sometimes, when there’s a lot of blood in your vomit, it may make your poo dark, like tar, although some people may notice bright red blood in their poo.

There are lots of different causes for vomiting blood, including swallowing blood and stomach ulcers. But it could mean you’re losing a lot of blood and may be the sign of a more serious medical problem that needs emergency treatment, so it’s best to see a doctor as soon as possible – even if it’s just a small amount of blood in your vomit.

Common causes of vomiting blood

An obvious cause of vomiting blood is that you’ve swallowed blood from somewhere else, for example, after a serious nosebleed. Read more about

The other main causes of vomiting blood include:

• an ulcer in your tummy or small intestine, known as a
  peptic ulcer
  – it may also cause pain at the top of your tummy
• serious inflammation in your food pipe – known medically as oesophagitis, this may be caused by acid reflux, where acid from your stomach leaks into your food pipe and irritates its lining. You may feel this as
  heartburn
• serious inflammation in your tummy (gastritis) or in your small intestine (duodenitis)
• swollen veins (varices) in your food pipe – often caused by the serious liver disease
  cirrhosis
• a tear in your food pipe, known as a Mallory-Weiss tear – this may happen if you’ve been vomiting or coughing a lot, or lifting heavy things
• abnormal blood vessels that bleed (angiodysplasia)

A less common cause may be cancerous growths or other abnormal tissue growths.

The bleeding can be worse if you have liver disease, such as

or , are taking or have an inherited (genetic) condition that affects your blood clotting.

It’s important to know that vomiting blood and

are different. Blood that you’ve coughed up from your airways or lungs might look like flecks of blood that you see on a tissue or blood mixed in with phlegm or mucus. Either way, see a doctor as soon as possible, as both need medical attention.

When to see a doctor about vomiting blood

Vomiting blood can be very serious, so see a doctor as soon as you can – even if you’ve only vomited streaks of blood.

Call an ambulance or go straight to an emergency department if you've vomited more than a few streaks of blood, or you've vomited a few streaks of blood and you:

• feel dizzy or faint
• feel confused
• have pain in your chest
• look very pale
• feel your heart is beating fast
• have very bad tummy pain
• are over 60 years old
• also have red blood in your poo
• also have
  heart disease
  or liver disease

What’s the treatment for vomiting blood?

The treatment for blood in vomit depends on what’s causing it and how much blood you’ve brought up. When you see a doctor, they’ll usually ask you about what the blood looks like and any other symptoms you have. They’ll examine you and may want to do some tests.

Treatment to help with the bleeding may include:

• a
  blood transfusion
  or fluids in your vein to help replace the blood you’ve lost
• an
  endoscopy
  (a procedure where an instrument called an endoscope is inserted into your body to examine your organs) to find where the bleeding is coming from. If you’re still bleeding, a doctor might be able to do a procedure to stop the bleeding during the endoscopy
• a
  biopsy
  during the endoscopy to check for infection or to find out what a growth is if you have one
• surgery – if the bleeding can’t be stopped

Once the bleeding has stopped, the next steps in treatment will depend on what has caused the bleeding.

Peptic ulcers, gastritis and duodenitis

If you’re diagnosed with a peptic ulcer, gastritis or duodenitis, a doctor will try to find out what the cause is. Common causes include:

• an infection caused by a type of bacteria called Helicobacter pylori – it’s often treated with a combination of
  antibiotics
  and
  antacid medication
• certain medications like
  non-steroidal anti-inflammatory drugs
  (NSAIDs), including
  ibuprofen
  ,
  aspirin
  and naproxen – if you’re diagnosed with a peptic ulcer, it may help to avoid these, so discuss which other
  painkillers
  you could use with a doctor

Smoking can also increase your chance of getting a peptic ulcer, so it’s best to

.

To help ease the symptoms of gastritis and duodenitis, you can also try:

• avoiding foods that may irritate your tummy like spicy, acidic or fried foods
• avoiding or
  cutting down on alcohol

Read more about

and .

Oesophagitis

Like gastritis and duodenitis, oesophagitis is also treated with antacid medication, and following the same advice in the section above can help. Making the following changes may also help prevent acid leaking into your food pipe:

• losing weight
  if you’re overweight
• raising the head of your bed when you sleep so that your chest and head are above the level of your waist
• eating small, frequent meals and avoid eating late at night
• wearing loose, comfortable clothing

Sometimes, oesophagitis can also be caused by a

, which is when a part of your stomach moves up into your chest. This is sometimes treated with an operation.

Varices

Once your bleeding has been controlled, treatment will focus on trying to stop these varices from bleeding again. You may be advised to:

• stop drinking alcohol, because this makes
  cirrhosis
  worse. Don’t just stop by yourself – get help from a doctor to do it safely, as it can be dangerous if you’ve been drinking a lot. Read more about
  getting the support you need if you have an alcohol problem
• lose weight if you have
  fatty liver disease
  . Read more about
  foods that are good for your liver
• take medicines to lower your
  blood pressure
• have a procedure called a variceal band ligation – a doctor puts small rubber bands around the enlarged blood vessels to stop them bleeding

Mallory-Weiss tears and angiodysplasia

Mallory-Weiss tears often heal quickly by themselves, and bleeding from angiodysplasia can also sometimes stop by itself. But sometimes, you’ll need treatment during an endoscopy, or another procedure to stop the bleeding.

Cancers and growths

Cancers or any growths can be diagnosed from a biopsy of the growth during an endoscopy. The treatment will depend on the kind of growth, but if a cancer is found, you’re likely to need further treatment, for example, surgery,

or .

What can I expect after vomiting blood?

You must see a doctor as soon as possible after vomiting blood – even if it’s just a small amount or a few streaks of blood. After the cause has been found and the bleeding stopped, it’s important to follow the advice a doctor gives you to try to stop you vomiting blood again.

Some causes of vomiting blood, like varices or cancers, can be life-threatening and will need ongoing treatment. But other causes, like peptic ulcers and gastritis, can get better with medication and self-care.

Your health questions answered

I’m throwing up blood after drinking alcohol – is it normal?

Drinking too much alcohol can cause you to throw up and, if you vomit a lot, this may lead to a Mallory-Weiss tear. Drinking lots of alcohol can also be linked to acid reflux, gastritis and oesophagitis, which can all cause bleeding in your food pipe, stomach and small intestine. Throwing up blood can be a sign that you’re bleeding internally, so it’s best to see a doctor. –

Key takeaways

• if you’re vomiting blood, you should always get it checked by a doctor
• unless you only vomit a small amount, it’s likely you’ll need to go to hospital for tests
• common causes of vomiting blood include peptic ulcers, inflammation in your stomach, food pipe and small intestine, and tears in your food pipe
• you might need to have an endoscopy to find out where the bleeding is coming from
• treatment depends on the cause, but it may include a procedure to stop the bleeding and medicines like antacid medication