Back pain and throwing up blood: what you should know

Do not assume that a strained back or a spinal condition explains the blood. The two symptoms may have separate causes, and the bleeding should take priority.

Blood in vomit may be bright red, dark red, or look like coffee grounds. It can come from the food pipe, stomach, or first part of the small intestine. Possible causes include an ulcer, inflammation, a tear after forceful vomiting, or bleeding made worse by certain medicines. Swallowed blood from the nose or mouth can sometimes look similar, but this still needs medical assessment.

Back pain can arise from muscles, joints, discs, kidneys, or pain referred from the abdomen. Lumbar spondylosis may present with lower-back pain and stiffness, but it does not account for vomiting blood. A clinician must assess each symptom and whether they are connected.

Go to an emergency department now or call local emergency services. Do not drive yourself if you feel faint, weak, confused, short of breath, or generally unwell. If possible, have someone stay with you and bring your medicine packets or an up-to-date medication list.

Avoid taking aspirin or anti-inflammatory painkillers such as ibuprofen for the back pain unless a clinician who knows about the bleeding tells you to do so. Tell the emergency team about blood thinners, recent vomiting, black stools, abdominal pain, alcohol use, liver disease, ulcers, and any recent injury.

Treat any episode of vomiting blood as urgent. Call emergency services immediately if bleeding is continuing or heavy, or if there is fainting, dizziness, confusion, rapid or shallow breathing, pale clammy skin, severe abdominal or back pain, black tar-like stools, chest pain, or difficulty breathing. These features can occur when blood loss is affecting circulation or when another serious problem is present.

Ask where the bleeding may be coming from, which tests are needed, and whether any current medicine could increase bleeding. You can also ask whether the back pain appears separate, whether kidney or abdominal causes need checking, and which pain relief is appropriate while the bleeding is investigated.