Bleeding in the Small Bowel

Bleeding in the small bowel can have many underlying causes, and may be the cause of blood in the stool or anemia (not enough healthy red blood cells to get oxygen through the body) in some patients. It often stops for a while and then starts up again, and can occur anywhere along the 20-foot length of the small bowel. Therefore, finding the source of small bowel bleeding presents a great challenge.  

Small Bowel Bleeding Symptoms

Small bowel bleeding can be subtle or silent. However, when symptoms do occur they can include:

  • Blood in bowel movements
  • Black, tarry stools
  • Unexplained anemia

 If there is sudden or severe bleeding, symptoms can include:

  • Dizziness and/or weakness
  • Abdominal pain
  • Blood in the stool or black tarry stools

At the Small Bowel Program, part of the University of Michigan’s Gastroenterology Program, our multidisciplinary team provides minimally invasive treatments that are not widely available to  diagnose and treat bleeding in the small bowel. Our team of small bowel gastroenterologists has extensive experience with these procedures and our physicians rank among the country’s experts in the field. 

What are the Most Common Risks for Small Bowel Bleeding?

The most common source of small bowel bleeding is angioectasias, which are abnormal blood vessels that lie within the wall of the small bowel, and are most often found in older patients. Bleeding can also come from ulcers caused by non-steroidal medications, tumors, inflammation, or blood vessels associated with certain heart conditions or cardiac implantable devices.

Diagnosing Bleeding in the Small Bowel

To diagnose small bowel bleeding, we start with a comprehensive examination and obtain a thorough history. A blood test and checking the stool for blood are common.

After ruling out a bleeding source from the stomach or colon, a capsule endoscopy is the recommend diagnostic exam for the small bowel. Capsule endoscopy is a study that allows us to see all the way through the small bowel and find things we wouldn’t be able to see any other way. The procedure involves swallowing a small capsule, which is the size of a large vitamin pill. Inside the capsule is a tiny wireless camera that takes more than 50,000 digital pictures as it passes through the small intestine. Images are transmitted to a recording device worn on a belt around your waist. This recording device saves the pictures for a specialist to look at and interpret at a later time. Our doctors have performed over 3,500 capsule endoscopies.

Small Bowel Bleeding Treatment

If we see bleeding during the capsule endoscopy test, we often recommend a double balloon enteroscopy.

Double balloon enteroscopy is a specialty endoscopy, or scope test, which allows doctors to go deep into the small bowel. The technology includes the use of balloon attachments on a scope which help move the scope through the small bowel to the affected area. Through the scope we can treat lesions, for example, by taking a biopsy of a tumor or destroying a bleeding vessel by with laser therapy. Our experienced doctors have performed more than 1,000 double balloon enteroscopies although this minimally invasive procedure is not widely available.

Multidisciplinary Care for Small Bowel Disease

As members of the Gastroenterology Division of the University of Michigan, we have developed mutual benefits from the resources of our entire medical center, and work in collaboration with other divisions to provide the most complete care. Our surgeons specialize in small bowel diseases and our pathologists, who review unusual findings on biopsies, have extensive small bowel experience.

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page.

Make an Appointment

To schedule an appointment to discuss small bowel bleeding or other digestive or liver health concerns, call us at is 888-229-7408.