Understanding Fecal Transplant

Fecal transplant, also called fecal microbiota transplant (FMT), is used to treat an infection in the large bowel (colon) caused by bacteria called Clostridioides difficile. You may also hear this infection called C. diff. Older people who are in the hospital have a higher risk of getting C. diff. That’s because their ability to fight off germs is lower. But people who haven’t been in the hospital can sometimes get it, too. This is called community-acquired C. diff. A fecal transplant may be used when this infection happens over and over again and is severe.

Upsetting the balance

Normally, your large bowel has bacteria living in it. These bacteria are both good and bad.

• One of the bad bacteria is C. diff. C. diff makes toxins that harm the inside of your large bowel. These toxins cause your large bowel to become sore and irritated. The result is large amounts of severe diarrhea. Some people with C. diff never get sick, but they can spread the infection to others.

• The good bacteria help break down food, let nutrients get absorbed, and even help make some vitamins. These good bacteria also keep the bad bacteria from taking over.

So what happens? When you get medicines (antibiotics) for another infection, the medicine helps kill the bacteria causing the infection. But the medicines also kill some of the good bacteria. This changes the balance of the bacteria in your large bowel. With less good bacteria, the bad bacteria grow and take over.

Why fecal transplant is done

A fecal transplant is done to get the good bacteria in your large bowel back in balance. A bowel movement (stool) from a healthy donor has the right balance of good and bad bacteria. This means that there are more good bacteria than bad. This donor stool is then given to the person with the infection. As a result, there are more good bacteria to offset the bad. This gets the balance back to what it should be.

How fecal transplant is done

Before a fecal transplant can be done, the bowel movement from a donor is tested to make sure that it’s free of infection. The sample is then made into a form to be used for treatment. Before you start the fecal transplant procedure, you must sign an informed consent. Signing this document means you understand the risks and benefits of the transplant, other available treatments, and your questions were answered. Be certain to get answers to all your questions before you sign.

The fecal transplant can be swallowed as capsules or given in a colonoscopy or special enema. The sample can also be given through a tube placed in the nose and into the small intestine. You and your healthcare provider will talk about the transplant and decide which method will work best for you.

Here’s a general look at what happens with a fecal transplant. Follow your healthcare provider’s specific instructions. Your healthcare provider may do the following:

• You may need to stop taking any antibiotics for about 24 to 48 hours before the transplant. They may want you to take an antibiotic for a week before the procedure. In this case, your last dose would be the day before your procedure.

• You may be told to take a laxative the night before to make sure that your colon is clear.

• You may receive directions for not eating or drinking before the procedure, based on which method is planned. Be sure to follow these directions.

• You'll be told the recommended number of capsules to swallow. Or the sample will be given by colonoscopy or enema or through a tube placed in your nose.

Once the procedure is done, you can go home. You may need to have more than 1 treatment as an enema or through the tube over several days.

Risks of fecal transplant

The risks of fecal transplant are most often mild and last only a short time. These may include:

• Nausea or vomiting (most often with the oral capsules)

• Belly (abdominal) bloating or pain

• Diarrhea or constipation

Other more serious risks may happen. These are often linked to how the transplant was done, such as a colonoscopy. The risks may include:

• Effects of sedation

• Bleeding

• A tear in the colon

• Infection

After the procedure, call your healthcare provider if you have:

• A fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Severe belly pain or bloating

• Blood in your stool or vomit

• Severe vomiting

• Symptoms that get worse or new symptoms that develop