Fecal transplant

Your digestive tract is home to a complex ecosystem of microorganisms and bacteria. A healthy gut ideally contains a balanced mixture of many organisms. When this ecosystem becomes unbalanced, some bacteria can grow out of control and make you sick.

This is where fecal transplant, also called a stool transplant or fecal microbiota transplantation, can help.

An overview of fecal transplants

Fecal transplantation is a treatment that involves putting another person’s healthy stool into your large intestine. It’s most often used to treat recurrent Clostridium difficile (C. difficile or C. diff) infections and has an 85-95% success rate. Fecal microbiota transplantation restores healthy microbial communities in the colon that in turn fight off C. diff infection.

C. diff infection means the environment in your intestine has become unhealthy and resistant to treatment. Fecal transplantation uses donor feces to restore your intestine to a healthy baseline. Donors are carefully screened to make sure the stool you receive is healthy.

How does fecal microbiota transplantation work?

A fecal transplant is usually performed with a colonoscopy, and the prep for the procedure is the same as it is for a colonoscopy. Your gastroenterologist will guide a tube called a colonoscope through your colon and place the donor stool in your colon.

During the procedure, you’ll be given a sedative via a needle in your arm (IV) to make sure you’re comfortable. Once you’re sedated, your doctor will insert the colonoscope into your rectum and into your colon. As the tube is withdrawn, the donor stool is inserted through the tube into your colon. You’ll need to recover from the sedation medication before you go home, and you'll need someone to accompany you to the procedure and drive you home as well.

How to prep for fecal transplantation

A fecal microbiota transplantation procedure requires you to clean out your colon beforehand, which involves eating no solid food the day before the procedure and only drinking clear liquids. After midnight the night before, you’ll fast completely. You’ll also take a laxative in liquid or pill form the night before and possibly the morning of the exam.

You might also have to give yourself an enema the night before or the morning of the procedure to make sure your colon is completely emptied. Your doctor might also recommend that you stop taking certain medications before the procedure.

How are fecal transplants delivered?

While a fecal microbiota transplantation is most commonly performed as part of a colonoscopy, there are a few other options. These can include:

• Upper endoscopy: In this procedure, the microbiota transplantation is delivered through a tube that’s inserted through your mouth or nose and into the duodenum, where the stomach connects to the small intestine. This procedure is an option for those who can’t have a colonoscopy, but it has a higher risk of side effects and has a lower success rate since the donor stool has to travel farther to the colon where it’s needed.
• Enema: An enema delivers the fecal transplant through a tube inserted into the rectum. Fecal microbiota then spreads from the rectum into the colon.
• Oral capsule: Fecal transplant pills contain freeze-dried, live fecal microbiota and are designed to stay intact until they reach your colon.

What are the side effects from fecal transplant procedures?

Side effects from fecal microbiota transplantation treatments often depend on the delivery method. If you’re receiving a stool transplant from a colonoscopy, some of the temporary side effects may include:

• Bloating and gas
• Cramping
• Constipation
• Leaking of transplant solution through the anus

Risks of fecal transplantation

While fecal transplant procedures have a very high success rate, there are still risks involved. Some of them include:

• Reactions to the medicine you receive during the procedure
• Heavy or persistent bleeding
• Breathing problems
• Spread of disease from the donor (rare)
• Infection during colonoscopy (very rare)
• Blood clots (very rare)

Using fecal transplant procedures for other conditions

While fecal microbiota transplantations are primarily used to treat recurring C. diff, the procedure is also being researched as a treatment option for conditions such as:

• Irritable bowel syndrome
• Crohn's disease
• Constipation
• Ulcerative colitis

Using fecal microbiota to treat these conditions is still considered experimental, and more research is needed to confirm its efficacy. Consult with your health care provider to determine the best treatment option for your condition.