What the Heck is a Fecal Transplant?

Sometimes poop may be the best medicine.

This, at least, is what we know from the growing research on fecal transplants. Fecal transplants, officially called Fecal Microbiota Transplants or FMT, are just what they sound like: the insertion—through enema, colonoscopy, or endoscopy—of a donor’s fecal matter into a recipient’s colon.

Fecal transplants are still being studied to treat a variety of ailments, with some evidence indicating they can treat conditions as diverse as obesity and alopecia. They are, however, already a common treatment for one tough gastrointestinal disease, Clostridium difficile (C. diff) infection.

While third graders of the world (and the third grader in many adults) may find the phrase “fecal transplant” hilarious, fecal transplants are serious science—and, for many people, provide serious relief from a nasty illness. C. diff infection leads to severe cramping and bloody diarrhea, and, just like it sounds: it’s difficult to treat. Not only does C. diff often recur after antibiotics, which can perpetuate dysbiosis by killing off healthy bacteria alongside harmful bacteria, the diarrhea and digestive issues related to a C. diff infection can even be fatal; it can result in up to a 6.9% reported mortality rate. For those suffering from C. diff, this treatment can truly be a godsend.

The idea of someone’s poop being inserted into someone else’s colon may sound, well… gross. poop, however, is one of many elements of the awe-inspiringly complex and efficient human gastrointestinal system, influenced by the trillions of microbes that keep our bodies healthy. Think of a fecal transplant like an organ donation, but for the microbiome. As the Beatles said, we get by with a little help from our friends, and sometimes our friends are the trillions of microbes from someone else’s poop.


A difficult bacterium

It takes a village to raise a healthy digestive system, and the inhabitants of that village are bacteria. In the condition known as dysbiosis, the equilibrium of the village goes awry, and an overgrowth of harmful bacteria take over the helpful gut bacteria.

C. diff is a particularly nasty form of dysbiosis, and the infection can be truly debilitating. The condition is conventionally treated with vancomycin, but the antibiotic can also kill helpful bacteria, meaning the infection persists. As a last resort, C. diff sufferers may have their colons removed.

In several studies, a fecal transplant has been found to be more effective than antibiotics. Fecal transplants result in an 87-90% cure rate, defined by the resolution of diarrhea, which stands in stark contrast to  the mere 31% cure rate that results from conventional, antibiotic-based treatment.

Fecal transplants aren’t only beneficial for C. diff sufferers—they also represent a more fundamental shift in medical thinking about the microbiome; healthcare providers are increasingly acknowledging that antibiotics can have harmful side effects and that some bacteria are vital for health. Combining the best of both worlds, some healthcare providers recommend a combination of antibiotics and a fecal transplant, as the antibiotic kills off C. diff while the transplant encourages the replenishment of helpful bacteria.


Poop happens

So how does a fecal transplant work?  While the treatment has been around for years, it has recently gained more attention—and more regulation. In 2012, the FDA classified human feces as a drug, a label many healthcare providers and patients found unsatisfying, considering the dynamic, variable, and highly available nature of human feces (you don’t have to make poop in a lab!). Fecal transplants have been approved for the treatment of C. diff, but not for anything else, so using a fecal transplant for any other condition requires an application to the FDA.

If a healthcare provider does give the green light for a fecal transplant, the process involves several steps. First, a healthcare provider determines that the patient is suffering from C. diff and has not responded to conventional antibiotic treatment. Then, like any other transplant, the healthcare provider and patient locate a donor. This very generous donor should be a healthy individual without any communicable illnesses like HIV or Hepatitis and shouldn’t have gastrointestinal problems. The donor should be tested to make sure they don’t have dysbiosis, which could result in harmful gut bacteria being transferred to the recipient. The donor should also, for what it’s worth, have nice, regular, firm—but not hard—bowel movements.

Once a donor is located, the procedure commences like any colonoscopy. The donor kindly takes care of their business and offers their sample. Meanwhile, the patient receiving the donation prepares, with a liquid diet and laxative or enema.

When the special day arrives, the patient receiving the donation is given sedatives and painkillers and is lulled into a lovely, drug-induced dream state. Then the big moment arrives: the healthcare provider inserts the donor fecal matter into the patient’s colon. Easy, peasy, poop.


Can poop work for you?

Wondering if the power of poop is for you? That’s something only you and your healthcare provider can determine.

Even if a fecal transplant isn’t right for you, it’s neat to know that one of the world’s most common, and most vilified substances, can be beneficial as a treatment. And if you have model gut health, maybe one day you’ll be called upon to commit the noble act of donating your poop. Turns out one person’s poop really is another person’s gold—or another person’s life-saving cure.

Click here to learn how uBiome’s clinical SmartGut test can help you and your healthcare provider better understand your gut health.