Why You Shouldn't Try a DIY Fecal Transplant

Fecal bacteriotherapy (FB), which is also called fecal microbiota transplantation (FMT) or intestinal microbiota transplantation (IMT), is a type of therapy that has been used for many years to treat different conditions, especially those that are centered in the digestive tract. It is being studied for use in treating conditions from inflammatory bowel disease (IBD), and ulcerative colitis in particular, to irritable bowel syndrome (IBS) to obesity. However, so far, its use has been inconsistent and not proven to work across a variety of cases of any particular condition.

Fecal transplantation is done at specialized clinics, so it’s not available everywhere and it’s currently reserved for specific patients. As a result of some studies that have shown promise for the future of fecal transplants as a therapy, some people are opting to try to do this treatment at home.

There are serious risks involved, especially of infection and other adverse effects for which we don’t even know the potential long-term consequences.

Dr. Neilanjan Nandi, a gastroenterologist at Drexel Medicine in Philadelphia and a key opinion leader in fecal transplants, asks, "When it comes to the health of your intestine, how much faith do you want to place on anecdotal experience from online DIYers for non-established indications and without validated patient safety data?"

Fecal Microbiota Transplantation

Fecal transplants have been in use since 1958 when it was used to treat patients who were battling severe infections with the bacteria Clostridioides difficile (C. difficile). The lives of these patients were at stake and the physicians used fecal transplants in an effort to save their lives. It worked.

A fecal transplant is pretty much what it sounds like: stool from one person is introduced into the digestive system of another person.

Of course, this is not a simple transfer of the raw fecal matter. There are several steps that are completed in order to make the stool ready for transfer.

Stool donors must be screened carefully in order to prevent introducing disease or other adverse effects in a recipient. Not only must the stool from donors be tested to ensure it is as safe as possible, but it must also be processed and made into a form that can be used.

It is not approved for general use and in some cases is not covered by insurance except for the treatment of recurrent C. difficile infection.

Risks of DIY Fecal Transplants

The bacterial makeup of stool is extraordinarily complex. The study of the microbiota is an evolving area of research. It’s possible that every person’s gut flora could be so unique as to serve almost like a fingerprint: no two might be exactly the same.

Researchers are only beginning to understand not only what is in our digestive system but also how genetics, the environment, diet, and disease affect it over the course of our lives. The larger question that is still outstanding is how our gut flora affects our health and the development of disease.

Introduction of Potentially Harmful Pathogens

Without proper screening, it’s not known what might be in a person’s stool. Even a person who is seemingly healthy and has no symptoms (digestive or otherwise) could have something in their stool that is potentially harmful. The contents of a donor stool might include something that in a healthy person is not a problem but for a person that is ill with an infection, a digestive condition, or a serious illness, it could have unintended consequences.

It might be thought that using the stool from a close relative (and especially that of children) will provide some level of certainty or safety. Even if the donor is known to the person receiving the transplant, there are still no guarantees that the stool doesn’t contain something potentially harmful.

That’s why it is not recommended that anyone try a fecal stool transplant at home, without the supervision of a physician.

Damage to Rectum or Colon

Other risks of fecal transplants include those that come from the act of putting the stool where it needs to go (up through the anus and into the rectum and beyond). Doing the procedure at home with stool that hasn’t been processed by a lab probably means using an enema to insert the stool into the rectum and/or colon.

Even when fecal transplants are done in a clinical setting by a physician, there are risks of putting a hole (perforation) in the rectum or the colon. Doing it at home without the supervision of a physician or other healthcare professional could also put a patient at risk for these complications and others. Furthermore, the fecal transplant material must be delivered by colonoscopy in order to reach the right colon to be fully effective.

How Donor Stool Is Selected

The process to become a stool donor is lengthy. Donors are usually healthy adults between the ages of 18 and 50 and must first answer a series of questions about their health. There is then an in-person interview that is completed. At that point, the potential donor has their blood and their stool tested for anything that might be harmful, such as an infection with a bacteria or a pathogen.

There are a host of exclusion criteria, which are conditions or lifestyle choices that would make a potential donor not eligible to donate their stool. These can include:

• Having a history of medical conditions such as any digestive condition, topical infections, chronic pain syndrome, metabolic conditions, psychiatric conditions, or autoimmune conditions
• Antibiotic use in the previous three months
• Having diarrhea
• A family history of IBD or digestive cancer
• Personal history of cancer or chemotherapy
• Travel to certain areas of the world in the previous three months

Blood from potential donors is tested for the hepatitis virus, HIV, Epstein-Barr virus, as well as for fungus. In addition, complete blood count, complete metabolic panel, liver function panel, erythrocyte sedimentation rate, and C-reactive protein tests might also be done.

As might be suspected from this long list: many potential donors are excluded.

How Donor Stool is Processed

Once a donor is selected and a stool sample is received, the stool is then tested in various ways.

A stool is first inspected visually and compared to the Bristol stool type to ensure that it is within a healthy range (and not too hard or too loose). The stool is then filtered to remove anything that doesn’t belong, such as undigested food.

Tests are done to ensure that it does not contain viral or parasitic pathogens, as well as potentially harmful bacteria such as C. difficile. Donor stool might also be tested to see what it contains (as opposed to what it does not). That is, which strains of bacteria that are present that are normal and/or expected in stool and how many of them there are in a sample.

Death Prompts FDA Warning

Beyond the testing, a host of additional measures and checks and balances are put in place for the protection of those who would be receiving the donor stool.

There have been adverse events that occur even after all this rigorous testing of donors and of stool. In one case, a person receiving a fecal transplant died and it was discovered that the stool contained extended-spectrum beta-lactamase (ESBL)-producing E. coli. A second person receiving the same stool was also infected with the bacteria.

The death of a patient receiving a fecal transplant prompted the FDA to issue a warning about the risks of the procedure. In a statement, the FDA acknowledged that investigational therapies are important but that the risks should not be discounted.

Dr. Nandi points out that, "The recent death of a post-IMT patient was associated with donor stool possessing a pathogenic MDRO (multidrug-resistant organism). The recipient’s MDRO status is reportedly unknown, but notably, the donor was not screened in advance. This may have been preventable."

The agency went on to recommend that physicians warn patients about the potential for infection with multi-drug resistant organisms and reaffirmed their commitment to patient protection and safety.

Fecal Transplants for Various Conditions

Researchers are continuing to study it because it does seem to have some promise. In most cases, study authors call for randomized controlled trials that will help understand how this treatment could work and for which patients it might help.

For IBD

There has been some study on the use of fecal transplants for the treatment of Crohn's disease and/or ulcerative colitis but so far they’ve not been shown to be a magic bullet. That’s not to say that they might not play a role in some kind of treatment scenario in the future: studies are still being done.

There’s still so much more to understand about how fecal transplants affect the microbiome, including the unintended effects which could be harmful.

For C. Difficile

Where fecal transplants are sometimes used is in the treatment of C. difficile infection. This bacteria is normally found in the colon of healthy people, along with billions of other bacteria.

Sometimes, though, the bacteria makeup can get out of balance. This can occur for several reasons, including treatment with antibiotics, changes in diet, or high stress levels.

Most of the time, the flora in the gut being forced away from its normal levels isn’t going to result in significant disease, though it may cause symptoms like bloating. However, it can happen that the imbalance gives C difficile an opportunity to grow out of control in the digestive tract, especially after a person receives treatment with antibiotics.

One area where fecal transplants have been shown to be effective is in treating an infection with C. difficile, and especially what is called refractory infection where conventional treatments with antibiotics aren’t working to clear the bacteria. Patients with this type of infection may be acutely ill, and introducing something harmful into their body could have significant consequences, including death. In fact, infection with C. difficile caused over 29,000 deaths in 2011.

In November 2022, the FDA approved the first fecal microbiota product, Rebyota. Rebyota is approved for the prevention of the recurrence of C. difficile infections in adults who have completed antibiotic treatment for recurrent C. difficile infections. 

A Word From Verywell

Even some proponents of the do-it-yourself fecal transplants recommend having donor stool tested before using it. However, there’s no lab available to consumers that can test stool with the rigor that is done in the labs that supply donor stool to physicians for treatment and for clinical trials. And, in fact, in at least one instance, even that testing done in a clinical environment was not enough to find a bacteria that turned out to be harmful and to ultimately cause one death.

Further, labs that process donor stool for use by physicians also have other protections in place, such as keeping samples of stool sent out in order to have it available for any testing that’s needed at a later date. In addition, the blood tests that are done on potential donors are extensive, not to mention expensive, and aren’t going to be covered by insurance for a do-it-yourself transplant.

As Dr. Nandi states, "Improperly screened donor stool can transmit infections causing IBD flares. This is preventable if utilizing academically established protocols but very costly to pursue independently, especially for the DIYer."

People who live with digestive conditions such as IBD or IBS face significant challenges in going about their daily life coping with symptoms, which makes the idea of fecal transplantation appealing. It’s no surprise that some people take matters into their own hands and probably wonder what could be the harm in using a stool from a healthy family member.

However, the potential risks are real and serious, not to mention the unintended effects that could occur that might not be life-threatening but could further make one’s health deteriorate. Fecal transplants might be used in the future to treat all sorts of diseases and conditions but as it stands right now, there’s just not enough known about our gut bacteria.

It’s best to reserve this treatment for those who really need it, in a medical setting.