fecal transplant at home

DISCLAIMER:

These “Fecal Transplant At Home – DIY Instructions” are based on the experiences of one person, the anecdotal reports of others and questions most frequently asked by  e-Patients. They are not medical advice. FMT is still considered an experimental procedure without known future consequences.
Please read the disclaimer and discuss your options with your doctor before doing fecal microbiota transplant (FMT). It is critical that your doctor test your donor before FMT. An outwardly healthy person could carry an asymptomatic parasite or blood borne illness that could wreak havoc in your fragile system.

Step 3 – On The Big Day

You have your donor. They have been tested and found to be clear of pathogens as well as having a healthy microbial diversity.  You and your donor have discussed the logistics about and made arrangements for dropping off the stool.  You have talked with your doctor, done your pre-FMT arrangements for diet/antimicrobials etc.  You have all your shopping done and all the implements are ready for your fecal transplant.

Now that you have all the research and pre-FMT work done…You are ready for your big day!
Preparation for The Day:

  • Prepare your FMT area. Put enema bag, lubricant, tissues, paper towels, plastic bag, diagram of colon & timer within easy reach together with anything you need to be comfortable eg rug and pillow. The cushion should go underneath the towel so that it raises your rear end. This will use gravity to keep the FMT in.
  • Assume you will have a spill and make sure paper towels and plastic bag are nearby to dispose of clean-up items. A bath is easier as you can wash the mess away.
  • Take Imodium upon waking (unless you suffer from constipation).
  • Collect donor stool sample.
  • Do not use sample if it does not look healthy. Sample should look like 2, 3 or 4 on the Bristol Stool Chart.
  • Keep sample at room temperature and use within 2-3 hours unless freezing.
  • If your donor produces stool in the morning and you cannot get to the sample until evening (or vice versa), then too many hours will pass with the stool exposed to air.  It would be better to freeze the sample immediately for use later in the day.
  • If you are going to freeze some sample, separate it into portions and put it in the freezer. For Freezing & Thawing Instructions Click Here!
  • Regardless of fresh or frozen stool, you will want to warm the distilled water so that it is tepid (around body temperature). Too hot will kill the FMT and too cold will be uncomfortable for you to hold in.
  • To make saline add ¼ tsp. sea salt to 1 cup distilled water. Do not use table salt with additives.

The FMT Slurry

  • Put stool and water/saline in a zip lock bag (many put the ziplock bag inside another zip lock bag to minimize spilling) then mush/blend with your hangs. We used to recommend blending but too much air can kill anaerobic bacteria and reduce the potency of the sample. Plus, Zip-lock bags require less clean up than blender-method and expose the microbiota to less turbulence, but the process is somewhat more revolting as you are closer to the poop and have to mush it by hand through the bag. Your choice.
  • Add as much water as necessary to make the FMT the consistency of paint. Too thick will block the nozzle and too runny will be harder to hold in and reduce the potency of the FMT.
  • Most people do not need a lot.  A four ounce fleet (120 ml) enema is enough.  Those with IBD often want to do more and use enema systems the put the fecal matter higher up.  But it doesn’t seem to be necessary.  The samples used in the hospital to treat C.diff and in IBD trials are only a few ounces.
  • Take care not to expose the sample to any more air or water than absolutely necessary as this will reduce its quality.
  • Make sure enema nozzle switch is shut. VERY important or it will spurt everywhere!
  • Pour FMT slurry into enema bag using kitchen strainer & funnel
  • Hang enema bag on hook.
  • Lift tube high in the air (to prevent spill), release nozzle to let air out, lower gradually until all air is released. Close nozzle once you can see all air has gone and FMT has reached the nozzle.
  • If you are using a syringe or enema bottle, simply fill them with the slurry.

Inserting The Enema

  • Prepare for entry with a little lubricant
  • Lie down on your left side making sure your rear is raised on the cushion.
  • Lift up your right leg and slowly, gently insert enema
    a nozzle. A little discomfort is normal but do not continue if it is painful. It can help to dilate the entry with a finger before insertion.
  • Open the enema nozzle switch.
  • Feel the FMT flowing. If it’s not flowing sit up, carefully holding the nozzle in place and shake the enema bag to get it flowing.
  • Lie down and take a deep breath as the FMT flows in. Hold your butt tight.
  • Congratulate yourself for having come this far! Think of all the good bugs that are going to repopulate your gut. Breathe.
  • When you are ready, switch off the enema nozzle, then remove the nozzle and put it straight into the plastic bag. Wipe yourself if necessary.
  • If you feel like you are going to expel the FMT then turn off the enema nozzle. You can put more in later if you want.  The quantity doesn’t need to be a lot.  Hospitals don’t use more than a few ounces.

After You Complete The Enema Process

  • You will want to help the microbes make there way around the colon. Refresh your memory by looking at the diagram of the colon.
  • Lie on your left side for 10 minutes. Massage the FMT gently up your colon.
  • Then lie on your stomach for 10 minutes.
  • Lie on your back for 10 minutes. Massage the FMT gently across your colon.
  • Lie on your right side for 10 minutes. Massage the FMT gently down your colon.
  • If you are having trouble holding it in, don’t panic. It doesn’t matter if you lose a little. That’s what the big brown towel and paper towels are for. Try doing a little at a time, massaging, and then doing some more.
  • Try and hold it in for as long as possible.  For some, that will be only twenty minutes or so.  For others, that will be hours.  Do what you can.  Don’t try to overdo it.  No one wants to encourage constipation.
  • If you are using a re-useable enema bag, wash it and store it in a bucket of water with 1 lb. / 500g of dissolved sea salt or your preferred method of keeping it sterile.


<– Back to Step 2: Donor Pathology Tests

To Step 4: After The Big Day –>


DISCLAIMER:

These “Fecal Transplant At Home – DIY Instructions” are based on the experiences of one person, the anecdotal reports of others and questions most frequently asked by  e-Patients. They are not medical advice. And FMT is still considered an experimental procedure without known future consequences.
Please read the disclaimer and discuss your options with your doctor before doing fecal microbiota transplant (FMT). It is critical that your doctor test your donor before FMT. An outwardly healthy person could carry an asymptomatic parasite or blood borne illness that could wreak havoc in your fragile system.

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