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UPDATE 5/1/2019: The effect of the FMTs has largely worn off. What remains is my bowel movements being consistently a bit wetter, softer, and thinner with somewhat reduced gas, bloating, and discomfort. However, I have reverted to needing probiotics/probiotic yogurt in order to move my bowels every day. It is the same pattern where the probiotics seem to stop working after 2 weeks and then I have to switch to another one. Mutaflor is a new probiotic I tried and it is working extremely well. Especially if you live in the USA like I do, where you have to order it online express shipped from Canada since it is not available for sale here, I would recommend making yogurt from it so that you can save money since it can be pretty expensive. (Long story short, you can turn 1 pill into 2 WEEKS of yogurt doses versus taking 4 pills PER DAY otherwise, which means it ends up being around 1/50 or 2% of the original price!) So far I have favorable results from the following probiotics: Mutaflor (available through feelgoodnatural.com), Bifidobacterium longum BB536 (Morinaga brand, available through eBay), Lactobacillus plantarum 299v (Jarrow brand, available through Amazon), and Symbioflor 2 (available through paulsmarteurope.com). I have not had any positive effects from BioGaia Gastrus (which is Lactobacillus reuteri DSM 17936). I have not re-tried the Clostridium butyricum (Miyari brand, available through eBay) though I'm sure it would be helpful.
UPDATE 5/31/2019: My gas and abdominal discomfort -- especially starting an hour or so after a meal -- has gotten worse over the past few months, becoming more significant this recent month. However, this week I started taking Heather's peppermint oil capsules (available through Amazon or at CVS) an hour before breakfast and an hour before dinner which are fantastic for helping my discomfort and gas. I am currently only taking the 2 peppermint oil capsules per day (no probiotics or yogurt or other laxatives) and I have bowel movements every morning. The bowel movements are the same strange thinness that seems to be a result of the FMT series I did, but they are also more wet than my movements used to be before the FMTs, so I'll take the wetness with the thinness since I haven't had an anal fissure in many, many, many months at this point. It's quite a relief. I'm still considering doing another FMT series with a friend as my donor since she is an ideal donor by almost every standard, but I am going to get some GI testing done first to rule out anything serious. (SIBO breath test, endoscopy, etc.)
Original post below...
TL;DR I did two series of Fecal Microbiome Transplants (FMTs) at home for severe, chronic constipation and had moderate success.
Hello Reddit! I will try to be as organized in this post as possible, and to that end I will provide a Table of Contents here at the top. I hope you find this information helpful. Please skip to whichever section you believe will be most helpful for you (which I imagine will be Section 3, where I discuss the details of my FMTs).
The Reddit community, in particular /u/MaximilianKohler , has been vital to my ability to gather information during this process as I did not find any medical professional, including naturopaths, knowledgable about or willing to discuss probiotics, FMT, and so on where I live (the Northeastern United States). A big thank you to everyone who helped me in this process.
Important before reading, I will be using the Bristol Scale to rate my stool (e.g. type 1), so please familiarize yourself with this helpful graphic: https://upload.wikimedia.org/wikipedia/commons/thumb/9/9e/BristolStoolChart.png/400px-BristolStoolChart.png
SECTION 1: Overarching narrative of my health with focus on GI issues.
SECTION 2: Write-up in the form of a medical note, detailing symptoms
SECTION 3: FMT preparation, set-up, and log with links to photos (NSFW).
SECTION 4: Summary and advice.
SECTION 1
I am a young gay male who was in a 6-year long-term relationship with another man (until 2015). At the end of 2015, I started having extremely strained bowel movements with stool so hard that it would cause severe anal fissures and bleeding from my anus. I was diagnosed with an anal gonorrhea infection - my partner had cheated on me (I left him thereafter) and I am unsure how long I was harboring the infection, though in my best estimation it was at least 3 months. I was treated with two antibiotics and my symptoms seemed to resolve, i.e. I had diarrhea and my pain/anal fissures subsided. However, my symptoms returned shortly. The infection was verified as eliminated so my GI doctor said to take docusate sodium (a stool softener) and magnesium oxide (an osmotic laxative) for awhile until things settled back to normal. These helped for a bit, but, unfortunately, my symptoms only got worse and my bowel movements were entirely dependent on softeners and laxatives. I saw many, many GI doctors and they effectively told me I had a chronic condition that had no discernible cause so I should accept dependence on laxatives forever. They all tried to push prescription-strength laxatives onto me, particularly Linzess, but I turned these prescriptions down as I wanted to try to treat things as naturally and delicately as possible while I problem-solved on my own. I believed that I could find long-term healing if I preserved what natural function and sensation in my gut still existed. To this end, I avoided stimulant laxatives (e.g. senna, Dulcolax, etc.) as those have been shown to damage the nervous system and gut-brain connection. I only used osmotic laxatives (e.g. mineral oil, magnesium citrate, etc.) and stool softeners, both of which are “gentle” and “non-addictive."
Importantly, in my first year of illness, I realized that if a bacterial infection caused my issues, perhaps probiotics could help me heal. I did research into probiotics through labdoor.com , discovering that the Renew Life brand of probiotic was the most reliable. I bought the highest CFU amount (150 billion) and took the recommended dose of 1 pill per day for one week. This did nothing, so I doubled the dose to 2 pills per day. After 1 week I saw results and my BMs were absolutely perfect. Almost better than before my infection! I continued the regimen of 2 pills per day for 2 additional weeks and then stopped, thinking I’d cured myself. My symptoms came back and then, tragically, the pills did not work when I took them again.
For the next year and a half, I was hopping from one over-the-counter softener and/or laxative to the next as they would all eventually stop working. The pain and discomfort every day made me thoroughly stressed and depressed. Inevitably it was not just the quality or frequency of my BMs (and any associated tearing, pain, and bleeding in my rectum/anus) but also visceral hypersensitivity and increased gas that were causing me distress. Luckily, I never had any food sensitivities (other than lifelong lactose intolerance) and when I tried the FODMAP or other diets I found no relief. I maintained a high fiber diet (soluble and insoluble fibers, including fiber supplements), but this would only help mildly. I kept hearing “drink more water” from my physicians, and at one point I almost had a breakdown after having another medical professional question me about my water intake yet again. I was tied at the hip to my water bottle and guzzling plenty of liters every day, without relief.
In the fall/winter of 2017, I discovered the Reddit probiotic wiki page and decided to try some of the recommended probiotics for constipation. In particular, I read about a user making Bifidobacterium BB536 yogurt and finding relief, so I bought a yogurt maker and ordered the pills from Morinaga, a reputable brand (unfortunately no longer available in the USA). The yogurt gave me the most natural-feeling, comfortable BMs I’d had in a long time. However, this relief lasted only a couple weeks before I went back to my usual hard stool and/or absence of any bowel movements without laxative intervention. I tried culturing another probiotic — Lactobacillus plantarum 299v — in yogurt that I had read literature about. I also found success with this probiotic but then slid back to my unhealthy state after a week or two. Another probiotic, Clostridium butyricum from Miyari-san, was supposed to be helpful for constipation and had the advantage of being “colonizing”, meaning it would implant in my intestines and therefore, hopefully, not stop working like the other probiotics. It worked longer than the others — about a month or two — but did not create long, healthy logs like my BMs were before illness. (It only decreased transit time so I would have daily BMs and somewhat softened stool that was formed into bigger pieces.) I then tried E. coli from Symbioflor 2 and found that it made thicker, wetter, longer stools with decreased transit time, and this also worked for 1 to 2 months. However, it, too, stopped working.
In the middle of experimenting with probiotics (January 2018), I was diagnosed with late-stage Hodgkin lymphoma, a type of immune system cancer. The cause of Hodgkin lymphoma is unknown and there are no specific links to the GI system. My physician EXPLICITLY said that constipation was not known to be associated with Hodgkin lymphoma and that my symptoms were, according to current medical literature, unrelated. However, there is extraordinary evidence of an immune system-microbiome link and cancer-microbiome link that my physician acknowledged could be relevant. However, the evidence, in his view, was not robust enough to definitively claim that my infection/constipation/dysbiosis was related to my cancer. (A few papers illustrating this are available on the Reddit microbiome wiki page.) I was assigned to 5-6 months of chemotherapy and my oncologist said this would change my microbiome, though by how much and in what way he could not say, so he was unsure what effect if any it would have on my constipation. During chemotherapy my GI symptoms were either the same or slightly worse. The most helpful thing ended up being small doses of magnesium citrate sipped throughout the day. (Natural Calm magnesium citrate power on Amazon is my go-to brand.)
After chemotherapy, I miraculously but slowly began to regain bowel function. At the beginning of August 2018, a month and a half after stopping chemotherapy and nearly 3 years after my infection, I was able to stop using any laxatives, softeners, or probiotics without halting BMs. I was going every day and the quality of the majority of my BM each time was fairly normal. However, I was still having hard type 1 stool at the beginning of every BM, regardless of changing diets, probiotics, laxatives, etc. It would often be a few pieces of hard/dry type 1 for the first 15% of the movement, then a fairly normal type 3 or 4 bowel movement for the remaining, though a bit on the drier side. This was causing anal fissures/bleeding/pain still and I didn’t feel normal urgency to go to the bathroom. I also still felt something was “wrong” since I had visceral hypersensitivity and excess gas. Therefore, I opted to initiate a series of 10 FMTs using donations from Michael Garcia, a “professional” donor in Florida working with a C. difficile clinic. ( https://mginfusions.com/ )
The FMTs spanned from mid-August to the beginning of September. At first, the infusions were wildly successful. However, the infusions thereafter were a bit up and down (details in Section 3), making me fear that this was going to stop working in a similar fashion to previous treatments. I even got a severe anal fissure during the series but continued on nonetheless. Three months after completing this series of 10 infusions, my BMs continued to be daily and were significantly more comfortable than before, i.e. my stool did not start as type 1 and I did not experience anal fissures any longer. I did not achieve day-to-day consistency with my BMs, meaning that the quality of my stool was different each day. In all, it seemed that my stool was almost TOO wet and required a lot of wiping that I hadn’t needed to do before I was infected. My stool also narrowed to about half the width or less of my normal, pre-infection movements, which was very odd and prevented proper pressure from being applied to my gut to signal urgency. I learned to attempt a bowel movement with any slight inkling of a full colon and performed deep breathing exercises on the toilet to push on my colon with my diaphragm to initiate movements. (I received a sigmoidoscopy that did not find any anatomical abnormalities or obstructions in the rectum, sigmoid colon, or descending colon, though I have yet to receive a full colonoscopy.) Finally, although gas and discomfort was diminished, I still had more-than-average discomfort and gas.
Because I did not achieve full remission, I attempted another four infusions (again from Michael Garcia) in December 2018. These infusions further diminished discomfort and gas, though still not to the degree that I possessed prior to infection. The infusions also reduced the excessive wetness I had been experiencing from my BMs. These changes were modest and not the full resolution I’d hoped for, although I added psyllium husk (fiber) supplements back into my diet and this has helped bulk up my stool, creating more comfortable bowel movements but still with some undue gas and discomfort throughout the day. I still would not consider myself to have “normal” bowel function compared to my pre-infected self, but my current condition is leaps and bounds improved over how I was in the years before chemotherapy.
I believe that the success I have had with FMT is due to a few factors. First, the onset of my illness was in adulthood, the onset was acute (i.e. came on all of the sudden), and the onset was from an infectious disease that involved bacteria. Second, my condition responded to antibiotics and probiotics, albeit for only brief periods of time. Third, my condition was (likely) localized to the distal (end) part of my colon, since that is where the infection was deposited. Therefore, the problematic area was easily accessed by the FMTs, which I administered via enema. I cannot speak for alternative FMT methods as I did not try them.
As an aside, I think I succumbed to long-term effects from my infection because my microbiome started out weak. It was weakened in childhood due to long-term (year-long) use of proton pump inhibitors for acid reflux, years of antibiotics in childhood due to overzealous parents/doctors using them for sore throats and acne, and, probably, a poor microbiome inherited from my mother due to her significant anxiety issues. (Anxiety is associated with a defunct microbiome and probably the reason my mother contracted a C. difficile infection a few years ago).
SECTION 2
Chief Complaint: Hard, dry bowel movements beginning with type 1 stool that cause pain and anal fissures with minor bleeding.
History of Present Illness: Anal gonorrhea infection in mid-late 2015 with at least 3 months between exposure and testing. Symptoms resolved immediately after antibiotic administration but relapsed shortly thereafter. Tolerance built to laxatives and probiotics, necessitating cycling of numerous medications. Laxatives were always osmotic (never stimulant).
Past Medical History: Mild acid reflux and lactose intolerance since childhood. Anxiety disorder since childhood continuing through adulthood with remission since 2014. Mild to moderate back/sciatic pain from physical labor accident in 2017 that arises on a near-daily basis. Stage 3 Hodgkin lymphoma in 2018.
Surgical History: Appendectomy (2005); Excisional Biopsy on Lymph Node (2018).
Social History: Educated through doctoral level in USA. Never smoked tobacco and less than 1 alcoholic drink per month on average for the past 10 years. Current marijuana user (1x/week on average).
Family History: Mother has had significant anxiety and GI issues (IBS-D, C. difficile). Father has cardiac issues, lower back issues.
Medications: None currently. Past medications include childhood use of Proton Pump Inhibitors (for acid reflux) for at least one year, various antibiotics for infections and acne for years, and numerous antidepressants and anxiolytics on and off until 2014 (medication free since then). Received chemotherapy for Hodgkin lymphoma for 6 months Jan-Jun 2018. Currently taking psyllium husk (fiber) supplement daily.
Allergies: lactose intolerance (lifelong); cats
SECTION 3
My FMT protocol was adopted from numerous resources, including the Reddit microbiome wiki. I had my donor produce a bowel movement directly into a ziplock bag, add 3-4oz of water, add 1 tablespoon of (vegetable) glycerin, add 1/2 teaspoon of salt, then press the air out of the bag, seal it, and smash it together repeatedly with his hands to distribute everything evenly before placing it in a second ziplock bag and storing it in a freezer held at least at -20 degrees Celsius. Once a good number of samples were ready, they were shipped on dry ice overnight. Once at my doorstep, they were placed into a medical-grade freezer held at least at -20 degrees Celsius.
Once ready, I thawed a single FMT infusion (still in the double bag) in a bowl of warm water (~35 degrees Celsius but no warmer than 37 degrees Celsius) until it reached room temperature, which typically took 1 hour. In the meantime, I washed my hands and put on nitrile gloves. I sterilized a glass 4-cup measuring cup (a tapered spout is important!) and sterilized a pair of scissors with 70% rubbing alcohol. I hung a medical-grade enema bag with pre-lubricated tip on a coat hanger on my shower rod, ensuring that I moved the clamp toward the end of the tube and then properly clamped the enema tube shut. I placed two pillows into two separate trash bags, then placed these in the bathtub. Right before administering the FMT, I took a fresh piece of cheesecloth from a package bought off Amazon and placed it in the measuring cup. I then took the plastic bags with the infusion, removed the outer bag, and added an additional 2-4oz of bottled Poland Spring water to the remaining bag with the infusion (to thin out consistency for enema flow). I resealed this bag and smashed the contents between my hands to distribute the water. I then cut a small corner off the corner of the bag and poured the solution into the measuring cup with the cheesecloth. I placed the empty bag into a trash bag nearby. I then picked up the cheesecloth in one hand and twisted it with the other to apply pressure to the remaining stool, squeezing out excess liquid. I threw the cheesecloth and soiled gloves into a trash bag thereafter. I removed the enema bag from the coat hanger, poured the contents of the measuring cup into the enema bag, then re-hung the enema bag. I released the clamp on the enema tube until the liquid flowed close to the clamp then quickly clamped it shut. (This eliminates the amount of air you infuse into your colon which reduces discomfort and helps you retain the solution better.) I got into the bath tub with my butt in the air, knees on one pillow, and chest pressed to the floor on another pillow. I then removed the tube cap, inserted the tube into my anus, and unclamped the tube (without looking at it since my chest/face was on the floor). I relaxed and let the solution flow into me, then looked behind me to see when the bag was empty. Once this happened, I tried to clamp the tube closed again and removed it from inside me.
Please see the diagram here for a (terribly drawn) illustration of the positions I held https://imgur.com/XbAdNcG . I held each position for about 5 minutes and cycled through twice for a total of 30 minutes, then stayed in bath tub at least an additional 30 minutes to prevent leaking or urgency.
Here is what my stool looked like (if I was able to pass stool at all) before I started receiving chemotherapy (which, as noted above, inevitably and unexpectedly helped with my condition, though not completely and thus prompted my FMTs): https://imgur.com/6fLs6b4 https://imgur.com/ZJvnERM
8/10 Stopped eating at 11am. Chicken broth during day. Took 2 Dulcolax tablets and around 100g (6 17g capfuls) of Miralax at 8pm with 28oz Gatorade (last bit of Gatorade and miralax was finished by 9pm). This was half the amounts recommended by a hospital colonoscopy cleanse protocol. Shitted my brains out, like pure liquid, at 2am 4am and 8am (technically 8/11). Abdominal cramping, sweating.
8/11 Half-life of dulcolax is 16.5 hours so waited until 1:30pm. (Took 2 2mg loperamide at 1pm.) First attempt failed (1:30pm). Did not clench sphincter or actively fight expulsion. Stood up too soon (after 30 mins). Second attempt better (6:30pm). Urinated before infusion to reduce internal pressure. However, did not take 2 2mg loperamide right before (which I did before the first attempt). Hard clenching and butt in air when an urge would come. Urge passed in a short amount of time. Lots and lots of noises, gurgling. Felt I could walk around, eat a small amount, etc. slowly after 2ish hours of retention. Used 1 2mg loperamide before bed.
8/12 much easier to retain, some feelings of needing to go to the bathroom but could not go when I strained/tried around 3:30pm. Mostly normal feeling. No loperamide. Ate lightly.
8/13 couldn’t go to the bathroom in morning even after breakfast and with straining; some stomach discomfort. Minor gas and feeling a bit full but not much pain. Ate lunch at 12pm. 3:30pm expelled FMT (45 hours elapsed). PICTURE NSFW https://imgur.com/iZnuPTl Quality was type 4, long. Very comfortable to pass. Took 2 2mg loperamide and began to thaw next infusion. Peed. Next FMT (third attempt/bag total) at 5:30pm. Ate dinner. Real gurgling, some urgency happened again around 9:30pm. Subsided 10:30pm. Could pass gas safely by 10:45pm but while lying down.
8/14 needing to actively hold it in all day but in evening felt a bit constipated. Bit gassy at night.
8/15 bit gassy in morning. Expelled FMT at 1pm (held in for 43.5 hours). Type 3, bordering on type 2, somewhat more difficult to pass than 8/13 expulsion. Required straining. 2 2mg loperamide at 3:45pm. 5:15pm used fourth bag of FMT. Urinated before and after. Bit easier to hold in. Got up at 6:45pm but laid down again bc some gurgling and minor urgency. Safe to pass gas at 7:10pm. 9:15pm, ate decent size meal, no urge to go to bathroom. No longer lying down. Very comfortable.
8/16 BM at 2pm (held for 21 hours) and 5pm. Both with some straining, smooth but smaller movements. Not as log-like. No cracks and not painful upon passing. 2pm was wet, lots of wiping. 5pm no wiping necessary. No gas or discomfort after passing 5pm movement. Next FMT infusion (fifth bag) at 8:30pm, no loperamide. Couldn’t hold it in. Expelled infusion at 9pm. Solid feces came out with the infusion. Hoping I didn’t wash out/undo the progress from the previous FMTs. Felt some relief with the “wash out” but not entirely normalized.
8/17 tiny/normal amount of gas. Less discomfort, pain, etc.
8/18 felt slight urge to go, no emergency or anything. Ate breakfast, went to toilet at around 9:30am, and a single long log of very soft type 3 / type 4 was passed (with one pellet of soft type 1 at first). PICTURE NSFW https://imgur.com/j1Jb6zI No tearing, not much straining, one big log, and felt completely empty/good afterward. Similar to healthy-times (pre-infection) movements. No wetness/no wiping needed, just like before infection. Took 1 2mg loperamide at 12:45pm and urinated, did the next infusion (sixth bag) at 1:15pm. Fairly easy to retain.
8/19 only slept 6 hours. Went for a hike. Expelled FMT at 5:15pm (held for 28 hours). Smooth type 1, maybe type 2. Some straining. Incomplete evacuation. Didn't urinate, no loperamide before (seventh bag) FMT at 7pm. Easy to hold it in. 8:30pm tried to stand up, move around. Expelled infusion (had to run to bathroom).
8/20 only slept 6.5 hours. Felt mild urge throughout day, including morning. Felt very strong urge at 3:30pm. BM at 3:45pm. Some straining, two large sized type 1 pellets followed by perfect long type 4. Type 4 comfortable to pass, type 1 felt like it created a fissure upon passing. Feeling of complete evacuation afterward. 4pm took two 2mg loperamide, thawed next FMT (eighth bag). 5:30pm infusion. 7:30pm walked around. 8:30pm ate dinner. 9pm feeling some urgency, laid down. 9:15pm passed gas.
8/21 felt slightly urgey in morning, disappeared in afternoon. Could not go with straining.
8/22 no urge in morning. Strong urge at 5:30pm. Some straining but complete evacuation (truly “empty”). (Held in for around 48 hours.) Extremely long log of type 2 connected to type 4. Severe anal fissure developed on right lateral side. Painful. Wetness when wiping. Started nifedipine/lidocaine ointment to treat anal fissure.
8/23 some soreness/slight pain lower left quadrant. 9am had three type 1 stools. Bleeding on tissue paper from fissure. 5:00pm had some type 1 and type 2/type 4 thin/soft hybrid. Stinging, pain. Used nifedipine before this bowel movement. 6:45pm FMT (ninth bag). No loperamide. Initial urgency but after holding it in for a few minutes there is oddly no urgency anymore. No gas at all. No discomfort. Passed gas after eating around 9pm.
8/24 strained to go in morning, could not go. Very slight urge, very minor gas. BM at around 12:15pm (held around 18 hours). Hard, typical type 1 at first, followed by excellent, long, comfortable type 3/4. Thawed next bag for FMT (tenth bag). Administered at 2pm. No loperamide. Because wanting to distribute primarily to rectal area, stood upright immediately after infusion and shook hips back and forth for 30 seconds before assuming normal infusion positions. Completely comfortable, no urgency, no gas. 3:30pm walked around, ate at 4:15pm. Ate dinner at 8:30pm.
8/25 strong urge when waking. Ate small breakfast. 8:40am BM (held for about 19 hours), started as type 4 with no type 1. (Finally!) Small, soft type 1 at end. Wet stool came off on wipe.
10:05am another BM, multiple somewhat thinner soft type 4 stools. Next FMT (eleventh bag) at 1:15pm. No loperamide. Shimmied/shook upright at beginning. Very easy and comfortable to hold in. Ate around 4, then at 4:30 some urgency and gurgling.
8/26 minor urgency upon waking. Ate a little breakfast. 9am small BM (held for 20 hours), two thin logs of smooth type 2 / type 3 hybrid. PICTURE NSFW https://imgur.com/XTAtNkR
10:20am another BM, same shape and thinness but consistency was more type 4. Fairly comfortable to pass.
Urgency was very subtle but listened to my body and was able to go if I relaxed.
11am another BM similar in amount and texture to 10:20am BM.
4pm next FMT (twelfth bag). No loperamide. No gurgling. No clenching. Very easy to retain.
8/27 3:30pm had BM (held for 23.5 hours). Started as small log, smooth type 2 followed by separate small log, smooth type 3. Not wet on wiping. Notably, minimal gas and discomfort all day. Better appetite.
8/28 7:30am BM soft type 1 and type 4. “Fell out” of me, extremely fast. Urge beforehand wasn’t extraordinary. Very wet on wiping. Minor urgency from 1:30pm on. BM at 4:00pm. Very comfortable, type 3 / type 4. Somewhat wet on wiping. 5:30pm final FMT (thirteenth bag). Quite easy to retain. No loperamide.
8/29 significant urgency in morning. BM before breakfast at 7:15am. (Held for 15 hours.) Type 4 throughout. Very wet on wiping.
12pm BM type 4 very wet on wiping. 8:30pm type 4, also very wet on wiping. No type 1 all day!
-end of FMT series-
8/30 after breakfast feel urgency like I used to have pre-infection. 10:15am BM. Healthy-feeling. Very comfortable type 4 the entire way through ! Yesssss! Felt like old, healthy stool. Followed by very wet very thin soft type 4 / type 5 stool. This morning and yesterday have felt a bit rumble, urgey throughout day. Like, transit time is TOO fast. Not like a “weak” stomach per se but a bit overactive. Afternoon felt more normal.
8pm another BM. Started and ended as a solid long log of type 3 / type 4. Very comfortable to pass, felt like pre-sickness BM in terms of minimal but still a tiny bit of straining, wet but not too wet, etc.
8/31 No urgency on waking. Urgency 9:15am after breakfast. BM 10:00am, type 3 / 4, then thin type 4. PICTURE NSFW https://imgur.com/Wxyaiy1 Less shooting, acute lower left quadrant abdominal pain in past couple days (at random intervals, not during BM). Less internal soreness. No aggravation of fissure(s). Fully empty on regular basis.
Another BM at 4:15pm. Smooth, thick, single log of type 3 / 4. PICTURE NSFW https://imgur.com/VXaf0Gm Not too wet on wiping.
Completely normal feeling in evening. Utterly, completely normal. Wow.
9/1 Urgency upon waking but after getting up no urgency (9:00am). Ate breakfast. Very minor urgency, strained a bit for type 4 at 9:30am.
Very minor urgency, another BM at 5:30pm. Thick comfortable type 4.
9/2 Minor urgency upon waking at 8:40am. Very slight, subtle pain in lower left quadrant. Moderate urgency after breakfast 9:00am. BM at 9:10am. Minor straining. Started with one soft, large type 1 then type 4 “fell out” with somewhat ragged edges. Some thin loose strands also after that. PICTURE NSFW https://imgur.com/wfJNtm1
Another BM at 6:10pm. Only minor urgency. Short but comfortable log of type 3 (started as type 3). Very minor straining. After log had a bit of smooth, wet type 1. Very wet on wiping.
9/3 Minor urgency on waking 8:20am. Laid in bed until 8:45am and then completely lost urgency even after breakfast. Couldn’t go even with straining. No urgency. 1:30pm, after lunch, significant straining to produce very small type 2 / type 3 log. PICTURE NSFW https://imgur.com/Sj7sgQJ No urgency rest of day or BM.
-skipping ahead for Reddit post brevity, in summary had type 1 with straining, type 4 straining, type 1 straining, soft type 1 and then type 5, then comfortable classic type 3-
9/8 mild urgency upon waking 8:15am. Ate breakfast 8:30am. Moderate urgency 8:45am, BM. Started as soft type 3 / type 4, somewhat disconnected but thicker pieces. PICTURE NSFW https://imgur.com/ZiWRKeo Comfortable to pass.
5:30pm another BM, a couple very short soft type 4 pieces. Comfortable to pass.
9/9 moderate urgency on waking 10:45am. BM 11:10am. Soft type 4 thick at start, then very soft type 4 maybe even type 5 following this log. Very wet on wiping (as has been this past week.)
6pm another BM. Very soft and comfortable but somewhat thin type 4 / type 5 log(s).
-skipping ahead for Reddit post brevity but in summary, some comfortable type 3/4, then type 3, then straining for type 2, then smooth type 1 straining, then very thin type 4, then some dry type 3/4 stool with occasional type 1/2 thrown in, then dry type 3-
9/24 BM at 5pm. Some hard type 1 only. PICTURE NSFW https://imgur.com/U42RJBE
No full evacuation feeling. Significant straining. Huge setback today. Again at night 9pm-ish. Type 1. Significant straining. Hard/dry.
9/25 BM at 9:00am. Started hard dry type 1 with moderate straining, switched to dry type 3 short logs with mild straining. PICTURE NSFW https://imgur.com/41njhdA Another BM at 4pm. Moderate straining for thin type 4. Dry on wiping. PICTURE NSFW https://imgur.com/rCbAe3A
9/26 BM at 10am. Fell out. Comfortable, very wet. Type 4 but mix of thin and not thin. PICTURE NSFW https://imgur.com/2o0TGZG
9/27 BM at 12:15pm during lunch. One long, mildly wet log. Type 3 / type 4. Comfortable to pass. Only mildly wet on wiping. Similar to “healthy times” BM. PICTURE NSFW https://imgur.com/yXJaMtQ
9/28 BM at 12:15pm. Type 2 thin. Not wet. Moderate straining.
9/29 BM in morning. Type 2 somewhat thin. Not wet. Moderate straining.
Another BM at 2pm. Very thin type 4. Moderate straining. (Picture)
Another BM at 7pm. Acceptable thickness (though not “normal”) with mild straining and very wet. Type 4.
9/30 BM in morning at 10:40am, strong urgency right after breakfast. Classic type 3 log, mild/moderate straining but not too bad, wet on wiping. PICTURE NSFW https://imgur.com/0DP0a6a
Another BM 7:45pm, moderate urgency after dinner. Classic type 3 log, mild straining wet on wiping.
-skipping ahead for Reddit post brevity, in summary had type 4/5, type 4, type 4 but thin, type 2, type 3 starting as type 1-
10/6 BM around 11am. Excellent length and thickness. Comfortable type 3. Wet on wiping. No straining. Perfect BM!! Feeling of complete evacuation afterward, etc.
Another BM 2pm after a lot of tummy rumbling and feeling like I had diarrhea. Ended up having type 6 for the first time in years. Even though it’s diarrhea I feel amazing. Like fully empty.
10/7 At 1pm soft type 4, mild straining, very thin and moderate wetness. Overall volume not that much and the thin strands were disconnected.
Another BM at 6:15pm. Type 4, shortish but good thickness. Very wet on wiping. Mild straining and comfortable to pass.
-skipping ahead for brevity, in summary a bunch of type 4/type 3 with varying qualities and some straining but not too bad, occasional type 1 or dry/thin type 3-
10/13 BM at 8:50am. Perfect thickness and extremely long but started first 3 inches of log as type 2 before switching to type 4. PICTURE NSFW https://imgur.com/IuWV4eg Wet. No straining. Disrupted first 3 inches makes sense as this is the approximately length of the rectum, where my infection incubated and caused the most damage.
10/14 BM 8:00am. Perfect thickness, extremely long, first inch or two of log was type 2. Rest was type 4. Wet. No straining.
10/15 BM 9:30am. Perfect thickness, long, type 4. Started as type 2. Bit of type 5 afterward. Wet and comfortable without straining.
10/16 BM 8:50am. Not one solid log, slightly thin, type 4, mild straining, very wet.
Another BM 6:30pm. Perfect thickness, long, type 4. No straining, wet.
-skipping ahead for brevity, in summary lots of somewhat or very wet type 2-4 but getting to be very, very thin and one day without any bowel movements (11/2). On the night of 11/2 I used 1 teaspoon MgCitrate-
11/8 Very thin type 3-4 in morning. Straining. Somewhat wet.
11/9 One very thin type 3-4 in morning and one at night. Straining necessary. Somewhat wet on wiping.
11/10 One perfect thickness type 4 (starting type 2) with minimal straining.
11/11 One perfect thickness type 4 (starting type 2) with minimal straining. Very wet on wiping. Minimal gas throughout day.
11/12 Very long perfect thickness type 4 minimal straining.
I did not record after this but suffice it to say that my bowel movements became a bit thinner but more consistently very, very wet. By the end of December they were somewhat thin and still very, very wet. I underwent another 4 FMTs (also from Michael Garcia) and this helped to reduce the wetness but did not dramatically alter the thickness until I started taking some psyllium husk (fiber) supplements in the morning and night. Now I have somewhat thicker/more “normal” stool (current date is February 2) and only rarely does it start as type 1. I do not experience fissures any longer.
SECTION 4
Overall, I am happy I did the FMTs. The biggest boost in my GI health came from chemotherapy, which took me from years of dependence on laxatives and probiotics to spontaneous, daily bowel movements, much to the shock of both my physician and myself. I resolved the most significant issue at that time - beginning bowel movements with type 1 stool that caused anal fissures - by undergoing 10 FMTs and then an additional 4 FMTs four months after that. My stool quality was extremely variable for the first three months after the initial FMTs and then somewhat normalized, though not to my previously healthy state. The additional 4 FMTs gave a further boost but still my stool is a bit thinner than I would like and the first part is a bit drier than the rest. The thinness makes it difficult to feel urgency in a normal fashion and makes it difficult to begin expulsion of stool. I also experience more-than-average gas and abdominal discomfort, though these issues (and, really, all my issues) are quite manageable. The greatest gift is not needing to constantly change laxatives, probiotics, etc. to pass stool. A bit of extra fiber supplement does me right and, compared to years past, I'm a happy camper.
My next move, if I decide to do further experimentation, would be to use non-absorbable antibiotics (i.e. antibiotics that do not leave the GI tract) administered via enema and without following these antibiotics by FMT. Perhaps this could instigate repopulation of my gut as it was before? Depending on these results, I may then elect to use antibiotics again but in conjunction with an FMT series. If I decide to do further FMTs, I may consider a donor other than Michael Garcia to see if they are a better match with my natural microbiome makeup or I may combine MG's stool and another donor's stool. The issue is that it is extremely difficult to find good donors, unfortunately.
If you are hesitating about FMTs, cannot find a donor, or do not have the money to afford donations from Michael Garcia, please reference my history section for helpful probiotics or see the probiotics page on Reddit. Please also see that above section for advice on some helpful, gentle laxatives.
02 Feb 2019 (10 comments).
UPDATE 5/31/2019: My gas and abdominal discomfort -- especially starting an hour or so after a meal -- has gotten worse over the past few months, becoming more significant this recent month. However, this week I started taking Heather's peppermint oil capsules (available through Amazon or at CVS) an hour before breakfast and an hour before dinner which are fantastic for helping my discomfort and gas. I am currently only taking the 2 peppermint oil capsules per day (no probiotics or yogurt or other laxatives) and I have bowel movements every morning. The bowel movements are the same strange thinness that seems to be a result of the FMT series I did, but they are also more wet than my movements used to be before the FMTs, so I'll take the wetness with the thinness since I haven't had an anal fissure in many, many, many months at this point. It's quite a relief. I'm still considering doing another FMT series with a friend as my donor since she is an ideal donor by almost every standard, but I am going to get some GI testing done first to rule out anything serious. (SIBO breath test, endoscopy, etc.)
Original post below...
TL;DR I did two series of Fecal Microbiome Transplants (FMTs) at home for severe, chronic constipation and had moderate success.
Hello Reddit! I will try to be as organized in this post as possible, and to that end I will provide a Table of Contents here at the top. I hope you find this information helpful. Please skip to whichever section you believe will be most helpful for you (which I imagine will be Section 3, where I discuss the details of my FMTs).
The Reddit community, in particular /u/MaximilianKohler , has been vital to my ability to gather information during this process as I did not find any medical professional, including naturopaths, knowledgable about or willing to discuss probiotics, FMT, and so on where I live (the Northeastern United States). A big thank you to everyone who helped me in this process.
Important before reading, I will be using the Bristol Scale to rate my stool (e.g. type 1), so please familiarize yourself with this helpful graphic: https://upload.wikimedia.org/wikipedia/commons/thumb/9/9e/BristolStoolChart.png/400px-BristolStoolChart.png
SECTION 1: Overarching narrative of my health with focus on GI issues.
SECTION 2: Write-up in the form of a medical note, detailing symptoms
SECTION 3: FMT preparation, set-up, and log with links to photos (NSFW).
SECTION 4: Summary and advice.
SECTION 1
I am a young gay male who was in a 6-year long-term relationship with another man (until 2015). At the end of 2015, I started having extremely strained bowel movements with stool so hard that it would cause severe anal fissures and bleeding from my anus. I was diagnosed with an anal gonorrhea infection - my partner had cheated on me (I left him thereafter) and I am unsure how long I was harboring the infection, though in my best estimation it was at least 3 months. I was treated with two antibiotics and my symptoms seemed to resolve, i.e. I had diarrhea and my pain/anal fissures subsided. However, my symptoms returned shortly. The infection was verified as eliminated so my GI doctor said to take docusate sodium (a stool softener) and magnesium oxide (an osmotic laxative) for awhile until things settled back to normal. These helped for a bit, but, unfortunately, my symptoms only got worse and my bowel movements were entirely dependent on softeners and laxatives. I saw many, many GI doctors and they effectively told me I had a chronic condition that had no discernible cause so I should accept dependence on laxatives forever. They all tried to push prescription-strength laxatives onto me, particularly Linzess, but I turned these prescriptions down as I wanted to try to treat things as naturally and delicately as possible while I problem-solved on my own. I believed that I could find long-term healing if I preserved what natural function and sensation in my gut still existed. To this end, I avoided stimulant laxatives (e.g. senna, Dulcolax, etc.) as those have been shown to damage the nervous system and gut-brain connection. I only used osmotic laxatives (e.g. mineral oil, magnesium citrate, etc.) and stool softeners, both of which are “gentle” and “non-addictive."
Importantly, in my first year of illness, I realized that if a bacterial infection caused my issues, perhaps probiotics could help me heal. I did research into probiotics through labdoor.com , discovering that the Renew Life brand of probiotic was the most reliable. I bought the highest CFU amount (150 billion) and took the recommended dose of 1 pill per day for one week. This did nothing, so I doubled the dose to 2 pills per day. After 1 week I saw results and my BMs were absolutely perfect. Almost better than before my infection! I continued the regimen of 2 pills per day for 2 additional weeks and then stopped, thinking I’d cured myself. My symptoms came back and then, tragically, the pills did not work when I took them again.
For the next year and a half, I was hopping from one over-the-counter softener and/or laxative to the next as they would all eventually stop working. The pain and discomfort every day made me thoroughly stressed and depressed. Inevitably it was not just the quality or frequency of my BMs (and any associated tearing, pain, and bleeding in my rectum/anus) but also visceral hypersensitivity and increased gas that were causing me distress. Luckily, I never had any food sensitivities (other than lifelong lactose intolerance) and when I tried the FODMAP or other diets I found no relief. I maintained a high fiber diet (soluble and insoluble fibers, including fiber supplements), but this would only help mildly. I kept hearing “drink more water” from my physicians, and at one point I almost had a breakdown after having another medical professional question me about my water intake yet again. I was tied at the hip to my water bottle and guzzling plenty of liters every day, without relief.
In the fall/winter of 2017, I discovered the Reddit probiotic wiki page and decided to try some of the recommended probiotics for constipation. In particular, I read about a user making Bifidobacterium BB536 yogurt and finding relief, so I bought a yogurt maker and ordered the pills from Morinaga, a reputable brand (unfortunately no longer available in the USA). The yogurt gave me the most natural-feeling, comfortable BMs I’d had in a long time. However, this relief lasted only a couple weeks before I went back to my usual hard stool and/or absence of any bowel movements without laxative intervention. I tried culturing another probiotic — Lactobacillus plantarum 299v — in yogurt that I had read literature about. I also found success with this probiotic but then slid back to my unhealthy state after a week or two. Another probiotic, Clostridium butyricum from Miyari-san, was supposed to be helpful for constipation and had the advantage of being “colonizing”, meaning it would implant in my intestines and therefore, hopefully, not stop working like the other probiotics. It worked longer than the others — about a month or two — but did not create long, healthy logs like my BMs were before illness. (It only decreased transit time so I would have daily BMs and somewhat softened stool that was formed into bigger pieces.) I then tried E. coli from Symbioflor 2 and found that it made thicker, wetter, longer stools with decreased transit time, and this also worked for 1 to 2 months. However, it, too, stopped working.
In the middle of experimenting with probiotics (January 2018), I was diagnosed with late-stage Hodgkin lymphoma, a type of immune system cancer. The cause of Hodgkin lymphoma is unknown and there are no specific links to the GI system. My physician EXPLICITLY said that constipation was not known to be associated with Hodgkin lymphoma and that my symptoms were, according to current medical literature, unrelated. However, there is extraordinary evidence of an immune system-microbiome link and cancer-microbiome link that my physician acknowledged could be relevant. However, the evidence, in his view, was not robust enough to definitively claim that my infection/constipation/dysbiosis was related to my cancer. (A few papers illustrating this are available on the Reddit microbiome wiki page.) I was assigned to 5-6 months of chemotherapy and my oncologist said this would change my microbiome, though by how much and in what way he could not say, so he was unsure what effect if any it would have on my constipation. During chemotherapy my GI symptoms were either the same or slightly worse. The most helpful thing ended up being small doses of magnesium citrate sipped throughout the day. (Natural Calm magnesium citrate power on Amazon is my go-to brand.)
After chemotherapy, I miraculously but slowly began to regain bowel function. At the beginning of August 2018, a month and a half after stopping chemotherapy and nearly 3 years after my infection, I was able to stop using any laxatives, softeners, or probiotics without halting BMs. I was going every day and the quality of the majority of my BM each time was fairly normal. However, I was still having hard type 1 stool at the beginning of every BM, regardless of changing diets, probiotics, laxatives, etc. It would often be a few pieces of hard/dry type 1 for the first 15% of the movement, then a fairly normal type 3 or 4 bowel movement for the remaining, though a bit on the drier side. This was causing anal fissures/bleeding/pain still and I didn’t feel normal urgency to go to the bathroom. I also still felt something was “wrong” since I had visceral hypersensitivity and excess gas. Therefore, I opted to initiate a series of 10 FMTs using donations from Michael Garcia, a “professional” donor in Florida working with a C. difficile clinic. ( https://mginfusions.com/ )
The FMTs spanned from mid-August to the beginning of September. At first, the infusions were wildly successful. However, the infusions thereafter were a bit up and down (details in Section 3), making me fear that this was going to stop working in a similar fashion to previous treatments. I even got a severe anal fissure during the series but continued on nonetheless. Three months after completing this series of 10 infusions, my BMs continued to be daily and were significantly more comfortable than before, i.e. my stool did not start as type 1 and I did not experience anal fissures any longer. I did not achieve day-to-day consistency with my BMs, meaning that the quality of my stool was different each day. In all, it seemed that my stool was almost TOO wet and required a lot of wiping that I hadn’t needed to do before I was infected. My stool also narrowed to about half the width or less of my normal, pre-infection movements, which was very odd and prevented proper pressure from being applied to my gut to signal urgency. I learned to attempt a bowel movement with any slight inkling of a full colon and performed deep breathing exercises on the toilet to push on my colon with my diaphragm to initiate movements. (I received a sigmoidoscopy that did not find any anatomical abnormalities or obstructions in the rectum, sigmoid colon, or descending colon, though I have yet to receive a full colonoscopy.) Finally, although gas and discomfort was diminished, I still had more-than-average discomfort and gas.
Because I did not achieve full remission, I attempted another four infusions (again from Michael Garcia) in December 2018. These infusions further diminished discomfort and gas, though still not to the degree that I possessed prior to infection. The infusions also reduced the excessive wetness I had been experiencing from my BMs. These changes were modest and not the full resolution I’d hoped for, although I added psyllium husk (fiber) supplements back into my diet and this has helped bulk up my stool, creating more comfortable bowel movements but still with some undue gas and discomfort throughout the day. I still would not consider myself to have “normal” bowel function compared to my pre-infected self, but my current condition is leaps and bounds improved over how I was in the years before chemotherapy.
I believe that the success I have had with FMT is due to a few factors. First, the onset of my illness was in adulthood, the onset was acute (i.e. came on all of the sudden), and the onset was from an infectious disease that involved bacteria. Second, my condition responded to antibiotics and probiotics, albeit for only brief periods of time. Third, my condition was (likely) localized to the distal (end) part of my colon, since that is where the infection was deposited. Therefore, the problematic area was easily accessed by the FMTs, which I administered via enema. I cannot speak for alternative FMT methods as I did not try them.
As an aside, I think I succumbed to long-term effects from my infection because my microbiome started out weak. It was weakened in childhood due to long-term (year-long) use of proton pump inhibitors for acid reflux, years of antibiotics in childhood due to overzealous parents/doctors using them for sore throats and acne, and, probably, a poor microbiome inherited from my mother due to her significant anxiety issues. (Anxiety is associated with a defunct microbiome and probably the reason my mother contracted a C. difficile infection a few years ago).
SECTION 2
Chief Complaint: Hard, dry bowel movements beginning with type 1 stool that cause pain and anal fissures with minor bleeding.
History of Present Illness: Anal gonorrhea infection in mid-late 2015 with at least 3 months between exposure and testing. Symptoms resolved immediately after antibiotic administration but relapsed shortly thereafter. Tolerance built to laxatives and probiotics, necessitating cycling of numerous medications. Laxatives were always osmotic (never stimulant).
Past Medical History: Mild acid reflux and lactose intolerance since childhood. Anxiety disorder since childhood continuing through adulthood with remission since 2014. Mild to moderate back/sciatic pain from physical labor accident in 2017 that arises on a near-daily basis. Stage 3 Hodgkin lymphoma in 2018.
Surgical History: Appendectomy (2005); Excisional Biopsy on Lymph Node (2018).
Social History: Educated through doctoral level in USA. Never smoked tobacco and less than 1 alcoholic drink per month on average for the past 10 years. Current marijuana user (1x/week on average).
Family History: Mother has had significant anxiety and GI issues (IBS-D, C. difficile). Father has cardiac issues, lower back issues.
Medications: None currently. Past medications include childhood use of Proton Pump Inhibitors (for acid reflux) for at least one year, various antibiotics for infections and acne for years, and numerous antidepressants and anxiolytics on and off until 2014 (medication free since then). Received chemotherapy for Hodgkin lymphoma for 6 months Jan-Jun 2018. Currently taking psyllium husk (fiber) supplement daily.
Allergies: lactose intolerance (lifelong); cats
SECTION 3
My FMT protocol was adopted from numerous resources, including the Reddit microbiome wiki. I had my donor produce a bowel movement directly into a ziplock bag, add 3-4oz of water, add 1 tablespoon of (vegetable) glycerin, add 1/2 teaspoon of salt, then press the air out of the bag, seal it, and smash it together repeatedly with his hands to distribute everything evenly before placing it in a second ziplock bag and storing it in a freezer held at least at -20 degrees Celsius. Once a good number of samples were ready, they were shipped on dry ice overnight. Once at my doorstep, they were placed into a medical-grade freezer held at least at -20 degrees Celsius.
Once ready, I thawed a single FMT infusion (still in the double bag) in a bowl of warm water (~35 degrees Celsius but no warmer than 37 degrees Celsius) until it reached room temperature, which typically took 1 hour. In the meantime, I washed my hands and put on nitrile gloves. I sterilized a glass 4-cup measuring cup (a tapered spout is important!) and sterilized a pair of scissors with 70% rubbing alcohol. I hung a medical-grade enema bag with pre-lubricated tip on a coat hanger on my shower rod, ensuring that I moved the clamp toward the end of the tube and then properly clamped the enema tube shut. I placed two pillows into two separate trash bags, then placed these in the bathtub. Right before administering the FMT, I took a fresh piece of cheesecloth from a package bought off Amazon and placed it in the measuring cup. I then took the plastic bags with the infusion, removed the outer bag, and added an additional 2-4oz of bottled Poland Spring water to the remaining bag with the infusion (to thin out consistency for enema flow). I resealed this bag and smashed the contents between my hands to distribute the water. I then cut a small corner off the corner of the bag and poured the solution into the measuring cup with the cheesecloth. I placed the empty bag into a trash bag nearby. I then picked up the cheesecloth in one hand and twisted it with the other to apply pressure to the remaining stool, squeezing out excess liquid. I threw the cheesecloth and soiled gloves into a trash bag thereafter. I removed the enema bag from the coat hanger, poured the contents of the measuring cup into the enema bag, then re-hung the enema bag. I released the clamp on the enema tube until the liquid flowed close to the clamp then quickly clamped it shut. (This eliminates the amount of air you infuse into your colon which reduces discomfort and helps you retain the solution better.) I got into the bath tub with my butt in the air, knees on one pillow, and chest pressed to the floor on another pillow. I then removed the tube cap, inserted the tube into my anus, and unclamped the tube (without looking at it since my chest/face was on the floor). I relaxed and let the solution flow into me, then looked behind me to see when the bag was empty. Once this happened, I tried to clamp the tube closed again and removed it from inside me.
Please see the diagram here for a (terribly drawn) illustration of the positions I held https://imgur.com/XbAdNcG . I held each position for about 5 minutes and cycled through twice for a total of 30 minutes, then stayed in bath tub at least an additional 30 minutes to prevent leaking or urgency.
Here is what my stool looked like (if I was able to pass stool at all) before I started receiving chemotherapy (which, as noted above, inevitably and unexpectedly helped with my condition, though not completely and thus prompted my FMTs): https://imgur.com/6fLs6b4 https://imgur.com/ZJvnERM
8/10 Stopped eating at 11am. Chicken broth during day. Took 2 Dulcolax tablets and around 100g (6 17g capfuls) of Miralax at 8pm with 28oz Gatorade (last bit of Gatorade and miralax was finished by 9pm). This was half the amounts recommended by a hospital colonoscopy cleanse protocol. Shitted my brains out, like pure liquid, at 2am 4am and 8am (technically 8/11). Abdominal cramping, sweating.
8/11 Half-life of dulcolax is 16.5 hours so waited until 1:30pm. (Took 2 2mg loperamide at 1pm.) First attempt failed (1:30pm). Did not clench sphincter or actively fight expulsion. Stood up too soon (after 30 mins). Second attempt better (6:30pm). Urinated before infusion to reduce internal pressure. However, did not take 2 2mg loperamide right before (which I did before the first attempt). Hard clenching and butt in air when an urge would come. Urge passed in a short amount of time. Lots and lots of noises, gurgling. Felt I could walk around, eat a small amount, etc. slowly after 2ish hours of retention. Used 1 2mg loperamide before bed.
8/12 much easier to retain, some feelings of needing to go to the bathroom but could not go when I strained/tried around 3:30pm. Mostly normal feeling. No loperamide. Ate lightly.
8/13 couldn’t go to the bathroom in morning even after breakfast and with straining; some stomach discomfort. Minor gas and feeling a bit full but not much pain. Ate lunch at 12pm. 3:30pm expelled FMT (45 hours elapsed). PICTURE NSFW https://imgur.com/iZnuPTl Quality was type 4, long. Very comfortable to pass. Took 2 2mg loperamide and began to thaw next infusion. Peed. Next FMT (third attempt/bag total) at 5:30pm. Ate dinner. Real gurgling, some urgency happened again around 9:30pm. Subsided 10:30pm. Could pass gas safely by 10:45pm but while lying down.
8/14 needing to actively hold it in all day but in evening felt a bit constipated. Bit gassy at night.
8/15 bit gassy in morning. Expelled FMT at 1pm (held in for 43.5 hours). Type 3, bordering on type 2, somewhat more difficult to pass than 8/13 expulsion. Required straining. 2 2mg loperamide at 3:45pm. 5:15pm used fourth bag of FMT. Urinated before and after. Bit easier to hold in. Got up at 6:45pm but laid down again bc some gurgling and minor urgency. Safe to pass gas at 7:10pm. 9:15pm, ate decent size meal, no urge to go to bathroom. No longer lying down. Very comfortable.
8/16 BM at 2pm (held for 21 hours) and 5pm. Both with some straining, smooth but smaller movements. Not as log-like. No cracks and not painful upon passing. 2pm was wet, lots of wiping. 5pm no wiping necessary. No gas or discomfort after passing 5pm movement. Next FMT infusion (fifth bag) at 8:30pm, no loperamide. Couldn’t hold it in. Expelled infusion at 9pm. Solid feces came out with the infusion. Hoping I didn’t wash out/undo the progress from the previous FMTs. Felt some relief with the “wash out” but not entirely normalized.
8/17 tiny/normal amount of gas. Less discomfort, pain, etc.
8/18 felt slight urge to go, no emergency or anything. Ate breakfast, went to toilet at around 9:30am, and a single long log of very soft type 3 / type 4 was passed (with one pellet of soft type 1 at first). PICTURE NSFW https://imgur.com/j1Jb6zI No tearing, not much straining, one big log, and felt completely empty/good afterward. Similar to healthy-times (pre-infection) movements. No wetness/no wiping needed, just like before infection. Took 1 2mg loperamide at 12:45pm and urinated, did the next infusion (sixth bag) at 1:15pm. Fairly easy to retain.
8/19 only slept 6 hours. Went for a hike. Expelled FMT at 5:15pm (held for 28 hours). Smooth type 1, maybe type 2. Some straining. Incomplete evacuation. Didn't urinate, no loperamide before (seventh bag) FMT at 7pm. Easy to hold it in. 8:30pm tried to stand up, move around. Expelled infusion (had to run to bathroom).
8/20 only slept 6.5 hours. Felt mild urge throughout day, including morning. Felt very strong urge at 3:30pm. BM at 3:45pm. Some straining, two large sized type 1 pellets followed by perfect long type 4. Type 4 comfortable to pass, type 1 felt like it created a fissure upon passing. Feeling of complete evacuation afterward. 4pm took two 2mg loperamide, thawed next FMT (eighth bag). 5:30pm infusion. 7:30pm walked around. 8:30pm ate dinner. 9pm feeling some urgency, laid down. 9:15pm passed gas.
8/21 felt slightly urgey in morning, disappeared in afternoon. Could not go with straining.
8/22 no urge in morning. Strong urge at 5:30pm. Some straining but complete evacuation (truly “empty”). (Held in for around 48 hours.) Extremely long log of type 2 connected to type 4. Severe anal fissure developed on right lateral side. Painful. Wetness when wiping. Started nifedipine/lidocaine ointment to treat anal fissure.
8/23 some soreness/slight pain lower left quadrant. 9am had three type 1 stools. Bleeding on tissue paper from fissure. 5:00pm had some type 1 and type 2/type 4 thin/soft hybrid. Stinging, pain. Used nifedipine before this bowel movement. 6:45pm FMT (ninth bag). No loperamide. Initial urgency but after holding it in for a few minutes there is oddly no urgency anymore. No gas at all. No discomfort. Passed gas after eating around 9pm.
8/24 strained to go in morning, could not go. Very slight urge, very minor gas. BM at around 12:15pm (held around 18 hours). Hard, typical type 1 at first, followed by excellent, long, comfortable type 3/4. Thawed next bag for FMT (tenth bag). Administered at 2pm. No loperamide. Because wanting to distribute primarily to rectal area, stood upright immediately after infusion and shook hips back and forth for 30 seconds before assuming normal infusion positions. Completely comfortable, no urgency, no gas. 3:30pm walked around, ate at 4:15pm. Ate dinner at 8:30pm.
8/25 strong urge when waking. Ate small breakfast. 8:40am BM (held for about 19 hours), started as type 4 with no type 1. (Finally!) Small, soft type 1 at end. Wet stool came off on wipe.
10:05am another BM, multiple somewhat thinner soft type 4 stools. Next FMT (eleventh bag) at 1:15pm. No loperamide. Shimmied/shook upright at beginning. Very easy and comfortable to hold in. Ate around 4, then at 4:30 some urgency and gurgling.
8/26 minor urgency upon waking. Ate a little breakfast. 9am small BM (held for 20 hours), two thin logs of smooth type 2 / type 3 hybrid. PICTURE NSFW https://imgur.com/XTAtNkR
10:20am another BM, same shape and thinness but consistency was more type 4. Fairly comfortable to pass.
Urgency was very subtle but listened to my body and was able to go if I relaxed.
11am another BM similar in amount and texture to 10:20am BM.
4pm next FMT (twelfth bag). No loperamide. No gurgling. No clenching. Very easy to retain.
8/27 3:30pm had BM (held for 23.5 hours). Started as small log, smooth type 2 followed by separate small log, smooth type 3. Not wet on wiping. Notably, minimal gas and discomfort all day. Better appetite.
8/28 7:30am BM soft type 1 and type 4. “Fell out” of me, extremely fast. Urge beforehand wasn’t extraordinary. Very wet on wiping. Minor urgency from 1:30pm on. BM at 4:00pm. Very comfortable, type 3 / type 4. Somewhat wet on wiping. 5:30pm final FMT (thirteenth bag). Quite easy to retain. No loperamide.
8/29 significant urgency in morning. BM before breakfast at 7:15am. (Held for 15 hours.) Type 4 throughout. Very wet on wiping.
12pm BM type 4 very wet on wiping. 8:30pm type 4, also very wet on wiping. No type 1 all day!
-end of FMT series-
8/30 after breakfast feel urgency like I used to have pre-infection. 10:15am BM. Healthy-feeling. Very comfortable type 4 the entire way through ! Yesssss! Felt like old, healthy stool. Followed by very wet very thin soft type 4 / type 5 stool. This morning and yesterday have felt a bit rumble, urgey throughout day. Like, transit time is TOO fast. Not like a “weak” stomach per se but a bit overactive. Afternoon felt more normal.
8pm another BM. Started and ended as a solid long log of type 3 / type 4. Very comfortable to pass, felt like pre-sickness BM in terms of minimal but still a tiny bit of straining, wet but not too wet, etc.
8/31 No urgency on waking. Urgency 9:15am after breakfast. BM 10:00am, type 3 / 4, then thin type 4. PICTURE NSFW https://imgur.com/Wxyaiy1 Less shooting, acute lower left quadrant abdominal pain in past couple days (at random intervals, not during BM). Less internal soreness. No aggravation of fissure(s). Fully empty on regular basis.
Another BM at 4:15pm. Smooth, thick, single log of type 3 / 4. PICTURE NSFW https://imgur.com/VXaf0Gm Not too wet on wiping.
Completely normal feeling in evening. Utterly, completely normal. Wow.
9/1 Urgency upon waking but after getting up no urgency (9:00am). Ate breakfast. Very minor urgency, strained a bit for type 4 at 9:30am.
Very minor urgency, another BM at 5:30pm. Thick comfortable type 4.
9/2 Minor urgency upon waking at 8:40am. Very slight, subtle pain in lower left quadrant. Moderate urgency after breakfast 9:00am. BM at 9:10am. Minor straining. Started with one soft, large type 1 then type 4 “fell out” with somewhat ragged edges. Some thin loose strands also after that. PICTURE NSFW https://imgur.com/wfJNtm1
Another BM at 6:10pm. Only minor urgency. Short but comfortable log of type 3 (started as type 3). Very minor straining. After log had a bit of smooth, wet type 1. Very wet on wiping.
9/3 Minor urgency on waking 8:20am. Laid in bed until 8:45am and then completely lost urgency even after breakfast. Couldn’t go even with straining. No urgency. 1:30pm, after lunch, significant straining to produce very small type 2 / type 3 log. PICTURE NSFW https://imgur.com/Sj7sgQJ No urgency rest of day or BM.
-skipping ahead for Reddit post brevity, in summary had type 1 with straining, type 4 straining, type 1 straining, soft type 1 and then type 5, then comfortable classic type 3-
9/8 mild urgency upon waking 8:15am. Ate breakfast 8:30am. Moderate urgency 8:45am, BM. Started as soft type 3 / type 4, somewhat disconnected but thicker pieces. PICTURE NSFW https://imgur.com/ZiWRKeo Comfortable to pass.
5:30pm another BM, a couple very short soft type 4 pieces. Comfortable to pass.
9/9 moderate urgency on waking 10:45am. BM 11:10am. Soft type 4 thick at start, then very soft type 4 maybe even type 5 following this log. Very wet on wiping (as has been this past week.)
6pm another BM. Very soft and comfortable but somewhat thin type 4 / type 5 log(s).
-skipping ahead for Reddit post brevity but in summary, some comfortable type 3/4, then type 3, then straining for type 2, then smooth type 1 straining, then very thin type 4, then some dry type 3/4 stool with occasional type 1/2 thrown in, then dry type 3-
9/24 BM at 5pm. Some hard type 1 only. PICTURE NSFW https://imgur.com/U42RJBE
No full evacuation feeling. Significant straining. Huge setback today. Again at night 9pm-ish. Type 1. Significant straining. Hard/dry.
9/25 BM at 9:00am. Started hard dry type 1 with moderate straining, switched to dry type 3 short logs with mild straining. PICTURE NSFW https://imgur.com/41njhdA Another BM at 4pm. Moderate straining for thin type 4. Dry on wiping. PICTURE NSFW https://imgur.com/rCbAe3A
9/26 BM at 10am. Fell out. Comfortable, very wet. Type 4 but mix of thin and not thin. PICTURE NSFW https://imgur.com/2o0TGZG
9/27 BM at 12:15pm during lunch. One long, mildly wet log. Type 3 / type 4. Comfortable to pass. Only mildly wet on wiping. Similar to “healthy times” BM. PICTURE NSFW https://imgur.com/yXJaMtQ
9/28 BM at 12:15pm. Type 2 thin. Not wet. Moderate straining.
9/29 BM in morning. Type 2 somewhat thin. Not wet. Moderate straining.
Another BM at 2pm. Very thin type 4. Moderate straining. (Picture)
Another BM at 7pm. Acceptable thickness (though not “normal”) with mild straining and very wet. Type 4.
9/30 BM in morning at 10:40am, strong urgency right after breakfast. Classic type 3 log, mild/moderate straining but not too bad, wet on wiping. PICTURE NSFW https://imgur.com/0DP0a6a
Another BM 7:45pm, moderate urgency after dinner. Classic type 3 log, mild straining wet on wiping.
-skipping ahead for Reddit post brevity, in summary had type 4/5, type 4, type 4 but thin, type 2, type 3 starting as type 1-
10/6 BM around 11am. Excellent length and thickness. Comfortable type 3. Wet on wiping. No straining. Perfect BM!! Feeling of complete evacuation afterward, etc.
Another BM 2pm after a lot of tummy rumbling and feeling like I had diarrhea. Ended up having type 6 for the first time in years. Even though it’s diarrhea I feel amazing. Like fully empty.
10/7 At 1pm soft type 4, mild straining, very thin and moderate wetness. Overall volume not that much and the thin strands were disconnected.
Another BM at 6:15pm. Type 4, shortish but good thickness. Very wet on wiping. Mild straining and comfortable to pass.
-skipping ahead for brevity, in summary a bunch of type 4/type 3 with varying qualities and some straining but not too bad, occasional type 1 or dry/thin type 3-
10/13 BM at 8:50am. Perfect thickness and extremely long but started first 3 inches of log as type 2 before switching to type 4. PICTURE NSFW https://imgur.com/IuWV4eg Wet. No straining. Disrupted first 3 inches makes sense as this is the approximately length of the rectum, where my infection incubated and caused the most damage.
10/14 BM 8:00am. Perfect thickness, extremely long, first inch or two of log was type 2. Rest was type 4. Wet. No straining.
10/15 BM 9:30am. Perfect thickness, long, type 4. Started as type 2. Bit of type 5 afterward. Wet and comfortable without straining.
10/16 BM 8:50am. Not one solid log, slightly thin, type 4, mild straining, very wet.
Another BM 6:30pm. Perfect thickness, long, type 4. No straining, wet.
-skipping ahead for brevity, in summary lots of somewhat or very wet type 2-4 but getting to be very, very thin and one day without any bowel movements (11/2). On the night of 11/2 I used 1 teaspoon MgCitrate-
11/8 Very thin type 3-4 in morning. Straining. Somewhat wet.
11/9 One very thin type 3-4 in morning and one at night. Straining necessary. Somewhat wet on wiping.
11/10 One perfect thickness type 4 (starting type 2) with minimal straining.
11/11 One perfect thickness type 4 (starting type 2) with minimal straining. Very wet on wiping. Minimal gas throughout day.
11/12 Very long perfect thickness type 4 minimal straining.
I did not record after this but suffice it to say that my bowel movements became a bit thinner but more consistently very, very wet. By the end of December they were somewhat thin and still very, very wet. I underwent another 4 FMTs (also from Michael Garcia) and this helped to reduce the wetness but did not dramatically alter the thickness until I started taking some psyllium husk (fiber) supplements in the morning and night. Now I have somewhat thicker/more “normal” stool (current date is February 2) and only rarely does it start as type 1. I do not experience fissures any longer.
SECTION 4
Overall, I am happy I did the FMTs. The biggest boost in my GI health came from chemotherapy, which took me from years of dependence on laxatives and probiotics to spontaneous, daily bowel movements, much to the shock of both my physician and myself. I resolved the most significant issue at that time - beginning bowel movements with type 1 stool that caused anal fissures - by undergoing 10 FMTs and then an additional 4 FMTs four months after that. My stool quality was extremely variable for the first three months after the initial FMTs and then somewhat normalized, though not to my previously healthy state. The additional 4 FMTs gave a further boost but still my stool is a bit thinner than I would like and the first part is a bit drier than the rest. The thinness makes it difficult to feel urgency in a normal fashion and makes it difficult to begin expulsion of stool. I also experience more-than-average gas and abdominal discomfort, though these issues (and, really, all my issues) are quite manageable. The greatest gift is not needing to constantly change laxatives, probiotics, etc. to pass stool. A bit of extra fiber supplement does me right and, compared to years past, I'm a happy camper.
My next move, if I decide to do further experimentation, would be to use non-absorbable antibiotics (i.e. antibiotics that do not leave the GI tract) administered via enema and without following these antibiotics by FMT. Perhaps this could instigate repopulation of my gut as it was before? Depending on these results, I may then elect to use antibiotics again but in conjunction with an FMT series. If I decide to do further FMTs, I may consider a donor other than Michael Garcia to see if they are a better match with my natural microbiome makeup or I may combine MG's stool and another donor's stool. The issue is that it is extremely difficult to find good donors, unfortunately.
If you are hesitating about FMTs, cannot find a donor, or do not have the money to afford donations from Michael Garcia, please reference my history section for helpful probiotics or see the probiotics page on Reddit. Please also see that above section for advice on some helpful, gentle laxatives.
02 Feb 2019 (10 comments).
- FMT Clinics
- I included all required info