Which of the following statements is true about patient collection of a stool sample?

The stool guaiac test looks for hidden (occult) blood in a stool sample. It can find blood even if you cannot see it yourself. It is the most common type of fecal occult blood test (FOBT).

Guaiac is a substance from a plant that is used to coat the FOBT test cards.

Usually, you collect a small sample of stool at home. Sometimes, a doctor may collect a small amount of stool from you during a rectal examination.

If the test is done at home, you use a test kit. Follow the kit instructions exactly. This ensures accurate results. In brief:

• You collect a stool sample from 3 different bowel movements.
• For each bowel movement, you smear a small amount of the stool on a card provided in the kit.
• You mail the card to a laboratory for testing.

Be sure to keep the stool away from any urine. Mixing of urine and stool can spoil the sample.

Some foods can affect test results. Follow instructions about not eating certain foods before the test. These may include:

• Red meat
• Cantaloupe
• Uncooked broccoli
• Turnip
• Radish
• Horseradish

Some medicines may interfere with the test. These include vitamin C, aspirin, and NSAIDs such as ibuprofen and naproxen. Ask your health care provider if you need to stop taking these before the test. Never stop or change your medicine without first talking to your provider.

The at-home test involves a normal bowel movement. There is no discomfort.

You may have some discomfort if the stool is collected during a rectal exam.

This test detects blood in the digestive tract. It may be done if:

• You are being screened or tested for colon cancer.
• You have abdominal pain, changes in bowel movements, or weight loss.
• You have anemia (low blood count).
• You say you have blood in the stool or black, tarry stools.

A negative test result means that there is no blood in the stool.

Abnormal results may be due to problems that cause bleeding in the stomach or intestinal tract, including:

• Colon cancer or other gastrointestinal tumors
• Colon polyps
• Bleeding veins in the esophagus or stomach (esophageal varices and portal hypertensive gastropathy)
• Inflammation of the esophagus (esophagitis)
• Inflammation of the stomach (gastritis) from gastrointestinal infections
• Hemorrhoids
• Crohn disease or ulcerative colitis
• Peptic ulcer

Other causes of a positive test may include:

• Nosebleed
• Coughing up blood and then swallowing it

If the stool guaiac results come back positive for blood in the stool, your doctor will likely order other tests, often including a colonoscopy.

The stool guaiac test does not diagnose cancer. Screening tests such as colonoscopy can help detect cancer. The stool guaiac test and other screenings can catch colon cancer early, when it is easier to treat.

There can be false-positive and false-negative results.

Errors are reduced when you follow instructions during collection and avoid certain foods and medicines.

Colon cancer - guaiac test; Colorectal cancer - guaiac test; gFOBT; Guaiac smear test; Fecal occult blood test - guaiac smear; Stool occult blood test - guaiac smear

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the US Multi-Society Task Force on colorectal cancer. Am J Gastroenterol. 2017;112(7):1016-1030. PMID: 28555630 pubmed.ncbi.nlm.nih.gov/28555630/.

Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 20.

US Preventive Services Task Force website. Final recommendation statement. Colorectal cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Published May 18, 2021. Accessed May 27, 2022.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

We are pleased that you have decided to participate in the Svit Programme and thus take care of your health.

Do not change your diet or stop using any medication prescribed by your general practitioner before collecting the stool samples. If you’ve always had a slow digestion but no other special problems, you can buy a mild laxative in your pharmacy before collecting the stool samples. Please do not forget to consult a pharmacist or doctor beforehand.

To help you in the collection of your stool samples, you can watch this video animation:

The kit for stool samples includes:

• Two containers with sticks to collect stool samples – one with brown and one with red serial sticker. The container has a green lid with a stick, which will help you to collect the sample.

• A plastic bag with your name and surname, birth data and two blank fields where you will write the dates when you used the container with the brown sticker and when the one with the red sticker.

• Two folded sheets of special degradable paper to help you keep the stool in the toilet.

• A postage-paid padded envelope with the address of the Svit Programme central laboratory.

 Don’t collect the stool samples if:

• You have your period. You can collect both stool samples three days after the end of your period.
• You have diarrhoea. Regulate your digestion first, and then collect both stool samples.
• There is blood in your urine or if you see blood in the toilet after you have urinated. Visit your personal doctor and follow his or her instructions. You can collect the stool samples when there is no more blood in your urine.
• You have bleeding haemorrhoids, which were confirmed by your doctor. You can collect the stool samples when the haemorrhoids are not bleeding anymore (when the doctor determines that the treatment of haemorrhoids has been successfully completed and tells you that you can collect the stool samples).

Collecting the first stool sample

Use one container with a stick to collect one stool sample. You will use the second container with the stick for the second stool sample. It’s not important which colour you use first, but be careful to write the date when you collected the stool sample into the brown container with the brown sticker in the field for the brown container, and the date when you collected the stool sample into the container with the red sticker in the field for the red container.

Procedure

• We recommend that you collect the stool sample during your first daily bowel movement.
• Empty your bladder and flush the toilet.
• Put a sheet of degradable paper, which you have received in the stool sample kit, into the toilet with the side containing the illustrated instructions facing up. The paper will temporarily hold the stool so you can collect the stool sample more easily.
• Empty your bowel

•  Take the first container from the bag, unscrew the lid and take out the stick attached to the lid. Don’t squeeze the container and be careful not to spill the liquid!

•  Using the stick, scrub the surface of the stool on different places in several directions several times. There are notches at the end of the stick (the same as in screws), which will collect your stool. A very small amount of the sample stool is enough for the analysis!

• Insert the stick with the stool sample back into the container (the central round hole!). Do not repeat the procedure since a very small amount of the stool is needed for the analysis!
• Press the container and the lid together until you hear a click. This is when the container with the sample is closed well enough and the content cannot leak out. Don’t try to open the container anymore!
• Insert the used container with the stool sample into the plastic bag, which you received in the stool sample kit, and close it well at the seal.
• The outside of the bag contains the sticker with your data. Write the date when you collected the sample in the relevant field. If you used the container with the brown serial sticker, enter the date in the field for the brown container, and if you used the container with the red serial sticker, write the date in the field for the red container.
• Keep the bag with used container with the stool sample in a dry and dark place at a temperature between 2°C and 10°C, until you have collected the second stool sample. We recommend you to keep the first sample in the refrigerator, separate from food.

Do not freeze the sample!

• Flush the toilet, leaving the degradable paper in the toilet.

Collecting the second stool sample

Collect the second stool sample during the second bowel movement, but not on the same day as the first sample . There should be a maximum of three days between the first and second sample collection- the second sample must not be collected later than on the fourth day after the first one.

When collecting the second stool sample, repeat all the procedures presented in figures.

Insert both used containers with the samples in a sealed bag into the enclosed padded envelope (Figure 7). Remove the protective tape and carefully seal the envelope. Take the envelope to the nearest post office as soon as possible (not into a post box) and send it to the address of the Svit Programme central laboratory, which is already printed on the envelope. The postage has been prepaid.

Before you seal the padded envelope, please check:

• Did you write both dates of the stool samples collection?
• Are both containers inserted in the plastic bag containing your data?
• Is the bag sealed properly?

We will inform you about the results of the laboratory test within a week after receiving your samples.

Should you have any questions regarding the collection of the stool samples, please consult your general practitioner or pharmacist. You can call the Center SVIT on 01/62 04 521 ,send us an email to or a fax to 01/62 04 529. We will be happy to help you with your questions.

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