Bowel Screening
Doing the at-home bowel cancer screening test
Our interviews here refer to the process done for the faecal occult blood test (FOBT) kit; however, the faecal immunochemical test (FIT) kit is now used.
We have not yet been able to interview for experiences with the FIT kit, which has some differences compared to the process for the FOBT kit.
With the FIT, only one sample is needed, and the sample must be sent as soon as possible after collection, ideally within 24 hours after collection. The stool sample for the FIT kit is collected with a collection stick that is placed in a tube with the sample on it that is sent for analysis.
Collecting the sample for the bowel cancer screening test
Almost all the people we talked to had done at least one faecal occult blood test (FOBT). Most thought the instructions with the test kit were excellent (see 'Instructions for the bowel cancer screening test kit'), and that any effort or embarrassment involved in doing the test 'was well worth it'.
People described how they managed to collect samples of their motion (bowel movement). Most people found it quite easy to collect their samples.
The methods they described for collecting stool samples for the FOBT kit are also able to be used with the FIT kit.
While the FIT kit involves scraping a small amount of stool from 1 sample onto a stick that is then placed in a tube, the FOBT kit involved smearing a very small amount of the stool sample onto a card with windows for a total of 3 movements.
Doing the Faecal Occult Blood test was as easy as ABC.
Doing the Faecal Occult Blood test was as easy as ABC.
You mean the test for'?
When the test kit came in the post to do at home.
Oh you just go to the toilet, you know, and the instruction was on the, you know in the kit you see and after, it was just easy you know the instructions it was just easy like A, B, C.
Is it?
Yeah it's just easy, you know.
Did you have to put a little bit of your bowel motion onto the card?
Yes onto, you know and seal it, easy.
It was quite easy?
Yeah, yeah.
And was it quite clear how much of the bowel motion you had to put on the card?
Yes it did, it explained, you know it explained on the, you know on the kit you know.
On the information?
Yes information.
And then what did you have to do with it after that?
You seal it you know and the, the thing that was, you put it into a disposal?
Into an envelope?
Yeah, you know, and then you wash your hands, that's right.
Many people used several thicknesses of toilet paper to catch their motions before they hit the water in the toilet pan. A few people used rubber or disposable gloves when collecting their stool samples. Others said that taking the sample was 'not so different from wiping childrens' bottoms'.
He held some toilet paper underneath his bottom in order to catch his motion.
He held some toilet paper underneath his bottom in order to catch his motion.
He used masking tape to fix toilet paper across the rear half of the pan to catch his motion.
He used masking tape to fix toilet paper across the rear half of the pan to catch his motion.
One man found it easier to put newspaper on the floor in the bathroom with strips of toilet paper placed on top of that in order to collect his bowel motion.
He put newspaper on the floor and toilet paper on top of that so that he could collect a sample to put on the test card.
He put newspaper on the floor and toilet paper on top of that so that he could collect a sample to put on the test card.
I think on the information leaflet they give you various ways that you might collect the sample.
Yes.
How did you, what did you find was the easiest?
Well, they talked about using a receptacle which you could throw away thereafter, or using a, a plastic glove and catching the sample, which I found almost amusing really, I just couldn't get to terms with that. So personally I found that just by putting the newspaper on the floor in the bathroom, putting strips of toilet paper on the floor, depositing the sample on the toilet paper, means that when I'd taken the sample and spread it onto the, onto the card, I could then pick up the toilet paper with the with the stools if you like, put in the toilet and flush it.
The only thing I would say, I mean this is, I don't know if this is worth mentioning, the actual things that you use to take the sample, which are like cardboard lollypop sticks is the best way to describe them, it would be nice if it was possible for those to be flushable. They do ask and you find that one, you've got to wipe the stick, so then you can fold them up, wrap them up, and put them in a bin etc etc. But it would be nice if it was possible at some stage to be able to put everything that you've used, everything, in the toilet and flush it away. That's my only comment.
(Note' The sticks used to be made of wood. They are now made of cardboard and can be flushed down the toilet)
Some people found it easier to use kitchen paper towels instead of toilet paper because it was 'stronger and more resilient'. Others used a container, such as a cleaned, empty margarine pot, or a cleaned, empty fruit basket from the supermarket to catch their motions.
Because kitchen roll was stronger than toilet paper she used that to catch her motion.
Because kitchen roll was stronger than toilet paper she used that to catch her motion.
It's very easy, but it is a little bit, I suppose you think, 'God this is unpleasant', because I mean, let's face it when you go to the toilet, it goes down the toilet and that's where you leave it.
And you don't deal with it at all do you? So I sort of read it and I thought, 'Oh flipping heck, I don't know whether I fancy doing, I don't think I fancy doing this.' So I went and got a piece of kitchen roll, so I thought, 'At least I can put it on there', you know, and I did it that way. And I thought, 'Oh, well it's not really very pleasant this'. Because its not, in a way.
So you found kitchen roll was easiest?
I found, yes because its, its bigger, and I thought, 'Well that can go there, and then you can place it on that, and then put it onto your'' because you needed to put it down somewhere, because, you know the weight of the faeces, if you just used toilet paper, it would've split, and gone on your floor, on your working surface or on, in the bathroom obviously. So I thought; I felt that the kitchen roll was the best.
Yes, they do suggest different ways don't they?
Mm.
And other people have used kitchen roll as well.
Mm. For me, I found that was the best. And when my husband was doing his, I said to him, 'Make sure you get the kitchen roll'.
She used a margarine container to catch her motion.
She used a margarine container to catch her motion.
I think on the information sheet they suggest different ways that you might manage to get a sample, either from the lavatory paper or from possibly a container inside the lavatory.
That's right yes.
Can you remember what you did?
Yes I did a container definitely yes, yes. I don't know whether I wore thin, thin gloves or not, possibly I did, but as long as one keeps the, the things and not touching other things that would mask any testing I think that's what I did.
Can you remember what sort of container you found useful?
Probably a small marg, well a margarine container possibly yes, a plastic container yes and then disposed of it afterwards, yes.
So the whole thing you found fairly straight forward?
Yes, yes.
One man used a supermarket bag and put that inside the toilet to catch his motion. He found it physically uncomfortable having to lean over the toilet to deal with his bowel motions. He said the smell made him feel sick.
A supermarket bag came in useful when he needed to catch some of his motion.
A supermarket bag came in useful when he needed to catch some of his motion.
Oh it was all very clear.
Was it?
It was all very clear, but by, I found it uncomfortable having to lean over the toilet in my own excretia and fiddling around with it.
But again not painful but, and not embarrassing since it was a solo activity.
By uncomfortable do you mean physically uncomfortable or psychologically uncomfortable?
Well physically, I mean my mind goes back to changing the nappy of the children and the nausea of leaning over and smelling the excretia yes.
How did, I think they suggest various ways that you might do that.
They did yes, I mean I personally I got a supermarket bag and put that inside the toilet.
And then performed on top of it, so that was a barrier between me and the toilet water and then having taken the sample I could simply shake the bag into the toilet and with another bag put that bag into and dispose of it.
Experiences with the at-home FOBT kit
Most people we talked to found the test relatively easy, but a few found it more difficult.
One man mistakenly collected 6 stool samples from 1 motion instead of 2 samples from 3 different movements for the FOBT kit. Note that only 1 sample is collected for the FIT kit.
One woman said that the first time she tried to do the test it was 'a complete disaster' because she wasn't sure how much of the motion she was supposed to smear onto the card and because the motion fell into the pan.
The first time she tried to do the Faecal Occult Blood test it was a 'disaster', but next time she was more organised and managed it successfully.
The first time she tried to do the Faecal Occult Blood test it was a 'disaster', but next time she was more organised and managed it successfully.
So I was a little bit apprehensive about the whole thing, didn't quite like the idea of it, but then I thought about the friends that I'd had that had had bowel cancer and it hadn't been diagnosed till much too late and I thought, 'No, this is a good idea, I should do it.' So with much trepidation, I may add, I tried for the first test and must admit that the first day that I tried it was a complete disaster because I didn't know the amount of faeces that they wanted and being as it was just such a small amount on the test paper. But the second day I had another go and it was quite successful. I had the rubber gloves to hand and just thought, 'This is, this is a good cause, I should be doing this,' even though I was sort of a bit turning my nose up a little bit. But eventually I managed to get the three and sent them away and was absolutely delighted when I did get the results through the post.
When you set out to do the testing did you make a plan beforehand or did you just sort of go into it without thinking too much about it?
Well I made what I thought was a plan, although it misfired on the first day because I didn't have my little table at the side, well actually it was a stool, I didn't have that at the side of me, and I didn't have everything to hand. And as I turned round to take the stuff off the cistern it just fell back in the pan and I had to start from scratch again. But after that I had it well planned, thought about it before I did it.
Several people worried that those with disabilities would find the test a bit difficult. One woman with rheumatoid arthritis found it a bit painful to collect the samples, but said that she 'managed it'.
The painful joints in her fingers and thumbs made it hard to hold the cardboard sticks to retrieve the samples, but she managed it.
The painful joints in her fingers and thumbs made it hard to hold the cardboard sticks to retrieve the samples, but she managed it.
Can you please tell me, given that you've got problems with rheumatoid arthritis, how this made it a little bit difficult for you, but you managed it?
The joints in my fingers and thumbs are very painful and to hold the spatula and to retrieve the sample and to use the toilet paper was painful but it can be done and I managed. The thumb and the finger to hold the spatula was the most painful I think, but I coped and you just, it's just momentarily, it goes off again, I have these pains any time, anywhere so'
What did you have to do exactly with the spatula? Can you explain for people who are not sure what they have to do?
Well you have to retrieve a sample from the toilet paper that you have cleaned yourself with and put it into the, the sample pack that was sent. I did that three days in succession and in the morning, it can be done any time but I found it, that was when I moved my bowels and I did it then and while I thought about it.
So each day, each morning you took a sample, using the spatula, and put it in the test kit?
That's right.
A man who was ‘very sensitive about dealing with bodily functions’ was not sure that he could face doing the test. His wife, who was a nurse and 'had a better stomach' than he did helped him with the sample.
Another man and his wife did their tests at the same time and described a process where ‘she only had to perform and leave the room' and he would then ‘sort it out for her’.
Another man worried about providing a sample because he was constipated, but he managed to do the necessary motions within the time allowed.
He was worried because at times he was constipated. Having the Freephone help number reassured him.
He was worried because at times he was constipated. Having the Freephone help number reassured him.
Yes.
What did you think about that?
Well I was a bit worried at first because I thought I couldn't get three samples in fourteen days and I thought, 'Well about if you're a bit slow going to the toilet', you know, 'fourteen days'. So I was a bit worried but I needn't have worried in the end. I mean you do do three samples in fourteen days, they must have thought it out very well when they put fourteen days I think so yeah. But it is a bit worrying, you see fourteen and you think, 'Oh am I going to go to the toilet three times in fourteen days,' so.
Did that make you wonder whether or not to try?
Well I didn't bother about that; I thought well if it takes longer than fourteen days I shall have to get in touch with them and do something about it.
Because I thought, 'Well I've got a phone number I can always phone and explain to them'. That's why I think as long as, there's always a get out, if they give you a phone number you can always phone and you know get in contact.
Good idea.
Talk to someone who knows something about it [laughs].
Sending the bowel cancer screening sample in the post
Some people were concerned about putting their sample in the post.
One man 'wondered if there was some kind of law against it', and others were worried about it being opened by mistake, or about possible hygiene issues. Others commented on the secure foil and plastic wrappings on the kit, which they believed were quite sterile and secure.
Of note, the pre-addressed envelope sent with the test kit is specially designed to be hygienic and secure for sending the sample through the post.
See also 'Posting the bowel cancer screening sample'.
It is important to note that no one is excluded from the test because of disability. If people have any difficulties, perhaps due to poor dexterity or poor eyesight, they can contact the help line by calling Freephone 0800 707 6060. Someone will give advice, and, if necessary, help with the test at home.
We have not yet been able to interview anyone who has experienced sample collection with the FIT kit. If you have had this type of testing and you would like us to include your story on this website, please email us at hexi@phc.ox.ac.uk for more information.
Copyright © 2024 University of Oxford. All rights reserved.
