The faecal occult blood test helps to diagnose bleeding disorders of the gut (intestine).
What is a faecal occult blood (FOB) test?
The FOB test detects small amounts of blood in your faeces, which you would not normally see or be aware of. (Faeces are sometimes called stools or motions. It is the waste that you pass out from your back passage (anus). Occult means unseen or invisible.)
Why is the faecal occult blood (FOB) test done?
There are several disorders which may cause bleeding into the gut (intestine). For example, gastric or duodenal ulcers, ulcerative colitis, bowel polyps, and bowel (colorectal) cancer. If these bleed heavily then your stools (faeces) would be obviously bloody or a very black colour. However, sometimes these disorders only bleed with a trickle of blood. If you only have a small amount of blood in your faeces then the faeces look normal. However, the FOB test will detect the blood. So, the test may be done if you have symptoms in the tummy (abdomen) such as persistent pain. It may also be done to screen for bowel cancer before any symptoms develop (see below).
Note: the FOB test can only say that you are bleeding from somewhere in the gut. It cannot tell from which part. If the test is positive then further tests will be arranged to find the source of the bleeding - usually, endoscopy and/or colonoscopy.
How is the faecal occult blood (FOB) test done?
A small sample of stool (faeces) is smeared on to a piece of card. You obtain a sample by using a small scraper to scrape some faeces off toilet tissue which you have just used after going to the toilet. A chemical is added to the sample on the card. If there is a change in colour after adding the chemical, it indicates that some blood is present.
A doctor may do this test in the GP surgery, or send a sample to the laboratory for testing. Also, if required, there are test kits that you can get at pharmacies, which enable you to do the test at home. Some people are issued with test kits to do testing at home.
Usually two or three FOB tests are done on two or three separate samples of faeces, obtained on different days. This is because a bleeding disorder of the gut (intestine) may only bleed now and then. So, not every sample may contain blood. A series of two or three samples done on several days may be more accurate in detecting a bleeding gut disorder.
There are some foods and medications which may affect the results of FOB tests, making it appear there was blood present when there wasn't. However, this is quite unusual and generally no dietary advice is now given when doing an FOB test.
Screening for bowel (colorectal) cancer
Screening means looking for early signs of a particular disease in otherwise healthy people who do not have any symptoms and when treatment is likely to be curative. Bowel (colorectal) cancer screening aims to detect colorectal cancer at an early stage when there is a good chance that treatment will cure the cancer.
As colorectal cancer is much more common in older people, the decision has been made for people of a certain age to be invited to participate in the colorectal cancer screening programme. This involves testing three samples of your stools (faeces) for blood. The NHS Bowel Cancer Screening Programme has been introduced in the UK as follows:
- In England, people aged 60-75 are routinely offered screening every two years.
- In Scotland, people aged 50-74 are routinely offered screening every two years.
- In Wales, people aged 60-71 are routinely offered screening every two years. The age range may be extended in the future.
- In Northern Ireland, people aged 60-69 are routinely offered screening every two years. The age range may be extended in the future.
The first test kit should automatically arrive by post within a few weeks after you reach the age at which screening starts. You can call the relevant helpline (details below) and ask for one if one does not come. After your first screening test, you will then be sent another invitation and screening kit every two years until you reach the maximum age. If you are older than the set ages for routine testing, you may still be able to request a kit to test yourself. Ring the relevant helpline for details.
A normal result is reassuring, but it is a test to look for cancer in people who have no symptoms. If you do have any bowel symptoms, such as a change in bowel habit, persistent loose stools (diarrhoea), tummy (abdominal) pain or weight loss, do not wait for a screening test. Make an appointment to talk to your GP about it.
See separate leaflet called Screening for Colorectal (Bowel) Cancer for more detail.
Further help & information
Dr Tim Kenny
Dr Jan Sambrook
Dr Jacqueline Payne