IT MIGHT sound foul, but the Royal Bolton Hospital is leading the way when it comes to poo.

Richard Catlin, assistant director of infection prevention and control at the hospital revealed it is the only trust in the area offering a disgusting-sounding but incredibly effective transplant procedure and that scientists are only scratching the surface of how important the bowel is to our overall health.

We all pay attention to what we put in our bodies, but not enough notice is given to what comes out, says Mr Catlin.

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The Royal Bolton Hospital is the only site in Greater Manchester offering faecal microbiota transplants (FMT), also known as poo transplants.

Mr Catlin said: “It sounds disgusting but the success rate is 98 per cent.”

The procedure is used in the treatment of a prolonged clostridium difficile (c. diff) infection which is not responding to antibiotic treatment.

Mr Catlin explained: “A faecal transplant comes from a donor, ideally a family member not in the same household.

“They provide us with a poo and we make it up and we give it the patient as an enema and reintroduce the bacteria.”

The theory goes that the reintroduced bacteria overcomes the c. diff in the gut, returning it to normal bacaterial levels.

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The hospital began offering the procedure about four years ago after gastroenterologist consultants piloted the scheme with patients with c. diff.

Mr Catlin said it was “a happy accident” and now the hospital “has made it common knowledge that we will do that for other patients as well. We take patients from across Greater Manchester. It’s about a dozen a year”.

For the pilot case, one of the consultants had to work out the right consistency for delivering a poo enema. So he bought himself a spare blender, peanut butter and chocolate spread to create a substitute poo and added water until he found the right mix to work with.

The hospital now has a 'Stomacher' machine to “squeeze” and “mash” the mixture into the right consistency.

Having the right level of bacteria in the gut not only stops a person from having awful diarrhoea but evidence is emerging to show it can even impact weight.

Mr Catlin said: “What’s in your gut influences everything really.

"I looked at a rat model study that shows if you transfer poo from a fat mouse to a thin mouse, you end up with two fat mice.

"And it works the other way. There seems to be a relationship there between the bacteria and your gut and health outcomes.”

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One woman in America is even suing her hospital because she became obese after she was given a faecal transplant from an obese man, he said.

Mr Catlin said: “There’s some evidence emerging now that there might be a use for faecal transplants to reduce diverticular disease. Bowel health and bowel medicine is going to be a focus for the next 20 years.”

One of the key indicators the NHS uses to assess someone’s bowel is the Bristol Stool Chart. The easy-to-follow chart was developed at Bristol Royal Infirmary.

Mr Catlin said: “Before 2008 across the whole NHS it was hit and miss how stool was assessed.

"What we would have is people says Doris has passed a formed stool or a loose stool – well what does that mean? Your loose stool might be my diarrhoea. People would assess that differently.”

Around that time there was a national increase in c. diff and guidelines were introduced for testing for the infection.

Ten years later this guidance is still followed, especially for people who are passing types five, six and seven, with no other obvious reason for diarrhoea.

Mr Catlin said the main use for the chart is assessing what is normal for a patient at home and then tracking and changes before entering hospital or while on medication in hospital.

As a rule of thumb for healthy people Mr Catlin said: “People will pass one type three every couple of days.

“A type-one stool being passed is a sign they are not drinking enough and may be dehydrated.

"Regularly passing six or sevens is possibly a sign there may be an underlying issue. If that’s persistent they probably need to be seen by a doctor.

“Two to five is the normal variance just depending on the diet and what you eat.”

There is also evidence which shows gender can affect stool make up. Women are more prone towards ones and twos while men tend to pass more fives and sixes.

Mr Catlin said: “Women tend to carry a different kind of fat than men so can become more dehydrated.

"You absorb a lot of water through your gut.”

Since learning more about bowel health Mr Catlin said he is “evangelical about hydration” and said being properly hydrated can stop “a lot” of admissions to hospital.