Understanding faecal calprotectin results

Overview

Faecal calprotectin is a protein found in your poo. When there is inflammation (swelling) in your gut (intestines), the level of this protein goes up. This test is used to help tell the difference between inflammatory bowel disease (IBD), like Crohn's disease or ulcerative colitis, and other conditions that cause similar symptoms, such as irritable bowel syndrome (IBS). It is not a test for cancer. A high result may suggest active inflammation, while a low result makes IBD less likely. Your doctor will use the result together with other information to make a diagnosis.

Faecal calprotectin testing is commonly used when a person has persistent bowel symptoms. Elevated results are seen in around 10-15% of people tested, but this varies depending on the population.

This test is used for people of all ages who have symptoms such as chronic diarrhoea, abdominal pain, or blood in the stool. It is especially helpful for distinguishing IBD from IBS in adults and children.

Symptoms

Common symptoms

• Chronic diarrhoea (lasting more than 4 weeks)
• Abdominal pain or cramping
• Blood or mucus in the stool
• Urgent need to use the toilet
• Unexplained weight loss
• Fatigue

Symptoms in children

• Poor growth or delayed puberty
• Persistent belly pain
• Frequent loose stools, sometimes with blood
• Feeling very tired

Symptoms in older adults

• Diarrhoea that may be severe or bloody
• Unintended weight loss
• General weakness or feeling unwell
• Other symptoms due to age-related changes in the gut

Causes

Main causes

• Inflammatory bowel disease (IBD) – such as Crohn's disease or ulcerative colitis – where the immune system attacks the gut lining, causing inflammation.
• Infections that cause gut inflammation (like bacterial or parasitic infections).
• Use of certain medications (such as nonsteroidal anti-inflammatory drugs, or NSAIDs) can cause gut inflammation.
• Coeliac disease (in some cases) may also raise calprotectin levels.

Risk factors

• Family history of inflammatory bowel disease
• Personal history of autoimmune conditions (e.g., rheumatoid arthritis, lupus)
• Smoking (increases risk of Crohn's disease)
• Certain medications like NSAIDs or antibiotics
• Environmental factors, such as living in a Western country (though risk factors are still being researched)

When to see a doctor

See a doctor urgently if:

• You have persistent blood in your stool, especially if it is dark or sticky
• You have severe abdominal pain that does not go away
• You are losing weight without trying
• You have diarrhoea that lasts more than a few weeks

Book a routine appointment if:

• You have mild but ongoing changes in your bowel habits (such as looser stools or constipation)
• You experience occasional abdominal pain after eating
• You feel bloated or have excess gas most days

Diagnosis

The faecal calprotectin test is a stool test. You collect a small sample of your poo in a container provided by your doctor or hospital. The sample is sent to a lab where the level of calprotectin is measured. Results usually come back within a few days to a week.

Tests that may be done

• Faecal calprotectin test (stool test)
• Full blood count (to check for signs of infection or anaemia)
• C-reactive protein (CRP) blood test (to measure inflammation in the body)
• Stool cultures (to rule out infection)
• Colonoscopy (directly visualises the lining of the large intestine with a camera) – often needed if calprotectin is high

What to expect at your appointment

Your doctor will explain your results. A normal (low) level usually means inflammation is less likely, and you may not need further tests. A high level means there is inflammation in your gut. This does not automatically mean you have IBD – it could be an infection or other cause. Your doctor will likely recommend additional tests, such as a colonoscopy, to find the cause. The entire process can take several weeks, but early testing helps guide the right treatment.

Treatment

Treatment depends on the cause of an abnormal faecal calprotectin result. If the result is normal (low) and symptoms are due to IBS, treatment focuses on symptom management. If the result is high and IBD is diagnosed, the goal is to reduce inflammation and control symptoms. Your doctor will create a plan tailored to you.

Self-care at home

• Keep a symptoms diary to track triggers, such as certain foods, stress, or activity levels.
• Eat smaller, more frequent meals if you have IBS.
• Stay well hydrated, especially if you have diarrhoea.
• Manage stress through relaxation techniques, exercise, or talking to a counsellor.
• Ask your doctor about probiotics – they may help some people, but evidence is mixed.

Medical treatments

If IBD is confirmed, treatment typically includes medicines that reduce inflammation or calm the immune system. Options range from aminosalicylates (anti-inflammatory drugs) to corticosteroids for short-term flares, and immunomodulators or biologic therapies for more severe disease. For IBS, treatments may include fibre supplements, laxatives (if constipated), or medicines that control diarrhoea or spasms. Always follow your doctor’s advice and never change or stop medication without speaking to them.

When is surgery considered?

Surgery is only considered for IBD if medicines do not control the condition, or if complications like strictures (narrowing of the gut), fistulas (abnormal connections between organs), or abscesses occur. It is not a first-line treatment and is reserved for severe or complicated cases.

Living with this condition

If you have a chronic gut condition, like IBD or severe IBS, daily management involves monitoring your symptoms, taking prescribed medicines consistently, and avoiding triggers. Many people learn to plan their day around toilet access and maintain a flexible schedule. Support from your healthcare team and loved ones can help you adapt.

Lifestyle tips

• Get regular exercise – gentle activities like walking, swimming, or yoga can improve mood and digestion.
• Prioritise sleep – aim for 7-9 hours per night to support your immune system.
• Avoid smoking and limit alcohol, as they can worsen gut inflammation.
• Consider stress-reducing practices like mindfulness, meditation, or therapy.

Diet and exercise

A balanced diet rich in fruits, vegetables (cooked if raw causes discomfort), lean proteins, and whole grains is generally recommended. For IBS, a low-FODMAP diet under guidance of a dietitian may help identify trigger foods. For IBD, there is no one-size-fits-all diet, but some people find that avoiding very spicy, fatty, or high-fibre foods during flares helps. Always stay hydrated. Exercise is safe and beneficial, but listen to your body – rest when you need to.

Mental health and emotional wellbeing

Living with a chronic gut condition can be emotionally challenging. You may feel anxious, embarrassed, or depressed. It is common to worry about flare-ups or social situations. Please know that mental health support is an important part of your care. Speak to your doctor about counselling, cognitive behavioural therapy (CBT), or support groups. If you are having thoughts of harming yourself, contact a crisis helpline immediately.

Prevention

Faecal calprotectin is a test, not a condition, so it is not something you prevent. However, you can reduce your risk of developing inflammatory bowel disease or IBS? The exact causes of IBD are not fully understood, but you may lower your risk by avoiding smoking, maintaining a healthy weight, and eating a balanced diet. For IBS, managing stress and avoiding known trigger foods may help prevent symptoms. There is no guaranteed way to prevent these conditions.

Screening programmes

If you have a family history of IBD, you may benefit from earlier evaluation if you develop symptoms. However, there is no routine screening test for IBD. The faecal calprotectin test itself is sometimes used as a way to decide who needs further investigation, especially in primary care.

Complications

If left untreated

• Persistent inflammation from untreated IBD can damage the gut lining over time, leading to scarring, strictures, or fistulas.
• In severe cases, untreated IBD can cause malnutrition, anaemia, or increase the risk of bowel cancer.
• Severe diarrhoea can lead to dehydration and electrolyte imbalances.
• Long-term uncontrolled disease may affect growth in children and quality of life in all ages.
• If the underlying cause of a high faecal calprotectin is an infection, not treating it can lead to spread of the infection.

Long-term outlook

The outlook for people with gut conditions detected through faecal calprotectin is generally good with proper care. Many people with IBD achieve remission (no symptoms) with treatment, and those with IBS can lead active lives with symptom management. Early diagnosis and treatment reduce the risk of complications. While some conditions are chronic, you can work with your healthcare team to maintain a good quality of life. There is hope – research continues to improve treatments.

Find support

International organisations

• Crohn's & Colitis Foundation (USA)
• International Foundation for Gastrointestinal Disorders (IFFGD)

Local organisations

• Crohn’s & Colitis UK · United Kingdom

Helplines

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