FIT positive next steps

Overview

A positive FIT (Fecal Immunochemical Test) result means that a small amount of blood was found in a sample of your stool (poo). This test is used to screen for signs of colorectal cancer or other bowel problems. A positive result does not mean you have cancer — many people with a positive result do not have cancer — but it does mean you need follow-up tests to find the cause of the blood.

Yes, FIT is used as a routine screening test for colorectal cancer in many countries, especially people aged 50 and older. Around 1 in 10 screening tests come back positive, so it is fairly common to get a positive result.

FIT screening is recommended for adults aged 50–74 (or as advised by your healthcare provider). It can also be used for people with certain risk factors, like a family history of bowel cancer.

Symptoms

Common symptoms

• Many people with a positive FIT have no symptoms at all — the blood was found only through screening.
• If symptoms are present, they may include: a change in bowel habits (like looser poo or going more often), blood in or on your poo, tummy pain or discomfort, unexplained weight loss, or feeling very tired.

Symptoms in children

• FIT is not typically used in children, but if a child tests positive, a doctor will check for causes like juvenile polyps, infections, or inflammatory bowel disease.

Symptoms in older adults

• Older adults with a positive FIT often have no symptoms, but they should still have follow-up tests because the risk of bowel problems increases with age.

Causes

Main causes

• Colorectal polyps (small growths that can sometimes turn into cancer).
• Colorectal cancer (the FIT helps find it early when treatment works best).
• Hemorrhoids (swollen veins in your back passage).
• Diverticulosis (small pouches in the bowel wall that can bleed).
• Inflammatory bowel disease like Crohn's disease or ulcerative colitis.
• Less common causes: angiodysplasia (abnormal blood vessels), infections, or anal fissures (small tears).

Risk factors

• Age 50 or older.
• A family history of colorectal cancer or certain polyps.
• Being overweight or not physically active.
• Smoking or drinking a lot of alcohol.
• A diet low in fiber and high in processed meats.
• Having a long-term condition like ulcerative colitis or Crohn's disease.

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number right away.
• If you see a large amount of blood in your stool or feel very weak.

Book a routine appointment if:

• If you received a letter or call saying your FIT result is positive, contact your doctor or screening programme as instructed.
• Even if you feel well, you need to arrange a follow-up test (usually a colonoscopy) as soon as possible – within a few weeks is typical.

Diagnosis

A positive FIT result is not a diagnosis – it is a signal that more investigation is needed. The main follow-up test is a colonoscopy, which lets a doctor examine the entire large bowel for polyps, cancers, or other problems.

Tests that may be done

• Colonoscopy: a thin, flexible tube with a camera is passed through your back passage into your bowel. You will be given medicine to help you relax or sleep, so it is not painful.
• If you cannot have a colonoscopy, another option is a CT colonography (a special X-ray scan of your bowel).
• Sometimes a flexible sigmoidoscopy (a shorter scope that only looks at the lower bowel) may be used.

What to expect at your appointment

You will need to prepare for the colonoscopy by cleaning out your bowel with a special laxative drink. During the test, if a polyp is found, it can often be removed right away. The whole test takes about 30 minutes, and you can usually go home the same day. Your doctor will discuss the results with you soon after.

Treatment

Treatment depends entirely on what the colonoscopy finds. Many people have no problem or only benign polyps that are removed during the test. If cancer is found, treatment options are highly effective, especially when caught early.

Self-care at home

• After a colonoscopy, follow your doctor’s instructions about diet and activity – usually you can eat normally once the sedation wears off.
• If you had a polyp removed, you may need to avoid heavy lifting or strenuous exercise for a few days.
• Stay hydrated and eat a high-fibre diet to keep your bowel healthy.

Medical treatments

If the colonoscopy finds only polyps that are not cancerous (benign), removing them is the only treatment needed. If cancer is found, treatment may involve surgery to remove the affected part of the bowel, and sometimes chemotherapy or radiotherapy. These treatments are tailored to each person’s situation and are discussed with a specialist team.

When is surgery considered?

Surgery is the main treatment for colorectal cancer. It typically removes the tumour and nearby lymph nodes. Most people recover well, and in many cases the cancer can be cured. Your surgeon will explain the specific procedure if it is needed.

Living with this condition

If your colonoscopy is normal or only shows benign polyps, you can return to your usual activities right away. You may need to have another FIT test or colonoscopy in a few years, as recommended by your doctor. If you are being treated for cancer, you will have a care plan with regular check-ups and support.

Lifestyle tips

• Eat a balanced diet rich in fruits, vegetables, and whole grains.
• Get regular physical activity – aim for at least 30 minutes most days.
• Limit red and processed meats.
• If you smoke, try to quit – your healthcare team can help.
• Drink alcohol in moderation (if at all).

Diet and exercise

A healthy diet and regular exercise can help reduce your risk of future bowel problems. Fibre helps keep your bowel moving well. Staying active also improves your overall health and recovery after any treatment.

Mental health and emotional wellbeing

Getting a positive FIT result can be worrying. It is normal to feel anxious or scared. Talking to your doctor or a counsellor can help. Remember that a positive result is a chance to take action, and most people do not have cancer. If you are diagnosed with cancer, support groups and mental health professionals can help you cope.

Prevention

You cannot prevent all cases of bowel cancer, but you can lower your risk with a healthy lifestyle. The best way to catch problems early is to take part in bowel screening programmes when offered. If polyps are found and removed, that can prevent them from developing into cancer.

Screening programmes

Screening with FIT every two years (in many countries) is a proven way to find bowel cancer early, when it is easier to treat. If you are aged 50–74, you should expect an invitation from your national screening programme. If you have a family history of bowel cancer, you may be offered screening earlier or more often.

Complications

If left untreated

• If a positive FIT is ignored and the cause is cancer, the cancer can grow and spread, making it harder to treat.
• Untreated polyps may slowly turn into cancer over many years.
• Ongoing bleeding from the bowel can cause anemia (low red blood cells), leading to tiredness and weakness.

Long-term outlook

The outlook is very good when problems are found early. Thanks to screening and modern treatments, most people with early-stage bowel cancer are cured. Even if cancer is more advanced, treatments are improving all the time. Following up on a positive FIT result is the most hopeful step you can take.

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