What is steatorrhea?

You may not think much about the makeup of your stool. Most of it is water, and the rest is a combination of:

  • bacteria
  • fats
  • fiber
  • mucus
  • protein
  • salts
  • various cell linings

Too much fat in your feces is called steatorrhea.

It may be a result of overconsumption of fatty and greasy foods, or it can be a sign of malabsorption. This means your body either isn’t absorbing nutrients properly or isn’t making the enzymes or bile needed to digest food effectively.

If you’re experiencing steatorrhea, make an appointment to talk with your doctor. They can help you figure out the underlying cause and recommend treatment options.

If you have steatorrhea, your stools may be:

  • bulkier
  • pale
  • foul smelling
  • floating

The stools also tend to be covered in a greasy film. You might even see drops of oil in the water inside the toilet bowl.

Steatorrhea is only one of several common symptoms of malabsorption. Others include:

  • abdominal cramps
  • diarrhea
  • gas
  • indigestion
  • weight loss

Too much fat in your stool suggests your digestive system isn’t breaking down food adequately. Your body may not absorb the useful parts of the food you eat, including dietary fat.

One of the most common causes of malabsorption is cystic fibrosis. This is an inherited condition that affects your sweat and mucous glands, as well as various organs in your body, including the pancreatic glands.

If steatorrhea is due to malabsorption, it can most often be related to problems with pancreas function. The pancreatic juices are important in digesting fat content.

Another cause of malabsorption that can lead to steatorrhea is chronic pancreatitis. Pancreatitis is an inflammation of your pancreas, an organ near your stomach. It releases enzymes to help you digest fat, protein, and carbohydrates in your small intestine.

Chronic pancreatitis can have many different causes. Some examples include alcohol use disorder, smoking, and family history.

Fatty stool is also a symptom of exocrine pancreatic insufficiency (EPI). EPI is a condition where your pancreas doesn’t make or release enough of the enzymes needed to help your digestive system break down food and absorb nutrients.

With EPI, steatorrhea happens when your digestive system gets rid of too many fats instead of absorbing them. This usually occurs when fat-digesting enzymes in your pancreas drop to 5 to 10 percent of typical levels.

A few other causes of malabsorption include:

  • Biliary atresia: a blockage in the ducts that carry bile (a fluid that helps your body digest and get rid of certain waste products) from your liver to your gallbladder
  • Celiac disease: when you have a sensitivity to gluten, a protein in wheat and certain other grains
  • Crohn’s disease: one of several conditions under the label inflammatory bowel disease, an inflammation of your gastrointestinal tract
  • Lactose intolerance: the inability to digest a sugar in milk products because you lack the enzyme lactase
  • Whipple disease: a bacterial infection of your digestive system that affects how your body breaks down fats and carbohydrates

If you notice that your stool floats and appears greasy, pale, and abnormally foul smelling, you should talk with your doctor.

This is especially true if you have other symptoms of malabsorption, such as weight loss or cramps.

In addition to reviewing your medical history and symptoms, your doctor will likely order two common tests for steatorrhea. One is a qualitative test of fecal fat; the other is a quantitative test of fecal fat.

Qualitative test

The qualitative test measures the number of fat globules (drops) in one stool sample.

Typical levels are fewer than 50 neutral fat globules and fewer than 100 fatty acid fat globules, both as seen under a microscope.

Quantitative test

For a quantitative test, you must collect stool samples over a period of 2 to 4 days. All the samples are then studied to determine the total amount of fat in each day’s stool.

Average test results would show 2 to 7 grams per 24 hours for adults, with fat making up less than 20 percent of the solid stool sample.

For an infant, there should be less than 1 gram per 24 hours. For bottle-fed babies, fat should make up 30 to 50 percent of the stool sample. For breastfed babies, a normal result ranges from 10 to 40 percent.

D-xylose test

Your doctor might also recommend a D-xylose absorption test. This is another test that’s done when malabsorption is suspected.

D-xylose is a kind of sugar. This test measures the levels of D-xylose in your blood or urine.

Other tests

Your doctor may order other tests to make a diagnosis.

For example, if you have symptoms after eating wheat, your doctor can do specific tests to check for celiac disease. The same is true for lactose intolerance and other potential causes. Be sure to discuss these tests with your doctor.

Treating steatorrhea is really about treating the underlying cause or causes of this condition. And because malabsorption can have many causes, it will be important to get a reliable diagnosis.

For diet-related causes, the treatment is usually a matter of avoiding the foods that trigger your symptoms.

For example, if you’re lactose intolerant, you’ll need to avoid milk products or perhaps consume them in very small doses. This will depend on the severity of your lactose intolerance.

For celiac disease, avoiding wheat and other foods that contain gluten will be your most effective treatment.

EPI is typically treated with medications, dietary changes, and nutrition supplements. Often supplementary pancreatic enzymes may be prescribed. Your treatment plan will depend on your symptoms and the cause behind your EPI.

For causes such as cystic fibrosis or chronic pancreatitis, medications and lifestyle changes will be necessary.

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