Table of contents
What is Steatorrhea?
Steatorrhea or “oily/fatty stools” is the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine. Oily stool occurs when there is too much fat in the stool. Stool contains a mixture of undigested nutrients, which contains mucus, proteins, fibers, and salts. It also normally contains mucus, dead cells, or other excreted waste. Although steatorrhea is not usually a major health concern, it may pose a serious health challenge.
Foods that are especially high in indigestible or difficult to digest fats and fibers are likely causes of oily stool.
Common foods and drinks are known to cause fatty stool, including:
- Artificial fats
- Coconut and palm kernel oil
- Nuts, especially whole nuts with the skin and shell intact
- Oily, high-fat fish, like escolar or oil fish
- Naturopathic or essential oils
- Whole wheat products
- Excessive alcohol
However, a prolonged oily stool could indicate a medical issue or an abnormality, for example, an imbalance in absorption, digestion disorder, or enzyme deficiency. The most common abnormal conditions that cause steatorrhea which can include:
- Cystic fibrosis
- Some pancreatic diseases
- Liver damage or failure
- Kidney damage or failure
- Gall bladder cancer or gallstones
- Gall bladder removal
- Crohn’s disease
- Celiac disease
- Disorders of metabolism of the lipids like Tey-Sachs’s Disease and Gaucher disease
- Intestinal damage or injury
- A few diabetes medications affect the kidney, pancreas, and liver chemotherapy
- Obesity medications, such as fats and carb-blockers
- Cholesterol medications
- Bacterial infection of the gastrointestinal tract, such as Clostridium difficile and Whipple disease
- Parasitic infections, commonly Giardiasis
- Tropical sprue
- Lymphoma or lymph damage
- Congestive heart
Allergies and intolerances to food like dairy or gluten can also impact nutrient absorption in the gut, leading to fatty stools. Some of these medical abnormalities that can cause steatorrhea are listed below:
This disorder is usually symptomatic since early childhood. It causes the mucous membrane in the body to become sticky as mucus becomes thick. This secretion (mucus) blocks the ducts and valves, or passages in the pancreas, thereby preventing the normal release of bile and lipase enzymes. Greasy, foul-smelling stools are always a common symptom of this disease.
The pancreas is responsible for the manufacture of enzymes that helps to break down fats properly. They combine with bile to break fat globules into tiny fat particles and also help in extracting nutrients from our foods. In situations of pancreas dysfunction, fat may not be broken down effectively, causing greasy stool.
A bacterial infection causes Whipple disease in the intestine. The disease negatively impacts the body’s ability to break down fats and carbohydrates. This leads to malabsorption and oily stool.
Crohn’s disease and all these conditions of the bowel and intestine are inflammatory conditions that affect how well the body absorbs nutrients and fats. Their influence on fat absorption can likely result in fatty stools.
Biliary atresia is one of the diseases of the biliary tract. It is a condition present at birth that involves the failure of the development of the bile ducts. Bile helps with digestion. It breaks down fat into fatty acids. Non-development of bile ducts will hinder the breakdown of fats and result in pale-colored fatty stools.
A rare indented metabolic disorder in which deficiency of enzyme glucocerebrosidase results in the accumulation of harmful quantities of certain fats throughout the body, especially within the bone marrow, spleen, and liver. This results in greasy, fatty stools.
Diabetes is a long-lasting metabolic disorder characterized by high concentrations of blood glucose, which can cause serious injuries to blood vessels, the heart, kidneys, eyes, and nerves over time. Excessive glucose in the blood can result in excess fat deposits, leading to fatty stools. Type 2 diabetes is a condition that occurs in adulthood when the body becomes intolerant to insulin or does not make enough insulin.
This is an immune reaction to eating gluten, a protein found in wheat, barley, and rye. It is characterized by oily stool, vomiting, heartburn, and acid reflux.
Lack of lactose enzyme results in the inability to digest the sugar in the milk products. This malabsorption of lactose can cause steatorrhea or fatty stools.
Medications that can produce steatorrhea includes:
- Orlistat (also known by trade names Xenical and Alli) is a diet pill that slims and works by blocking the enzymes that digest fat. As a result, some fat cannot be absorbed from the gut and is removed in the stool instead of being metabolically digested and absorbed, sometimes causing oily anal leakage.
- Vytorin (ezetimibe/simvastatin) tablets can cause fatty stool in some people.
- Octreotide or lanreotide, used to treat acromegaly or other neuroendocrine tumors, can cause an adverse effect that results in steatorrhea.
- High gas content
- Tends to float
Steatorrhea is one of the symptoms of malabsorption.
Other symptoms of malabsorption include:
- Abdominal swelling, distension, or bloating
- Abdominal pain or cramping
- Bloody stool (blood may be red, black, or tan in texture)
- Nausea with or without vomiting
- Pale feces
- Abdominal foul-smelling stools
- Weight loss
How is Steatorrhea diagnosed?
The doctor (gastroenterologist) will review the medical history and symptoms and may likely advise the patient to get two common tests for fatty stools–a qualitative test of fecal fat and a quantitative test for fecal fat. The doctor may also recommend a D-xylose absorption test. He may also ask for specific tests, such as celiac disease tests, lactose intolerance tests, and other potential causes.
How is Steatorrhea treated?
- Treatment for steatorrhea varies on the source and severity of symptoms. The doctor will then determine the problem’s source since various malabsorption sources exist. They will run a series of stool tests to determine the definite cause. The mild cases of steatorrhea could be managed at home with strict diet guidelines as well as a change in lifestyle.
- While severe cases of steatorrhea require medical care, medications used to treat and prevent steatorrhea are listed below:
- Intravenous fluids restore electrolytes and stop dehydration.
- Anti-diarrheal medications
- Proton pump inhibitors (PPI’s)
- Pancreatic enzyme replacement therapy (PERT)
- MHC oils.
There haven’t been any studies that link coffee with greasy stools. Caffeine is a powerful stimulator of smooth muscles within the intestinal tract. It is also believed to affect the function of the bowel. Sometimes, dairy products found in coffee may cause oily stool in people suffering from lactose insufficiency.
Yes. Certain gastric bypass procedures, including the jejunoileal bypass procedure, diversion of the biliopancreatic area, and Roux-en Y gastric bypass, may cause the stool to be greasy.
These procedures shorten the length of the functional small intestine to reduce the effectiveness of nutrient absorption, which contributes to greasy stools.
While a variety of conditions may cause impaired absorption of lipids and the development of steatorrhea (excess fats within the feces), the most frequent causes of steatorrhea can be traced to bile salt deficiencies or pancreatic enzyme deficiency, defective CM Synthesis, and lymphatic blockage.
Common beverages and foods that are known to cause steatorrhea comprise:
1) Nuts, especially whole nuts with the skin or shell intact
2) Oily, high-fat fish, like oilfish or escolar, which can be mislabeled as butterfish or fatty tuna.
3) Excessive alcohol
4) Artificial fats
5) Naturopathic or essential oils
6) Coconut and palm kernel oil.
Picture Courtesy: docplexus
Healthy fats are in foods like avocado, walnut, coconut oil, ghee, and cold-pressed olive oil. They may also add eggs and fish such as salmon, sardines, and tuna to help increase these foods in the diet to get their health benefits.
The complications associated with steatorrhea are:
3) Chronic fatigue
4) Muscle weakness and pain
5) Dry, scaly skin rashes
6) Stunted growth in children
One of the major signs of steatorrhea is unintentional weight loss because the fatty stool is often related to a medical condition that causes malabsorption of fat and other nutrients in the digestive tract.
Home remedies for preventing steatorrhea are listed below:
a) Drink plenty of liquids
b) Reduce fat and fiber intake
c) Reduce the amount of potassium oxalate intake
d) Avoid/ stop smoking and alcohol intake
e) Increase dietary intake of fat-soluble vitamins and nutritional food intake (Vit A, D, E, and K)
f) Increase the dietary intake of Vit B12, folic acid, iron, magnesium, and calcium.