Steatorrhea

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.

Causes

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
• Hyperparathyroidism
• 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
• Diabetes
• 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
• HIV
• Tropical sprue 
• Lymphoma or lymph damage
• Congestive heart
• Amyloidosis

Food Intolerances

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:

Cystic Fibrosis

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.

Pancreatitis

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.

Whipple Disease

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

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

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.

Gaucher Disease

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

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.

Cardiac Disease

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.

Lactose Disease

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

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.

Symptoms

• Greasy
• Bulkier
• Pale
• Foul-smelling
• 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
• Diarrhea
• Pale feces
• Gas
• 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? 

1. 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.
2. 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.

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