Steatorrhea - Causes, Symptoms, Diagnosis, and Treatment

What Is Steatorrhea?

The stool is made up mostly of water, along with fiber, bacteria, protein, mucus, salts, cell linings, and fats. Steatorrhea is when there is too much fat in the feces, which is common after a high-fat-containing meal. A fatty stool can be a sign of malabsorption. Malabsorption can occur either if the body cannot absorb nutrients properly or if enzymes or bile are insufficient to digest food. The underlying cause of fatty stool should be diagnosed to treat the condition.

What Are the Signs and Symptoms of Steatorrhea?

The signs of steatorrhea are:

• Bulkier stools.

• Pale or light-colored stools.

• Foul-smelling stools.

• The stools float because of the high gas content.

• They are covered with a greasy film.

• Oil can be seen floating inside the toilet.

• Foamy or frothy stool.

• The stool is difficult to flush away.

Severe or chronic steatorrhea can cause malabsorption and dehydration, so if steatorrhea is caused by an underlying condition, then the other signs and symptoms are:

• Weight loss.

• Stomach cramps.

• Loose stools.

• Gas.

• Bloating.

• General exhaustion.

• Muscle ache.

• Anemia.

• Fever.

• Stunted growth (in children).

• Eyesight problems.

• Neurological (nerve) problems.

• Osteoporosis.

How to Determine the Presence of Steatorrhea?

Stools might appear pale, bulky, and greasy, and float in the toilet bowl due to the high-fat content. Steatorrhea often causes stools to have a particularly strong and unpleasant odor. Fatty stools might be difficult to flush down the toilet due to their tendency to float in water. People might experience frequent diarrhea or loose, greasy stools.

Some individuals with steatorrhea may also experience abdominal discomfort, cramping, or bloating due to the underlying cause of malabsorption. Due to the high-fat content, stools in steatorrhea tend to float rather than sink in the toilet bowl. Stools might appear shiny or greasy due to the excess fat content, and they can leave an oily residue on the water's surface in the toilet.

What Are the Causes of Steatorrhea?

Steatorrhea can occur after eating meals high in indigestible fat, potassium oxalate, and fiber.

Some common foods that can cause this problem include:

• Whole nuts with intact skin or shell.

• Oily fish, such as tuna.

• Coconut and palm oil.

• Whole-wheat products.

• Consuming excess alcohol.

• Eating artificial fats.

On the other hand, a bulky and fatty stool can also mean that the digestive system is not breaking down food properly. It also indicates that the body cannot absorb fats from a diet efficiently.

The common conditions that can result in malabsorption are:

• Cystic Fibrosis - An inherited condition that affects the mucus, sweat gland, and other organs.

• Whipple Disease - it is a bacterial infection of the gut that affects the way the body breaks down fats and carbohydrates.

• Crohn’s Disease - It is a type of inflammatory bowel disease (IBD).

• Lactose Intolerance - The inability to digest lactose (a sugar in milk products) due to a lack of enzyme lactase.

• Chronic Pancreatitis - It is the inflammation of the pancreas, which is an organ that secretes enzymes that help in the digestion of fat, protein, and carbohydrates.

• Celiac Disease - Sensitivity to gluten (a protein in wheat and other grains).

• Biliary Atresia - The ducts that carry bile to the gallbladder from the liver are blocked.

• Kidney disease or failure.

• Liver failure.

• Gaucher disease and Tay-Sachs disease (conditions affecting fat metabolism).

• Hypoparathyroidism (less production of parathyroid hormone).

• Gallbladder cancer or gallstones.

• Gastric bypass surgery.

• Amyloidosis.

• Congestive heart failure.

• Diabetes.

• Taking cholesterol medications.

• HIV infection.

How Does a Doctor Diagnose Steatorrhea?

If stools float, look greasy, pale-colored, unusually foul-smelling, or have other symptoms of malabsorption, the best thing to do is consult a doctor. After taking a complete medical history, the doctor will suggest getting the following tests done:

• Qualitative Test - This measures the number of fat globules in the stool sample. Normally, neutral fat globules should be less than 50, and fatty acid fat globules should be less than 100.

• Quantitative Test - Stool samples are collected for over two to four days, and all the samples are studied to determine the amount of fat in every day’s stool. The normal results for adults are two to seven grams (0.07 to 0.25 ounces) per 24 hours, and infants are less than one gram (0.035 ounces) per 24 hours.

• D-Xylose test - D-Xylose is a type of sugar, and this test is done to check for malabsorption. This test measures the amounts of D-Xylose in the blood or urine.

• Other Tests - If needed, the doctor will perform other tests to check for celiac disease, lactose intolerance, and more based on other symptoms.

What Are the Treatment Options for Steatorrhea?

To treat steatorrhea, the underlying cause has to be identified and treated. As malabsorption can have many possible causes, it is crucial to diagnose the cause. If a certain food item triggers it, the best thing to do is avoid it. For example, if people are lactose intolerant, then they should avoid milk products, and for celiac disease, they should avoid wheat and other gluten-containing foods.

Mild cases can often be treated at home with rest and basic treatment. The following home remedies can help individuals who are suffering from a mild case of steatorrhea:

• Drinking water and staying hydrated.

• Reducing intake of dietary fiber.

• Reducing the intake of dietary fat.

• Quitting smoking.

• Reducing alcohol intake.

• Reducing the intake of foods containing potassium oxalate.

• Antidiarrheal medications (Loperamide and Bismuth subsalicylate)

• Consider taking antacids and gas medications.

• Increase intake of fat-soluble vitamins, such as vitamins A, D, E, and K.

• Also, consuming more vitamin B12, folic acid, magnesium, iron, and calcium.

Severe cases of steatorrhea might need medical treatment. The treatment options include:

• IV (intravenous) fluids to keep the patient hydrated and restore lost electrolytes.

• Anti-diarrheal medicines.

• PERT (pancreatic enzyme replacement therapy).

• PPIs (proton-pump inhibitors).

• MHC oils.

What Are the Possible Complications of Steatorrhea?

If steatorrhea is due to a serious underlying disease, no treatment can result in the following complications.

• Anemia.

• Failure to thrive (infants and children).

• Frequent infections.

• Stunted growth in children.

• Intestinal obstruction.

• Rupture of the intestinal wall.

• Poor nutrition.

• Need to remove parts of the digestive tract surgically.

Get immediate medical attention if an individual child is suffering from severe or chronic steatorrhea as it can lead to severe dehydration, heart attack, and organ failure.

Conclusion

Steatorrhea is characterized by an abundance of fat in the stool, which makes the feces bulky, loose, and foul-smelling. The condition is frequently a sign of malabsorption, a disorder in which the body is unable to adequately absorb fats from the food. Steatorrhea is frequently caused by pancreatic insufficiency, celiac disease, and other gastrointestinal conditions. Stool analysis is usually used for diagnosis, and the focus of treatment is on treating the underlying cause, such as dietary changes for illnesses like celiac disease or enzyme replacement therapy for pancreatic insufficiency. A comprehensive strategy is needed to manage steatorrhea to enhance overall digestive health and nutrition absorption.