Published on Jan 24, 2020 - 5 min read
Bulky or excessively fatty stools is called steatorrhea. They are difficult to flush, pale, and abnormally foul-smelling. Read about its causes, symptoms, diagnosis, and treatment options
Your 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 your feces, which is common after a high-fat content meal. A fatty stool can be a sign of malabsorption. Malabsorption can occur either if the body is not able to absorb nutrients properly, or there is not enough production of enzymes or bile, which is needed to digest food. The underlying cause of fatty stool should be diagnosed to treat the condition.
The signs of steatorrhea are:
Pale or light-colored stools.
The stools float because of 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:
Stunted growth (in children).
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.
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 is not able to absorb fats from your diet efficiently. The common conditions that can result in malabsorption are:
Cystic fibrosis - an inherited condition, which affects the mucus and sweat gland, and other organs.
Whipple disease - it is a bacterial infection of the gut, which 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 the 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 present in wheat and some other grains).
Biliary atresia - the ducts that carry bile to the gallbladder from the liver is blocked.
Kidney disease or failure.
Gaucher disease and Tay-Sachs disease - conditions affecting fat metabolism.
Hypoparathyroidism - less production of parathyroid hormone.
Gallbladder cancer or gallstones.
Gastric bypass surgery.
Congestive heart failure.
Taking cholesterol medications.
If your stools float, look greasy, pale-colored, unusually foul-smelling, and other symptoms of malabsorption, the best thing to do is consult a doctor. After taking a complete medical history, your doctor will suggest you get 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 - here, stool samples are collected for over 2 to 4 days, and all the samples are studied to determine the amount of fat in every day’s stool. The normal results for adults are 2 to 7 grams per 24 hours, and that of infants are less than 1 gram 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, etc., based on your other symptoms.
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 is triggering it, then the best thing to do is to avoid it. For example, if you have lactose intolerant, then avoid milk products and for celiac disease, avoid wheat and other foods items that contain gluten.
Mild cases can often be treated at home with rest and basic treatment. The following home remedies can help you if you are suffering from a mild case of steatorrhea:
Keep drinking water and stay hydrated.
Reduce the intake of dietary fiber.
Reduce the intake of dietary fat.
Reduce alcohol intake.
Reduce the intake of foods containing potassium oxalate.
Antidiarrheal medications (loperamide and Bismuth subsalicylate)
Consider taking antacid and gas medications.
Increase intake of fat-soluble vitamins, such as vitamins A, D, E, and K.
Also consume 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.
PERT (pancreatic enzyme replacement therapy).
PPIs (proton-pump inhibitors).
If steatorrhea is due to a serious underlying disease, no treatment can result in the following complications.
Failure to thrive (infants and children).
Stunted growth in children.
Rupture of the intestinal wall.
Need to remove parts of the digestive tract surgically.
Get immediate medical attention if you or your child is suffering from severe or chronic steatorrhea. As it can lead to severe dehydration, heart attack, and organ failure.
For more information on steatorrhea, consult a gastroenterologist online!
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