GastroIntestinal / Gastroenterology

What is steatorrhea or fatty stool?

Steatorrhea, or fatty stool, occurs when there is too much fat in the stool. Stool or feces contain a mixture of undigested nutrients. These include proteins, fibers, and salts.

Stool also typically contains mucous, dead cells, or any other waste the body is able to excrete. In this article, learn about what causes fatty stool and how it is treated.

Causes

Steatorrhea - various nuts on a wooden table
Steatorrhea may be caused by foods high in fat and fiber, such as nuts.

Steatorrhea is not usually a major health concern and happens after eating meals high in fat, fiber, or potassium oxalate.

Some foods that are especially high in indigestible or difficult to digest fats and fibers are likely causes of steatorrhea.

Common foods and drink known to cause steatorrhea include:

  • nuts, especially whole nuts with the skin or shell intact
  • oily, high-fat fish, such as escolar or oilfish which can be mislabelled butterfish or fatty tuna
  • excessive alcohol
  • artificial fats
  • naturopathic or essential oils
  • coconut and palm kernel oil
  • whole wheat products

Severe or long-term symptoms of steatorrhea may be a sign of a medical condition, such as a malabsorption disorder, enzyme deficiency, or gastrointestinal disease.

Medical conditions known to cause steatorrhea include:

  • some pancreatic diseases
  • cystic fibrosis
  • kidney damage or failure
  • liver damage or failure
  • hypoparathyroidism or too little parathyroid hormone
  • gallbladder cancer, gallstones, or gallbladder removal
  • celiac disease
  • Crohn’s disease
  • lipid (fat) metabolism conditions, such as Gaucher disease and Tay-Sachs disease
  • bacterial infections of the gastrointestinal tract, especially Clostridium difficile and Whipple disease
  • gastric bypass surgery
  • intestinal injury or damage
  • diabetes
  • some diabetes medications
  • kidney, liver, and pancreas cancer medications
  • obesity medications, such as fat- and carb-blockers
  • cholesterol medications
  • parasitic infections, commonly Giardia
  • HIV
  • tropical sprue
  • amyloidosis
  • congestive heart failure
  • lymphoma or lymph damage


Symptoms

Steatorrhea - person flushing a toilet
Symptoms of mild steatorrhea may include foul-smelling stool, a stool that floats, and a stool that is difficult to flush away.

Steatorrhea is when a person has a loose but bulky stool with globs of fat and noticeable oil separation. Mild or short-term cases of steatorrhea may cause some limited discomfort.

Additional symptoms of mild steatorrhea include:

  • foamy, frothy, or mucous-filled stool
  • foul-smelling stool
  • diarrhea or loose or runny stool that is bulkier than normal
  • light-colored stool, often a light brown, green, orange, or yellow
  • stool that floats
  • stool that appears to be covered in a thick, greasy film
  • stool that is difficult to flush away
  • abdominal pain, cramping, bloating, and gassiness
  • heartburn and indigestion
  • general exhaustion
  • minor muscle, bone, and joint ache

Malnutrition and dehydration may be caused by severe or chronic cases of steatorrhea. Further, serious symptoms can occur as well, especially when associated with underlying medical conditions.

Symptoms associated with severe or chronic steatorrhea include:

  • chronic loose, heavy, foul-smelling, fat-filled stool
  • anemia
  • muscle weakness and pain
  • chronic exhaustion
  • weight loss
  • fever
  • reduced growth rate in children
  • vision problems
  • skin conditions
  • neurological conditions
  • osteoporosis

Diagnosis

A doctor will usually diagnose steatorrhea by asking about a person’s symptoms, reviewing their medical history, and ordering a fecal fat test to assess the fat content of stool.

While some doctors may use a 24-hour test, fecal fat is best assessed when collected for 72 hours.

To prepare for a fecal fat test, an individual must consume 100 grams (g) of fat daily for 3 days prior to the test, and fast for 5 hours directly before the test.

They will need to collect a stool sample using a collection kit and instructions and take the sample to their clinic or doctor’s office.

When consuming 100 g of fat daily, a healthy individual should excrete 7 g or less per day of fat in their stool.

Steatorrhea is typically defined as excreting more than 7 g of fat in a 24-hour period when consuming 100 g of fat daily.

If steatorrhea is diagnosed, a doctor will likely need to do further tests to determine the underlying cause.


Treatment

woman drinking water from a glass
Home remedies to treat steatorrhea may include reducing dietary fat, quitting smoking, and staying hydrated.

The treatment for steatorrhea depends on the cause and severity of symptoms. Mild cases of steatorrhea can often be successfully treated at home with rest and basic care.

Following certain dietary guidelines may also help reduce the risk of fatty stool.

Home remedies for treating and preventing steatorrhea include:

  • staying hydrated
  • reducing dietary fiber intake
  • reducing dietary fat intake
  • quitting or reducing smoking
  • stopping or reducing alcohol use
  • reducing or limiting potassium oxalate intake
  • increasing dietary intake of fat-soluble vitamins by taking nutritional supplements, such as vitamins A, D, E and K
  • increasing dietary intake of vitamin B-12, folic acid, iron, magnesium, and calcium
  • taking over-the-counter antidiarrheal medications, including loperamide (Imodium) and bismuth subsalicylate (Kaopectate, Pepto-Bismol)
  • taking over-the-counter antacid, anti-bloating, and gas medications

Severe or chronic cases of steatorrhea will normally need medical intervention. People with steatorrhea because of an underlying medical condition will also usually need medical treatment.

Medications used to treat and prevent steatorrhea include:

  • intravenous fluids (IV) to restore electrolytes and stop dehydration
  • anti-diarrheal medications
  • pancreatic enzyme replacement therapy (PERT)
  • Proton-pump inhibitors or PPIs
  • MHC oils

When to see a doctor

Severe, chronic steatorrhea requires medical attention. Mild to moderate steatorrhea may only cause minor dehydration and discomfort but these symptoms can lead to serious conditions, including heart attack and organ failure, if left untreated.

Steatorrhea can also be a sign of underlying medical conditions that require treatment. These include gastrointestinal disease, enzyme deficiencies, or hypoparathyroidism.

The presence of fat in a stool sample can help diagnose these conditions.

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