Steatorrhea (Fatty Stool)

Medically reviewed by Elaine K. Luo, MD on June 2, 2017Written by James Roland

What is steatorrhea?

You may not think much about the makeup of your stool. Most of it’s water, and the rest is a combination of:

  • fiber
  • bacteria
  • mucus
  • protein
  • salts
  • various cell linings
  • fats

Too much fat in your feces is called steatorrhea. It can be a sign of malabsorption. This means your body either isn’t absorbing nutrients properly or isn’t making the enzymes or bile needed to digest food effectively.

People who are experiencing steatorrhea should be examined by a doctor, so they can get treated for the underlying cause.

What are the symptoms of steatorrhea?

If you have steatorrhea, your stools will be bulkier, pale, and foul-smelling. They tend to float because of higher gas content. The stools also tend to be covered in a greasy film. Drops of oil may be seen in the water inside the toilet bowl.

Steatorrhea is only one of several common symptoms of malabsorption. Others include:

  • weight loss
  • abdominal cramps
  • gas
  • indigestion
  • diarrhea

What causes steatorrhea?

Too much fat in your stool suggests that your digestive system isn’t breaking down food adequately. Your body may not absorb the useful parts of the food you eat, including dietary fat. One of the most common causes of malabsorption is cystic fibrosis. It’s an inherited condition that affects the sweat and mucus glands, as well as various organs in the body.

Another malabsorption cause that can lead to steatorrhea is chronic pancreatitis. Pancreatitis is an inflammation of the pancreas, an organ near the stomach. The pancreas secretes enzymes to help you digest fat, protein, and carbohydrates in the small intestine.

A few other causes of malabsorption include:

  • lactose intolerance, the inability to digest a sugar in milk products because you lack the enzyme lactase
  • celiac disease, when you have a sensitivity to gluten, a protein in wheat and certain other grains
  • biliary atresia, blockage in the ducts that carry bile from the liver to the gallbladder (Bile is a fluid that helps with digestion and in ridding the body of certain waste products.)
  • Whipple disease, a bacterial infection of your digestive system that affects how your body breaks down fats and carbohydrates
  • Crohn’s disease, one of several conditions under the label inflammatory bowel disease (IBD), an inflammation of the gastrointestinal tract

How is steatorrhea diagnosed?

If you notice your stool floats and appears greasy, pale, and abnormally foul-smelling, you should consult your doctor. This is especially true if you have other symptoms of malabsorption, such as weight loss or cramps.

In addition to reviewing your medical history and symptoms, your doctor will likely order two commonly done tests for steatorrhea symptoms. One is a qualitative test of fecal fat, and the other is a quantitative test of fecal fat.

Qualitative test

A qualitative test measures the number of fat globules in one stool sample. Normal levels are fewer than 50 neutral fat globules and fewer than 100 fatty acid fat globules, both as seen under a microscope.

Quantitative test

For a quantitative test, you must collect stool samples over a period of two to four days. All the samples are then studied to determine the total amount of fat in each day’s stool.

Normal test results would show 2 to 7 grams per 24 hours for adults, with fat making up less than 20 percent of the solid stool sample. For an infant, there should be less 1 gram per 24 hours. For bottle-fed babies, fat should make up 30 to 50 percent of the stool sample. For breastfed babies, a normal result is more like 10 to 40 percent.

D-Xylose test

Another test that is done when malabsorption is suspected is a D-Xylose absorption test. D-Xylose is a kind of sugar. This test measures the levels of D-Xylose in your blood or urine.

Other tests

Your doctor may order other tests to make a diagnosis. For example, if you have symptoms after eating wheat, your doctor can do specific tests to check for celiac disease. The same is true for lactose intolerance and other potential causes.

How is steatorrhea treated?

Treating steatorrhea is really about treating the underlying cause or causes of this condition. And because malabsorption can have many causes, it will be important to get a reliable diagnosis.

For diet-related causes, the treatment is usually a matter of avoiding the foods that trigger your symptoms. If you’re lactose intolerant, you’ll need to avoid milk products or perhaps consume them in very small doses. That will depend on the severity of your lactose intolerance. For celiac disease, avoiding wheat and other foods that contain gluten will be your most effective treatment.

For causes, such as cystic fibrosis or chronic pancreatitis, medications and lifestyle changes will be necessary.

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