Steatorrhea (Fatty Stool): Symptoms, Causes, and Treatment (2023)

When there is too much fat in the stool, it is called steatorrhea or fatty stool.Too much fat in the stool might be caused by consuming too many fatty or greasy foods or a sign of maldigestion or malabsorption. This is when your body isn’t properly digesting or absorbing nutrients or making the compounds necessary to digest the food you eat effectively.

This article discusses the symptoms and potential causes of steatorrhea. It also covers risk factors and when to seek tests or treatment for your symptoms.

Symptoms of Steatorrhea

Steatorrhea, or fatty stools, are foul-smelling and may be loose and bulkier than usual. They will float, appear filled with mucus, froth, or foam, and will be lighter in color. You might notice a greasy film covering the stool or drops of grease or oil in the toilet water or on the toilet paper.

Symptoms of steatorrhea include:

• Foul smelling stools
• Stools that float
• Mucousy, frothy, or foamy stools
• Diarrhea or loose bowel movements that are bulkier than normal
• Oily stools or stools covered in a greasy film
• Pale or light-colored stools
• Abdominal pain or cramping
• Abdominal bloating
• Indigestion or heartburn
• Flatulence (gas)

Complications Associated With Steatorrhea

Chronic or severe steatorrhea may be associated with other symptoms of malabsorption. These include:

• Malnutrition
• Dehydration
• Weight loss
• Stunted growth in children
• Muscle weakness and pain
• Chronic fatigue
• Weak bones, or osteoporosis
• Dry, scaly skin rashes

Causes of Steatorrhea

Steatorrhea can occur if your digestive system can’t effectively break down the fats in your food. Your body may also be unable to properly absorb some of the nutrients in your food, including fat. In other cases, people might be deficient in compounds necessary for healthy digestion. Here are some common causes of steatorrhea.

Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not make enough digestive enzymes (proteins that help speed up chemical reactions) for normal fat breakdown or digestion.

The result is fat remaining in your stool instead of being digested in your body. EPI most commonly occurs due to chronic inflammation of the pancreas and loss of acinar cells (the functional unit of the exocrine pancreas).

EPI causes maldigestion of food and is often associated with medical conditions that affect the pancreas, such as cystic fibrosis and chronic pancreatitis (inflammation of the pancreas).

Bile Salt Deficiency

Another common reason for steatorrhea is bile salt deficiency. This is due to impaired bile salt production or decreased secretion of bile salts. Bile saltsare a main component of bile and are needed by the body to help break down fats, aid in digestion, absorb vitamins and eliminate toxins.

Steatorrhea related to bile salt deficiency may also be due to reduced circulating bile acids. This can happen if you have had your gallbladder removed, have liver disease or failure, or experience biliary atresia (blockage of the tubes that carry bile from the liver to the gallbladder), or it might be due to other diseases of the bowel.

Malabsorption

Another cause of steatorrhea causes is malabsorption due to intestinal conditions that affect the absorption capacity of the bowel.

These include surgical resection of the bowel, inflammation of the bowel, medications, or other conditions that affect bowel function, including celiac disease, Crohn’s disease, Whipple disease (a rare bacterial infection), and other malabsorption syndromes.

Medication Side Effects

Some medications can cause changes to your stool, including steatorrhea. One medication that causes fatty, loose stools is Alli or Xenical (orlistat). Orlistat is a lipase inhibitor, which means it prevents some of the fat in foods consumed from being absorbed in the digestive tract, keeping it in the stool.

Diet

Eating high-fat and/or fiber meals might cause acute steatorrhea. Common foods high in fat and/or fiber include deep-fried foods, cookies, cakes, chips, fatty fish such as salmon, coconut or palm oils, whole nuts, whole grains, natural fat (e.g., jojoba oil and fish oil), artificial fat (e.g., olestra), and excessive alcohol.

Other Causes

Some causes of steatorrhea include:

• Lactose intolerance
• Celiac disease
• Cystic fibrosis (an inherited disorder that results in mucus buildup in the digestive tract and lungs and blocks digestive enzyme secretion)
• Pancreatic diseases
• Liver or biliary disease
• Gallbladder disease or removal
• Crohn’s disease (an inflammatory bowel disease)
• Infections of the digestive tract
• Damage or injury to the intestines
• Gastric bypass surgery

How to Treat Steatorrhea

To treat steatorrhea, you must first identify the underlying cause. Depending on the underlying cause, your treatment options may vary. When seeking treatment, working with a healthcare provider to correctly diagnose the cause of your steatorrhea and any associated maldigestion or malabsorption is best.

Lifestyle Changes

If your steatorrhea is associated with a medical condition that is treated with diet, changing what you consume can help. For example, avoid foods and beverages with lactose if you are lactose intolerant. If you are diagnosed with celiac disease, avoiding all foods and beverages containing gluten is essential to help decrease symptoms.

Mild or acute cases of steatorrhea may be treated at home. This includes:

• Resting
• Staying hydrated
• Avoiding meals and snacks very high in fat
• Avoiding meals and snacks very high in fiber
• Over-the-counter antidiarrheal medications
• Over-the-counter medications for indigestion
• Quitting or reducing smoking
• Limiting or avoiding alcohol
  

Medications

Sometimes a combination of dietary changes, medication, and nutritional supplements are needed to treat conditions that cause steatorrhea. For example, people with EPI need to ensure they eat a healthy, nutrient-rich diet, take pancreatic enzymes with each meal and snack, and take vitamins and supplements to ensure they get all the nutrients they need.

Consult your healthcare provider if you have chronic or severe steatorrhea associated with other malabsorption symptoms.

Are There Tests to Diagnose the Cause of Steatorrhea?

To diagnose steatorrhea, a healthcare professional will usually ask about your symptoms, review your medical history, and might order a test to check the fat content of your stool.

For a stool test, stool is collected over 72 hours while consuming a diet containing a certain amount of fat daily, usually 100 grams daily. Excreting 7 grams of fat or less over 24 hours is considered normal when consuming 100 grams of fat. If the fat in the stool is high (more than 7 grams), it suggests that the body is not absorbing fat, and steatorrhea may be diagnosed.

If your doctor diagnoses steatorrhea, you will likely need additional testing to identify the underlying cause.

For example, a biopsy (a procedure that removes cells or tissue from your body) of the small intestine may be done. Intestines can be biopsied by passing an endoscope (​​a medical device with a light attached) through your mouth and into your small intestine to collect tissues for additional tests. Sometimes, special staining of the biopsy is needed if an infectious cause like Whipple disease is suspected.

In some cases, other tests to take images of organs, such as the pancreas, may also be ordered.

When to See a Healthcare Provider

This occasional occurrence is usually not something to be concerned about. Mild to moderate acute cases of steatorrhea may be unpleasant but can usually be safely treated at home. If other symptoms associated with steatorrhea lead to more serious complications, contact a healthcare professional. These complications include:

• Dehydration
• Unintended weight loss
• Stunted growth in children
• Muscle weakness and pain
• Chronic fatigue or exhaustion
• Fever
• Easy bruising or bruising that takes a long time to heal
• Dry, scaly skin rashes

However, if you are experiencing too much fat in your stools regularly, it can be a sign of something more serious.Severe or chronic steatorrhea requires attention from a healthcare provider. Contact a healthcare provider to help identify the cause of your steatorrhea.

Summary

Steatorrhea, or fatty stool, may be caused by diet or a sign of malabsorption, such as seen in cystic fibrosis or some pancreatic diseases. Signs of steatorrhea include foul-smelling, greasy, oily, mucousy, or foamy stool and is bulkier than usual.

Most mild or acute cases can safely be treated at home. However, severe or chronic cases require medical attention to determine the underlying cause of the steatorrhea. Identifying and treating the underlying cause can help resolve symptoms associated with steatorrhea.

A Word From Verywell

Steatorrhea can be unpleasant and concerning. If you have fatty stool that only lasts a short time, there is usually nothing to be concerned about. Long-term steatorrhea may be due to malabsorption or another medical condition.

Working with your healthcare team is crucial to ensuring your body properly digests and absorbs the food and nutrients you consume. With the right treatment plan, you can reduce or resolve your symptoms of steatorrhea and resume a healthy and normal quality of life.