Steatorrhea (or steatorrhoea) is the presence of excess fat in

feces Feces ( or faeces), known colloquially and in slang as poo and poop, are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the large intestine. Feces contain a rela ...

. Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling. An oily anal leakage or some level of fecal incontinence may occur. There is increased fat excretion, which can be measured by determining the fecal fat level. The definition of how much fecal fat constitutes steatorrhea has not been standardized.

Causes

Impaired digestion or absorption can result in fatty stools. Possible causes include exocrine pancreatic insufficiency, with poor digestion from lack of lipases, loss of bile salts, which reduces micelle formation, and small intestinal disease-producing malabsorption. Various other causes include certain medicines that block fat absorption or indigestible or excess oil/fat in diet. The absence of

bile Bile (from Latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine. In humans, bile is produced continuously by the liver (liver b ...

secretion can cause the feces to turn gray or pale. Bile is responsible for the brownish color of feces. Other features of fat malabsorption may also occur such as reduced bone density, difficulty with vision under low light levels, bleeding, bruising, and slow blood clotting times.

Associated diseases

* Conditions affecting the

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...

. Exocrine pancreatic insufficiency can be caused by chronic pancreatitis, cystic fibrosis and pancreatic cancer (if it obstructs biliary outflow). * Conditions affecting bile salts. Obstruction of the bile ducts by gallstones ( choledocholithiasis),

primary sclerosing cholangitis Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts, which normally allow bile to drain from the gallbladder. Affected individuals may ...

, liver damage (intrahepatic cholestasis),

hypolipidemic Lipid-lowering agents, also sometimes referred to as hypolipidemic agents, cholesterol-lowering drugs, or antihyperlipidemic agents are a diverse group of pharmaceuticals that are used to lower the level of lipids and lipoproteins such as cholestero ...

drugs, or changes following gallbladder removal ( cholecystectomy). * Conditions producing intestinal malabsorption. These include celiac disease, bacterial overgrowth, tropical sprue, Giardiasis (a protozoan parasite infection), Zollinger-Ellison syndrome, short bowel syndrome,

inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as wel ...

and abetalipoproteinemia. * Other causes: Drugs that can produce steatorrhea include

orlistat Orlistat, sold under the brand name Xenical among others, is a medication used to treat obesity. Its primary function is preventing the absorption of fats from the human diet by acting as a lipase inhibitor, thereby reducing caloric intake. I ...

, a slimming pill, or as adverse effect of octreotide or lanreotide, used to treat acromegaly or other neuroendocrine tumors. It can be found in Graves' disease /

hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidis ...

Medications

Orlistat Orlistat, sold under the brand name Xenical among others, is a medication used to treat obesity. Its primary function is preventing the absorption of fats from the human diet by acting as a lipase inhibitor, thereby reducing caloric intake. I ...

(also known by trade names Xenical and Alli) is a diet pill that works by blocking the enzymes that digest fat. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically digested and absorbed, sometimes causing oily anal leakage. Vytorin (ezetimibe/simvastatin) tablets can cause steatorrhea in some people.

Excess whole nuts in diet

Some studies have shown that stool lipids are increased when whole nuts are eaten, compared to nut butters, oils or flour and that lipids from whole nuts are significantly less well absorbed.

Natural fats

Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible. Consuming escolar and oilfish (sometimes mislabelled as

butterfish Butterfish may refer to: * Stromateidae, found in coastal waters off the Americas, western Africa and in the Indo-Pacific * Sablefish The sablefish (''Anoplopoma fimbria'') is one of two members of the fish family Anoplopomatidae and the onl ...

) will often cause steatorrhea, also referred to as Gempylotoxism or Gempylid Fish Poisoning or keriorrhea.

Artificial fats

The fat substitute Olestra, used to reduce digestible fat in some foods, was reported to cause leakage in some consumers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenated form that is not liquid at physiologic temperature. The U.S.

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.

Diagnosis

Steatorrhea should be suspected when the stools are bulky, floating and foul-smelling. Specific tests are needed to confirm that these properties are in fact due to excessive levels of fat. Fats in feces can be measured over a defined time (often five days). Other tests include the (13)C-mixed triglycerides test and fecal elastase, to detect possible fat maldigestion due to exocrine pancreatic insufficiency, or various specific tests to detect other causes of malabsorption such as celiac disease.

Treatment

Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.

References

External links

{{Authority control Feces Diarrhea Gastrointestinal tract disorders Diseases of intestines Conditions diagnosed by stool test Symptoms and signs: Digestive system and abdomen Colorectal surgery Steatorrhea-related diseases