Steatorrhea is the presence of excess fat in feces. 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 secretion can cause the feces to turn gray or pale. 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.
Orlistat 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 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 will often cause steatorrhea, also referred to as Gempylotoxism or Gempylid Fish Poisoning or keriorrhea.
Artificial fats
The fat substituteOlestra, 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 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. Other tests include the 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.
