Steatorrhea: Symptoms, Diagnosis, Causes & Treatment

Steatorrhea is the excessive elimination of fat in the stool, leading to symptoms such as oily, pale, bulky, and foul-smelling stools that may also float in the toilet.

This condition can be caused by gastrointestinal diseases that interfere with fat absorption, including chronic pancreatitis, primary biliary cholangitis, celiac disease, or Crohn’s disease.

It is important to see a gastroenterologist if fat is noticed in the stool so the cause can be identified and the most appropriate treatment started. Treatment may involve antibiotics or anti-inflammatory medications, as well as following a healthy, low-fat diet.

Main symptoms

The main symptoms of steatorrhea include:

• Pale or yellowish stools

• Bulky, foamy stools or stools with mucus

• Visible fat droplets in the stool

• Strong or foul odor in the stool

• Stools that float in the toilet

Other symptoms may also develop, such as chronic diarrhea, nausea, abdominal pain or bloating, loss of appetite, and weight loss. These can vary depending on the underlying cause of steatorrhea.

In children, fat malabsorption can also lead to growth problems or delayed puberty.

How to confirm a diagnosis

The diagnosis of steatorrhea is made by a gastroenterologist through an assessment of symptoms, medical history, and stool tests to measure the presence and amount of fat.

Additional tests may be recommended to help identify the cause of steatorrhea, such as the D-xylose absorption test, abdominal X-ray, CT scan, MRI, endoscopy with small intestine biopsy, liver biopsy, or liver function tests.

Possible causes

Steatorrhea is most often caused by bile acid deficiency, pancreatic insufficiency, or problems in the digestive or absorption process in the intestine, which lead to fat being eliminated in the stool.

The main conditions linked to steatorrhea include:

• Celiac disease or Crohn’s disease

• Chronic pancreatitis or pancreatic tumors

• Primary biliary cholangitis

• Small intestinal bacterial overgrowth (SIBO)

• Cystic fibrosis

• Giardiasis

Other causes may include amyloidosis, Whipple’s disease, or the use of medications such as orlistat.

Steatorrhea can also occur after gastrointestinal surgery, since these procedures may interfere with fat absorption.

Treatment options

Treatment for steatorrhea should be guided by a gastroenterologist and depends on the underlying cause. It may involve pancreatic enzyme replacement, ursodiol (ursodeoxycholic acid), or antibiotics.

If nutritional deficiencies are present, the doctor may also recommend supplementation with fat-soluble vitamins, including vitamins A, D, E, and K.

In addition, avoiding foods that trigger symptoms, such as gluten or dairy products, may help relieve symptoms more effectively.