Steatorrhea

What is steatorrhea?

Steatorrhea means that you have excessive amounts of fat in your poop. Fatty poops are different from normal poops. They tend to be looser, smellier and paler in color, like clay. They might float. You might have an occasional fatty poop after eating a fatty meal. But if you have them consistently, it’s a sign that something in your digestive system isn’t working right.

Steatorrhea is a symptom of many diseases that can affect different organs in your digestive system. While it’s not a disease in itself, it’s usually a direct consequence of what’s called fat malabsorption. That means your body has trouble breaking down, digesting and metabolizing fats. When your body can’t use the fats you eat, it has to excrete them in your poop.

Is steatorrhea an emergency?

If you have steatorrhea and don’t know why, you should seek medical attention. It could be caused by a serious condition that needs treatment. Steatorrhea itself isn’t an emergency, but fat malabsorption will cause more problems for you over time. It's important to get diagnosed so your underlying condition can be addressed.

What does it mean if you have steatorrhea?

Digesting fats takes cooperation between several of your organs. Your small intestine is where fats are broken down and absorbed. But your small intestine doesn’t work alone. It needs digestive enzymes from your pancreas and bile from your liver to help break down the fats. Your pancreas and liver send these ingredients to your small intestine through your bile ducts. Diseases affecting any of these organs can affect your fat digestion.

If your pancreas can’t make enzymes or your liver can’t make bile, your small intestine won’t have the materials it needs to break down fats. Similarly, if your pancreas or your liver can’t deliver enzymes or bile through your bile ducts, your small intestine won’t have the materials it needs. And if your small intestine itself isn’t working right, it won’t be able to do the work to break down and absorb fats.

What are the most common causes of steatorrhea?

Conditions affecting your small intestine, pancreas, liver and bile ducts can cause steatorrhea. Below are some common causes.

Exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency is when your pancreas can’t produce enough pancreatic enzymes. It can be caused by:

• Chronic pancreatitis.
• Gallstone pancreatitis.
• Alcohol use disorder.
• Cystic fibrosis.
• Pancreatic cancer.
• Zollinger-Ellison syndrome.

Bile duct and liver diseases

Diseases in your liver and bile ducts tend to affect each other. They can interfere with your liver’s ability to make bile and with your bile ducts’ ability to deliver it. Examples are:

• Primary biliary cholangitis.
• Primary sclerosing cholangitis.
• Cholestasis.
• Cirrhosis of the liver.
• Liver failure.

Maldigestion and malabsorption conditions

Conditions affecting your small intestine may interfere with its ability to break down fats (maldigestion) or its ability to absorb them (malabsorption). Some of these conditions include:

• Celiac disease.
• Crohn’s disease.
• Whipple’s disease.
• Small intestinal bacterial overgrowth (SIBO).
• Giardiasis.
• Short gut syndrome.
• Lymphoma.
• Amyloidosis.

How do I know if I have steatorrhea?

Most people suspect something’s up when they notice changes in their poop. They might notice it's:

• Bulky.
• Loose.
• Greasy.
• Foamy.
• Light-colored.
• Smelly.
• Floating.
• Hard to flush.

However, sometimes in the early stages, your poop changes aren’t dramatic enough to notice.

A healthcare provider may also discover you have steatorrhea through evaluation and testing. One way of testing for steatorrhea is with a fecal fat analysis. A provider looks at samples of your poop over 24 to 72 hours and measures the fat content. They determine what percentage of fat from your diet was absorbed and what was left in your poop.

How do healthcare providers find out what’s causing my steatorrhea?

If they don’t know which organ is malfunctioning, they may begin by ordering a pee test, called a D-xylose test. This test tells them whether you have a problem in your small intestine. For the test, you drink a solution containing the sugar D-xylose and then provide a sample of your pee. Sometimes providers take a blood sample, too.

D-xylose in your pee or blood means that it was successfully absorbed through your intestines. In this case, you may have a problem in your pancreas or biliary system. Your provider will order further tests to find out. If there's no D-xylose in your samples, something went wrong in the absorption process, and they will look for the problem in your intestines.

How do healthcare providers treat steatorrhea?

To treat steatorrhea, a healthcare provider will need to treat your underlying condition, which could be many things. If you have EPI, you might need pancreatic enzyme replacement therapy (PERT). If you’re not getting enough bile to your intestines, you may benefit from a bile acid replacement such as ursodeoxycholic acid (Ursodiol).

You may also need separate treatment for the complications of fat malabsorption. For example, long-term fat malabsorption can cause severe fat-soluble vitamin deficiencies (A, D, E and K). These vitamin deficiencies can also have side effects. You may need treatment for various levels of malnutrition and its complications.

What should I eat if I have steatorrhea?

If you have occasional steatorrhea from eating too much fat or from difficulty digesting fats, you might want to avoid or reduce certain foods in your diet, such as:

• Whole nuts.
• Coconut and palm oils.
• Butter, shortening and lard.
• Processed coffee creamers.
• Red meat.
• Alcohol.

If you have steatorrhea due to malabsorption, you may have different dietary needs. You may need to eat more fats, especially healthy unsaturated fats, such as:

• Oily fish (salmon, tuna, mackerel.)
• Nut butters.
• Avocados.
• Olive oil.

You may also need to supplement fat-soluble vitamins (A, D, E and K.) This might require dietary supplements, but you can also seek out dietary sources of these vitamins. For example:

• Fish oil and butter are good sources of vitamin A.
• Fatty fish and mushrooms are good sources of vitamin D.
• Sunflower oil, sunflower seeds and almonds are good sources of vitamin E.
• Leafy green vegetables are great for vitamin K, especially kale and spinach.

A note from Cleveland Clinic

Steatorrhea can mean many things. If you’ve been eating a lot of fats lately or having digestive difficulties, it may just be an anomaly. But if you’ve had it for a while, you should see a healthcare provider. It may be a symptom of a chronic disease that you already know about reaching a new stage. It may also be your first hint of an underlying condition.