Key takeaways

  • Steatorrhea is a medical term that refers to having too much fat in your feces. It can be caused by eating excess fatty foods or malabsorption, where the body can’t absorb nutrients or make the enzymes needed to digest food.
  • Common symptoms include having bulkier, pale, or foul-smelling poop. You may also find that your poop looks as though it is covered in a greasy film.
  • In order to treat steatorrhea, you need to treat the underlying cause. For example, dietary changes may be suggested if your symptoms are caused by eating too many fatty foods, and nutrition supplements may be recommended for malabsorption.

You may not think much about the makeup of your stool. Most of it is water, and the rest is a combination of:

  • bacteria
  • fats
  • fiber
  • mucus
  • protein
  • salts
  • various cell linings

If you’re experiencing steatorrhea, make an appointment with your doctor. They can help you figure out the underlying cause and recommend treatment options.

If you have steatorrhea, your stools may be:

  • bulkier
  • pale
  • foul smelling
  • floating

The stools also tend to be covered in a greasy film. You might even see drops of oil in the water inside the toilet bowl.

Steatorrhea is only one of several common symptoms of malabsorption. Others include:

  • abdominal cramps
  • diarrhea
  • gas
  • indigestion
  • weight loss

Too much fat in your stool suggests your digestive system isn’t breaking down food adequately. Your body may not absorb the useful parts of the food you eat, including dietary fat.

One of the most common causes of malabsorption is cystic fibrosis. This is an inherited condition that affects your sweat and mucous glands, as well as various organs in your body, including the pancreatic glands.

If steatorrhea is due to malabsorption, it can most often be related to problems with pancreas function. The pancreatic juices are important in digesting fat content.

Another cause of malabsorption that can lead to steatorrhea is exocrine pancreatic insufficiency (EPI). EPI is a condition where your pancreas doesn’t make or release enough of the enzymes needed to help your digestive system break down food and absorb nutrients.

With EPI, steatorrhea happens when your digestive system gets rid of too many fats instead of absorbing them. This usually occurs when fat-digesting enzymes in your pancreas drop to 5 to 10 percent of typical levels.

EPI can be caused by a number of things including chronic pancreatitis. Pancreatitis is an inflammation of your pancreas, an organ near your stomach. It releases enzymes to help you digest fat, protein, and carbohydrates in your small intestine.

Chronic pancreatitis can have many different causes. Some examples include alcohol use disorder, smoking, and family history.

EPA may be caused by other conditions such as hereditary pancreatitis, pancreatic duct obstruction, or surgeries for cancer.

A few other causes of malabsorption include:

  • biliary disease
  • SIBO
  • small bowel surgeries

Steatorrhea may also be caused by giardiasis, a parasitic infection often spread through contaminated water or food.

If you notice that your stool floats and appears greasy, pale, and abnormally foul smelling, you should talk with your doctor.

This is especially true if you have other symptoms of malabsorption, such as weight loss or cramps.

In addition to reviewing your medical history and symptoms, your doctor will likely order two common tests for steatorrhea. One is a qualitative test of fecal fat; the other is a quantitative test of fecal fat.

Qualitative test

The qualitative test measures the number of fat globules (drops) in one stool sample.

Typical levels are fewer than 50 neutral fat globules and fewer than 100 fatty acid fat globules, both as seen under a microscope.

Quantitative test

For a quantitative test, you must collect stool samples over a period of 2 to 4 days. All the samples are then studied to determine the total amount of fat in each day’s stool.

Average test results would show 2 to 7 grams per 24 hours for adults, with fat making up less than 20 percent of the solid stool sample.

For an infant, there should be less than 1 gram per 24 hours. For bottle-fed babies, fat should make up 30 to 50 percent of the stool sample. For breastfed babies, a normal result ranges from 10 to 40 percent.

Your doctor may order other tests to make a diagnosis.

For example, your doctor can do a stool test for giardia.

A person with cystic fibrosis might need a sweat test and genetic testing. If they suspect pancreatic insufficiency, they may perform a pancreatic elastase test, imaging of the pancreas, or give you a stool test to monitor for low pancreatic elastase.

Be sure to discuss these tests with your doctor.

Treating steatorrhea is really about treating the underlying cause or causes of this condition. And because malabsorption can have many causes, it will be important to get a reliable diagnosis.

For diet-related causes, the treatment is usually a matter of avoiding the foods that trigger your symptoms.

For example, a person with giardia would need antibiotics.

Depending on the cause of the EPI, you might need medications or endoscopic intervention. EPI is typically treated with medications, dietary changes, and nutrition supplements. Often supplementary pancreatic enzymes may be prescribed.

Your treatment plan will depend on your symptoms and the cause behind your EPI.

For causes such as cystic fibrosis or chronic pancreatitis, medications and lifestyle changes will be necessary.