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Fat in Stool (Steatorrhea): Symptoms, Causes, Diagnosis and Treatment

Stool is the waste product that appears as a result of the digestion of food consumed throughout the day. They tend to have a precise appearance and composition according to the diet that people follow. Sometimes it is possible to see fat in the stool, which is a sign that something is not working properly.

The presence of micelles or fat droplets in the stools is a clinical manifestation called steatorrhea. Studies show that fat digestion and absorption is mediated by pancreatic lipases, bile acids, and the intestinal epithelium. In this way, the malfunction of any of these parts can generate the appearance of the condition.

Unfortunately, the epidemiology of steatorrhea is difficult to determine, as it is not usually apparent at the beginning. In these cases it is necessary to perform certain laboratory tests to confirm the presence of fat in the stool.

Symptoms of steatorrhea

The characteristics of stools usually change due to the presence of fat in them. In this sense, they can become more voluminous, fetid and pale. These stools often float in the toilet, making them harder to flush.

In some cases, steatorrhea is often more evident, so it is possible to observe fatty micelles in the toilet, similar to what happens when mixing water and oil. One of the main causes of this clinical manifestation is malabsorption syndrome, so people may have other general symptoms:

Children may have more severe symptoms, including growth retardation and delayed puberty. It is important to remember that little ones need a certain amount of nutrients for their development.

Causes and risk factors

Fat in stool usually appears when there is a deficiency in the production of pancreatic lipases or bile acids. Also due to damage to the epithelium of the first portion of the small intestine. In this way, many diseases that affect the liver, pancreas or intestine can generate the appearance of steatorrhea.

All conditions capable of causing exocrine pancreatic insufficiency (EPI) may be at the origin of the symptom, due to the lack of enzyme production. Some studies establish that chronic pancreatitis is the most common cause of IPE in adults.

A common condition that can cause fat in the stool is celiac disease. It is a pathology that is characterized by affecting the epithelium of the small intestine, which hinders the absorption of fats.

Other diseases in which steatorrhea may appear are the following:

  • Cystic Fibrosis.
  • Cholestasis.
  • Crohn’s disease.
  • HIV enteropathy.
  • Whipple’s disease.
  • Parasitosis, such as giardiasis.
  • Pancreatic or intestinal surgeries.

How is fat in stool diagnosed?

The presence of fat in the stool can be diagnosed based on clinical findings. However, confirmation is made by different laboratory tests. The specialist may first ask about the general characteristics of the stool. In addition, it will look for signs that indicate the presence of underlying pathologies.

The necessary laboratory tests consist of a qualitative and quantitative analysis of fat in stool samples. The qualitative will seek to demonstrate the presence of macroscopic fat in the sample. It consists of adding a special dye that will change color in the presence of fat.

On the other hand, quantitative analysis will seek to determine the amount of fat expelled in a period of time. This will require collecting different stool samples in 1, 2 or 3 days. The result will be positive when there is the expulsion of more than 7 grams of fat in the stool in 24 hours.

The preparation for quantitative analysis of fat in stool is very accurate. People must maintain a diet in which 100 grams of fat are consumed daily in the 3 days prior to the test. It can be an uncomfortable and cumbersome diet, but it is the most accurate way to determine steatorrhea.

Available Treatments for Fat in Stool

Treatment for the presence of fat in the stool will depend on the disease that is causing this manifestation. In general terms, it is recommended to maintain a balanced and low-lipid diet, as well as to have adequate hydration. The foods that trigger the symptoms should also be identified, in order to avoid them.

General measures, such as rest and smoking cessation, can also help reduce symptoms. The reduction in alcohol intake is also usually beneficial, as well as the administration of antiflatulents, antacids and antidiarrheals.

Administration of exogenous pancreatic enzymes is useful in the case of exocrine pancreatic insufficiency. For its part, the implementation of a celiac diet and education are essential for patients with this diagnosed pathology. Lastly, ursodeoxycholic acid administration and surgery are the first-line treatment for cholangitis, for example.

When to see a doctor?

All people should consult a specialist if they notice the presence of micelles or fat droplets in the stool. It is also important to seek professional help in the presence of an increase in the amount of daily stools, pale or very foul stools.

The presence of fat in the stool can lead to the presence of a malabsorption syndrome. In this sense, sudden and involuntary weight loss and abdominal discomfort should be warning signs.

A problem that should not be underestimated

The presence of fat in the stool can be a difficult manifestation to notice, since its symptoms are usually very nonspecific at the beginning. It is characterized by sudden and subtle changes in the stool, especially in its smell, color and quantity. In addition, it can generate the appearance of general signs, as the underlying disease progresses.

This clinical manifestation can be the product of multiple pathologies that affect the pancreas, the bile ducts or the intestinal epithelium. They can cause a poor absorption of nutrients, which complicates the general condition. In this sense, it is vitally important to seek medical assistance in the presence of any abnormal symptoms.

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