Steatorrhea
Encyclopedia
Steatorrhea is the presence of excess fat in feces
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

. Stools may also float due to excess lipid, have an oily appearance and be especially foul-smelling. An oily anal leakage or some level of fecal incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...

 may occur. There is increased fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...

 excretion, which can be measured by determining the fecal fat level. Definitions of how much fecal fat constitutes steatorrhea have not been standardized.

Possible biological causes

Possible biological causes can be lack of bile
Bile
Bile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the process of digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and upon eating is discharged into the duodenum...

 acids (due to liver damage, hypolipidemic drugs, or having had the gallbladder
Gallbladder
In vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....

 removed in a cholecystectomy
Cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.-Open surgery:A...

), defects in pancreatic enzymes, and defective mucosal cells. The absence of bile acids will cause the feces to turn gray or pale. Another cause of steatorrhea is due to the adverse effect of octreotide
Octreotide
Octreotide is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone...

 or lanreotide
Lanreotide
Lanreotide is a medication used in the management of acromegaly and symptoms caused by neuroendocrine tumors, most notably carcinoid syndrome. It is a long-acting analogue of somatostatin, like octreotide....

, which are analogs of somatostatin, used clinically to treat acromegaly
Acromegaly
Acromegaly is a syndrome that results when the anterior pituitary gland produces excess growth hormone after epiphyseal plate closure at puberty...

.

Associated diseases

  • malabsorption
    Malabsorption
    Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality...

    , e.g. in inflammatory bowel disease
    Inflammatory bowel disease
    In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...

    , celiac disease
    Coeliac disease
    Coeliac disease , is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward...

    , and abetalipoproteinemia
    Abetalipoproteinemia
    Abetalipoproteinemia, or Bassen-Kornzweig syndrome, is a rare autosomal recessive disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food. It is caused by a deficiency of apolipoprotein B-48 and B-100, which are used in the synthesis and exportation of...

  • exocrine pancreatic insufficiency
    Exocrine pancreatic insufficiency
    Exocrine pancreatic insufficiency is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. This disease is found frequently in dogs. EPI is also found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. EPI is caused by a progressive...

  • pancreatitis
    Pancreatitis
    Pancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...

  • choledocholithiasis (obstruction of the bile duct
    Bile duct
    A bile duct is any of a number of long tube-like structures that carry bile.Bile, required for the digestion of food, is excreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct to form the common bile duct, which opens into the intestine.The...

     by a gallstone
    Gallstone
    A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of...

    )
  • pancreatic cancer
    Pancreatic cancer
    Pancreatic cancer refers to a malignant neoplasm of the pancreas. The most common type of pancreatic cancer, accounting for 95% of these tumors is adenocarcinoma, which arises within the exocrine component of the pancreas. A minority arises from the islet cells and is classified as a...

     (if it obstructs biliary outflow)
  • primary sclerosing cholangitis
    Primary sclerosing cholangitis
    Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer...

  • bacterial overgrowth
  • short bowel syndrome
    Short bowel syndrome
    Short bowel syndrome is a malabsorption disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel. Most cases are acquired, although some children are born with a congenital short bowel...

  • cystic fibrosis
    Cystic fibrosis
    Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...

  • Zollinger-Ellison syndrome
    Zollinger-Ellison syndrome
    Zollinger–Ellison syndrome is a triad of gastric acid hypersecretion, severe peptic ulceration, and non-beta cell islet tumor of pancreas . In this syndrome increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Often the cause is a tumor of...

  • giardiasis
    Giardiasis
    Giardiasis or beaver fever in humans is a diarrheal infection of the small intestine by a single-celled organism Giardia lamblia. Giardiasis occurs worldwide with a prevalence of 20–30% in developing countries. In the U.S., 20,000 cases are reported to the CDC annually, but the true annual...

     (a protozoan parasite infection)
  • Graves' disease
    Graves' disease
    Graves' disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones...

     / hyperthyroidism
    Hyperthyroidism
    Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...

  • abuse or misuse of certain prescribed slimming pills (such as Orlistat
    Orlistat
    Orlistat , also known as tetrahydrolipstatin, is a drug designed to treat obesity. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake...

    )

Weight-loss drugs or 'functional foods'

Steatorrhea can also be due to eating indigestible oils or fats, such as Olestra
Olestra
Olestra is a fat substitute that adds no fat, calories, or cholesterol to products. It has been used in the preparation of traditionally high-fat foods such as potato chips, thereby lowering or eliminating their fat content...

, or as a side effect of medicines that prevent the absorption of dietary fats, such as Orlistat
Orlistat
Orlistat , also known as tetrahydrolipstatin, is a drug designed to treat obesity. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake...

.

Artificial fats

The fat substitute Olestra
Olestra
Olestra is a fat substitute that adds no fat, calories, or cholesterol to products. It has been used in the preparation of traditionally high-fat foods such as potato chips, thereby lowering or eliminating their fat content...

, 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
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

 warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.

Medications

Orlistat (also known by trade names Xenical and Alli) 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, sometimes causing oily anal leakage.

Natural fats

Consuming jojoba oil
Jojoba oil
Jojoba oil is the liquid wax produced in the seed of the jojoba plant, a shrub native to southern Arizona, southern California, and northwestern Mexico. The oil makes up approximately 50% of the jojoba seed by weight....

 has been documented to cause steatorrhea and anal leakage because it is indigestible.

Consuming escolar
Escolar
The escolar, Lepidocybium flavobrunneum, a species of fish in the family Gempylidae, is found in deep tropical and temperate waters around the world...

 and oilfish
Oilfish
The oilfish, Ruvettus pretiosus, is a species of snake mackerel in the family Gempylidae, and the only species in the genus Ruvettus. It is found in the Mediterranean, middle Atlantic and throughout the southern seas, at depths between 100 and 800 m...

 (sometimes called butterfish) will often cause steatorrhea. The fish is commonly used in party catering due to its delicate flavor and because it is cheap and readily available.

Treatment

Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.
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