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Fat stool: causes and therapy
Fat stool or pancreatic stool (steatorrhea) is an expression of poor digestion of the fats ingested through food. The increased fat content of the stool can be the result of serious illnesses such as chronic inflammatory bowel disease or, in the worst case, pancreatic cancer. Therefore, a visit to a doctor is urgently recommended in the case of fatty stools.
Experts refer to a pathologically increased fat content in the stool as a fatty stool. The stool contains a high proportion of dietary fats, as these are only insufficiently absorbed in the digestive tract. The stool appears brightly colored, sticky, voluminous, foamy and shiny, accompanied by a particularly pungent odor. From a fat loss of ten grams per day through bowel movements, the definition of pathological fatty stool is used.
Oily bowel movements
The symptoms of fatty stools are primarily characterized by the excretion of particularly fatty faeces. This often smears noticeably in the toilet bowl. Oily bowel movements are often accompanied by indigestion, abdominal pain, flatulence, diarrhea and other symptoms that depend on the causes of the fatty stool.
Not infrequently, in addition to impaired fat digestion, there is also a problem with protein digestion, which can lead to further complaints. Fatty stools are a symptom of insufficient utilization of the fats ingested through food. The emulsion of dietary fats formed in the stomach and intestine (here the bile produced by the liver and stored in the gall bladder plays an important role) cannot be processed adequately by the so-called lipases (special enzymes) of the intestine and pancreas, which leads to the excretion of the Entails dietary fats through bowel movements.
Possible causes of fatty stool
In general, malabsorption or insufficient absorption of dietary fats through the intestinal wall into the lymph and bloodstream is the cause of fatty stools. This malabsorption can in turn be triggered by various diseases, which range from harmless food intolerance to pancreatic carcinoma (pancreatic cancer).
One of the possible causes of greasy bowel movements is so-called celiac disease (gluten intolerance), in which inflammation of the mucous membrane of the small intestine occurs due to hypersensitivity to gluten components. The associated damage to the intestinal tissue can significantly impair the processing of nutrients. Dietary fats are also no longer adequately absorbed and remain undigested in the digestive tract.
Celiac disease often accompanies symptoms
Affected children often suffer from impairments in their physical development (too little weight gain and reduced length growth), while adults often have rather unspecific symptoms such as general weakness, nervousness, tooth damage or skin problems.
Diseases of the pancreas
The pancreas makes a significant contribution to the digestion of fat by providing the necessary enzymes. If the function of the organ is impaired, too few digestive enzymes are produced and fat digestion cannot take place to the required extent. This is the case, for example, with so-called exocrine pancreatic insufficiency.
Pancreatic insufficiency can be triggered by acute, chronic or hereditary diseases of the organ. The insufficient production of enzymes leads to considerable digestive disorders on the one hand and possibly damage to the intestinal mucosa on the other. The so-called intestinal villi experience considerable tissue atrophy, inflammation is favored and the enzyme activity on the intestinal mucosa is impaired. In addition to the increased fat content of the stool, those affected with exocrine pancreatic insufficiency often show progressive weight loss.
Inflammation of the pancreas
The occurrence of exocrine pancreatic insufficiency is relatively often triggered by inflammation of the pancreas (pancreatitis). However, this inflammation of the organ not only leads to considerable long-term impairment of the pancreatic function, but may also cause a reduced release of digestive enzymes in the acute stage.
Typical accompanying symptoms here are - in addition to the greasy stool - acute abdominal pain, which can radiate in the belt area to the back, as well as a particularly striking feature of pancreatitis: hematomas (bleeding) in the flank area. Furthermore, those affected often suffer from unspecific symptoms such as constipation, fever, nausea and vomiting.
In the worst case, the functional impairment of the pancreas and the associated fatty stool is caused by pancreatic cancer. A distinction must be made between tumors in the area of the exocrine (digestive secretion is released via the ducts directly into the duodenum) and the endocrine (release of hormones into the blood) gland cells. A large part of the pancreatic tumors affects the exocrine glandular tissue and here in particular the so-called pancreatic head. In addition to fatty stools, pancreatic cancer is usually accompanied by continuously worsening jaundice. The non-specific symptoms such as abdominal pain and significant weight loss are also common in pancreatic cancer.
Gallstones and inflammation of the bile ducts
Since a sufficient supply of bile juice is required for fat digestion, a blockage of the bile ducts by a gallstone can also lead to disturbances in the processing of food fats and a corresponding fat content in the stool. The formation of gallstones sometimes takes place without any further symptoms, but can also cause symptoms such as severe pain in the upper abdomen, flatulence, nausea and vomiting as well as persistent loss of appetite. Those affected may develop jaundice and have elevated liver values.
Inflammation of the bile ducts can also impair the secretion of bile and thus lead to an increased fat content in the stool. Acute inflammation of the bile ducts is often caused by bacterial infections. Typical symptoms, in addition to fatty stools, are unilateral pain in the right upper abdomen, fever (possibly with chills) and jaundice. If there is a severe purulent inflammation of the bile duct, there is also a risk of shock, impairment of kidney function and disorders of the central nervous system.
Other causes of greasy bowel movements
After the surgical removal of parts of the small intestine, fat digestion can be impaired to such an extent that undigested dietary fats are excreted in the stool. The location and length of the removed section of the small intestine have a considerable influence on the fat content of the stool. In addition to the fatty stool, those affected often suffer from severe diarrhea and an undersupply of water and nutrients, which promotes the corresponding deficiency diseases. Removing larger sections of the small intestine also usually results in significant weight loss.
Side effects of certain drugs should also be mentioned as possible triggers for increased fat content in the stool. In particular, the drug treatment of obesity with orlistat often results in fatty stools. The active ingredient inhibits the fat-degrading enzymes, which means that the ingested dietary fats can no longer be adequately processed. In addition to orlistat, fatty stools can also be caused by special antibiotics, for example.
During the diagnosis, in addition to a detailed questionnaire on the symptoms, diet, existing pre-existing illnesses, etc., the appearance and fat content of the stool should first be checked as part of a stool examination. If this is significantly increased, the search for the possible causes begins. Numerous different diagnostic methods are used here, depending on the possible underlying diseases.
For example, if gluten intolerance is suspected, a blood test for detectable antibodies is carried out (so-called serological tests), which can usually be used to determine the disease relatively clearly. In addition, the removal of tissue samples from the small intestine or the duodenum is provided in order to clearly confirm the diagnosis of gluten intolerance.
To check for possible exocrine pancreatic insufficiency, the so-called secretin-pancreozymin test, in which the release of pancreatic enzymes is measured with the help of a probe in the duodenum, is recommended for the most reliable diagnosis possible. However, the procedure is relatively complex and rather unsuitable for a quick diagnosis. Stool examinations, in which the excretion of fats (increased in pancreatic diseases) or pancreatic enzymes (reduced in pancreatic diseases) via the stool can help here. In order to achieve a meaningful result, the stool examinations must be repeated several times. If there are doubts about the result, there is currently no way around a secretin-pancreozymin test.
Even with inflammation of the pancreas, there is usually a significantly reduced concentration of pancreatic enzymes in the stool, so that a stool examination can under certain circumstances provide initial information about the inflammation of the organ. In addition, increased levels of special pancreatic enzymes (amylase, lipase) in the blood can be detected in chronic pancreatitis. In addition, pancreatic calcifications can be detected with the help of ultrasound and X-ray examinations, computed tomography (CT) and magnetic resonance imaging (MRI), which are typical signs of pancreatitis.
In the case of pancreatic cancer, the tumors can usually be diagnosed relatively clearly with the help of ultrasound examinations, CT and MRI. If no clear diagnosis can be made on the basis of these procedures, a so-called endoscopic retrograde cholangiopancreatography (ERCP) can provide information, in which contrast media for a special X-ray examination can be injected directly into the bile ducts with the help of an endoscope. This examination may also provide information about blockages of the bile ducts by gallstones or bile duct inflammation. In the case of pancreatic cancer, certain tumor markers often appear in the blood serum, which can be detected in a corresponding blood test.
In addition to the above-mentioned diagnostic methods, a physical examination with palpation, tapping and listening to the chest and stomach area is also generally advisable in order to derive initial indications of the causes of the fatty stool.
Fat stool treatment
Most diseases that can cause high levels of fat in bowel movements require urgent medical care. This applies in particular to the diseases of the pancreas, bile ducts and intestines shown. But a doctor should also be consulted in the event of gluten intolerance or drug intolerance. Which treatment approaches enable a successful therapy of the fatty stool depends on the respective causes of the fatty stool.
Treatment for gluten intolerance
The treatment of gluten intolerance is primarily based on a lifelong gluten-free diet. By avoiding gluten, the intestinal lining can gradually recover and the risk of long-term health problems can be significantly reduced. As part of the diet, cereals with a high gluten content such as wheat, barley, rye, spelled etc. are replaced by gluten-free cereals such as millet, rice, maize, buckwheat or soybeans.
In the case of processed foods and finished products, make sure that they do not contain any gluten-containing ingredients. Due to the extensive damage to the mucous membrane, lactose digestion is impaired in many people with gluten intolerance, which is why the diet usually includes a temporary low-lactose diet in the early stages, in which milk and milk products are replaced by soy milk. If the diet is strictly adhered to, the fatty stool should disappear after a relatively short time. If those affected continue to have greasy stools, gluten intolerance may not have been the sole cause of the symptoms.
Treatment of pancreatic disease
If greasy, light-colored stools are caused by a pancreatic disease, medical care should be given immediately, as there may be life-threatening consequences. The treatment of pancreatic insufficiency is usually based on drugs that contain the digestive enzymes of the pancreas with the active ingredient pancreatin. The necessary enzymes in the drugs are prepared in such a way that they can withstand stomach acid and only develop their effect in the small intestine. If the pancreas is underactive, a particularly high-carbohydrate diet with several small meals a day is recommended. The fat content of the food should not exceed 70 grams per day.
In the event of inflammation of the pancreas, intravenous fluids are given as an immediate medical measure to prevent the acute risk of volume deficiency shock. Since those affected usually suffer from considerable pain in pancreatitis, pain therapy is also of particular importance here, with so-called non-steroidal anti-inflammatory drugs (NSAIDs) or active ingredients such as butylscopolamine, tramadol, buprenorphine and pethidine being used more often as pain relievers.
Otherwise, changes in blood values are compensated for with the help of infusions as part of the therapy. If a bacterial infection is suspected to be the cause of the pancreatitis, antibiotics may also be used. If gallstones are the cause of the symptoms, they can be eliminated with the help of the ERCP. In the event of complications such as bleeding, infections or cysts, however, surgical intervention to remove the dead tissue or cysts is often the last option. Since pancreatitis is often associated with excessive alcohol consumption, abstinence from alcohol is an essential part of therapy.
The treatment of pancreatic cancer usually involves surgical removal of the tumors. However, many ulcers cannot be removed this way, so patients undergo chemotherapy. In addition, so-called mistletoe therapy is also used more frequently in conventional medicine, which on the one hand helps to alleviate the symptoms and on the other hand is intended to significantly improve the chances of recovery.
Further surgical interventions may also be planned to alleviate symptoms. For example, a so-called stent can be implanted in the bile ducts to ensure patency. Artificial connections between the blocked bile duct and the intestine can also be established in the course of an operation. However, such measures cannot defeat cancer, but only have a positive effect on the symptoms of those affected.
Gallstones and inflammation of the bile ducts
Once gallstones cause fatty stool and other health ailments, they should be eliminated urgently. The most gentle treatment approach here is the medicinal dissolution (lysis) of the gallstones with the help of so-called ursodeoxycholic acid or chenodeoxycholic acid. A procedure that is only promising for gallstones made from pure cholesterol. The gallstones must also not exceed a certain size (five millimeters) so that drug dissolution is possible.
In the case of acute or chronic inflammation of the gallbladder or biliary tract, medicinal lysis of the gallstones is generally ruled out. The same applies to gallbladder cancer, liver inflammation, pancreatitis and pregnancy. Since chenodeoxycholic acid often leads to considerable side effects, nowadays ursodeoxycholic acid, which is almost free of side effects, is mostly used.
Overall, the lysis of the gallstones offers several advantages over other treatment methods, as the functionality of the gallbladder can usually be maintained in the course of the therapy, there are no surgical risks and those affected remain able to work during the treatment. In addition to the medicinal lysis of the gallstones, mechanical dissolution can also take place with the help of extracorporeal shock wave lithotrypsy, in which the stones are shattered with shock waves.
However, when the gallstones are dissolved by means of drugs as well as by mechanical means, new gallstones form relatively often after the treatment.In addition, these procedures can only be used to a limited extent so that a cholecystectomy (surgical removal of the gallbladder) may be necessary. Nowadays, in most cases, this is done with the help of a minimally invasive procedure, known as laparoscopic surgery. Complications are extremely rare with such procedures and the gallbladder stones can be definitely eliminated.
The ERCP already explained is also suitable for removing the gallstones from the bile ducts. If the bile ducts are inflamed, endoscopic treatment (ERCP) can also be used to restore the bile flow. In most cases, biliary inflammation is treated with antibiotics. If these treatment methods do not work, the liver can also be increasingly damaged and for those affected in the end-stage of the disease, liver transplantation may be the last option.
Treatment of fat indigestion
If fat digestion disorders are the cause of fatty bowel movements after bowel surgery, those affected must also follow a special diet. Carbohydrate-rich foods and a proportion of medium-chain fatty acids in the triglycerides of 50 to 75 percent are recommended here. If possible, the change in diet should take place before the actual bowel operation, also in order to compensate for existing deficiency diseases. In case of doubt, those affected are supplied with liquid food or tube feeding.
After the operation, the digestive tract begins to adjust to the shortened intestinal length. In order to obtain the maximum of the remaining absorption capacity of the intestine, it should be constantly busy with the processing of food. This is also the reason why enteral feeding by means of a gastric tube is usually started immediately after the operation. The digestive tract can take up to a year to adjust after the operation before the intestine has adjusted functionally and structurally to the new conditions.
Fatty stools after bowel surgery usually require individually tailored nutritional therapy. If the patients already show signs of a deficiency disease, artificial nutrition may be necessary. In the worst case, those affected have to be supplied with nutrients parenterally (via the bloodstream) for a certain period of time. To prevent deficiency diseases, regular checks of the electrolyte, calcium, magnesium, phosphate, folic acid and zinc levels are provided. The blood level of vitamin B12 must also be continuously monitored and, if necessary, compensated for with additional administration. Overall, most patients with the so-called short bowel syndrome after an intestinal operation are not spared from adhering to a strict diet, whereby the nutritional therapy must be adapted to the individual symptoms of those affected.
Fat stool - naturopathy and holistic medicine
Although there is no way around conventional treatment for most diseases that can be the cause of greasy bowel movements, naturopathy offers numerous possibilities to support a successful therapy.
For example, in the case of diseases of the pancreas, various natural healing methods can be used, which bring about a relief of the symptoms and contribute to the general strengthening of the organ. Ear acupuncture, Bach flower therapies or foot reflexology therapies are said to stimulate the self-healing powers of the pancreas. Homeopathy also offers various preparations with which the pancreas function is to be improved. The utilization of food in the digestive tract can also be influenced by various spices, which - such as anise, cloves, ginger and cardamom - cause an increased production of digestive juices.
Basil, thyme, juniper, rosemary, oregano and marjoram are also said to have digestive effects that can help prevent fatty stools. Various herbal teas also show a positive effect here. Herbal medicine also knows numerous medicinal plants containing bitter substances, such as gentian, wormwood and rhubarb root, which are taken as tea or in the Maria Treben recipe combined with other medicinal plants (as so-called Swedish bitter). In this way, the medicinal plants are said to increase the production of gastric acid, bile and pancreatic enzymes, which helps improve digestion.
In the naturopathic treatment of the possible underlying disease of the fatty stool, nutritional therapy is generally given particular importance. In fact, if you stick to a strict diet, the symptoms can be avoided after a relatively short time. Here, not only the right choice of food has an essential part in the success of the therapy, but also the type of intake and eating behavior. So-called "Fletschern" - a special chewing technique in which the food stays in the mouth for as long as possible - offers a good opportunity here to significantly improve the pre-digestion of the food in the mouth and thus to make its work easier for the digestive tract. It is also advisable not to drink anything while eating, as the liquid mixes with the digestive juices that are formed and thus reduces their effectiveness. (fp)
Author and source information
This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.
- Dieter Häussinger: Gastroenterology, Hepatology and Infectiology: Compendium and Practical Guide, De Gruyter; Edition: 1 (July 9, 2018)
- Johannes Lenglinger, Marion Hädrich: Exocrine pancreatic insufficiency; in: Therapeutische Umschau, Volume 73, Pages 500-504, 2016, hogrefe.com
- Kaspar Truninger: Clarification of chronic diarrhea; in: Praxis, Volume 05, Pages 153-158, 2016, hogrefe.com
- Sinead N. Duggan: Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis; in: Proceedings of the Nutrition Society, Volume 76, Issue 4, pages 484-494, November 2017, cambridge.org
- Hogue, G .; Adams, R.:Lower Gastrointestinal Conditions: Malabsorption Syndromes; in: FP Essential, Volume 483, Pages 20-24, August 2019, PubMed
- Samy A. Azer, Senthilkumar Sankararaman: Steatorrhea; in: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2019, PubMed
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.
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