is the presence of excess fat in feces.

Stools may be bulky and difficult to flush, have a pale and oily appearance, and
can be especially foul-smelling.[1] An oily anal leakage or some level of fecal incontinence may occur. There is inc
reased fat excretion, which can be measured by determining the fecal fat level. The definition of how much fecal fat
constitutes steatorrhea has not been standardized.[citation needed]

Contents
1 Causes
1.1 Associated diseases
1.2 Medications
1.3 Excess whole nuts in diet
1.4 Natural fats
1.5 Artificial fats
2 Diagnosis
3 Treatment
4 See also
5 References
6 External links
Causes
Impaired digestion or absorption can result in fatty stools. Possible causes include exocrine pancreatic insufficiency,
with poor digestion from lack of lipases, loss of bile salts, which reduces micelle formation, and small intestinal dise
ase-producing malabsorption. Various other causes include certain medicines that block fat absorption or indigestibl
e or excess oil/fat in diet.[citation needed]

The absence of bile secretion can cause the feces to turn gray or pale. Bile is responsible for the brownish color of fe
ces. Other features of fat malabsorption may also occur such as reduced bone density, difficulty with vision under lo
w light levels, bleeding, bruising, and slow blood clotting times.[1]

Associated diseases
Conditions affecting the pancreas. Exocrine pancreatic insufficiency[2] can be caused by chronic pancreatitis, cystic
fibrosis and pancreatic cancer (if it obstructs biliary outflow).[1]
Conditions affecting bile salts. Obstruction of the bile ducts by gallstones (choledocholithiasis), primary sclerosing c
holangitis, liver damage (intrahepatic cholestasis), hypolipidemic drugs, or changes following gallbladder removal (c
holecystectomy).[1]
Conditions producing intestinal malabsorption. These include celiac disease, bacterial overgrowth, tropical sprue, Gi
ardiasis (a protozoan parasite infection), Zollinger-Ellison syndrome, short bowel syndrome, inflammatory bowel dis
ease and abetalipoproteinemia.[1][3]
Other causes: Drugs that can produce steatorrhea include orlistat, a slimming pill, or as adverse effect of octreotide o
r lanreotide, used to treat acromegaly or other neuroendocrine tumors.[4] It can be found in Graves' disease / hyperth
yroidism.[1]
Medications
Orlistat (also known by trade names Xenical and Alli) is a diet pill that works by blocking the enzymes that digest fa
t. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically di
gested and absorbed, sometimes causing oily anal leakage.[5][6][7] Vytorin (ezetimibe/simvastatin) tablets can caus
e steatorrhea in some people.[5][7]

Excess whole nuts in diet

Some studies have shown that stool lipids are increased when whole nuts are eaten, compared to nut butters, oils or f
lour[8] and that lipids from whole nuts are significantly less well absorbed.[9]

Natural fats
Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.[10]

Consuming escolar and oilfish (sometimes mislabelled as butterfish) will often cause steatorrhea, also referred to as
Gempylotoxism or Gempylid Fish Poisoning or keriorrhea.[11]
Artificial fats
The fat substitute Olestra, used to reduce digestible fat in some foods, was reported to cause leakage in some consum
ers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenat
ed form that is not liquid at physiologic temperature. The U.S. Food and Drug Administration warning indicated exc
essive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003
.[6][12]

Diagnosis
Steatorrhea should be suspected when the stools are bulky, floating and foul-smelling.[1] Specific tests are needed to
confirm that these properties are in fact due to excessive levels of fat. Fats in feces can be measured over a defined t
ime (often five days).[13] Other tests include the (13)C-mixed triglycerides test and fecal elastase, to detect possible
fat maldigestion due to exocrine pancreatic insufficiency,[13] or various specific tests to detect other causes of mala
bsorption such as celiac disease.[14]

Treatment
Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.[15]

See also
Rectal discharge
Keriorrhea
Fecal leakage
Steatocrit
References
Adam S Cheifetz; Alphonso Brown; Michael Curry; Alan C Moss (10 Mar 2011). Oxford American Handbook of G
astroenterology and Hepatology. Oxford University Press. p. 234. ISBN 9780199830121.
Lindkvist B (2013). "Diagnosis and treatment of pancreatic exocrine insufficiency". World J. Gastroenterol. (Revie
w). 19 (42): 7258 66. doi:10.3748/wjg.v19.i42.7258. PMC 3831207. PMID 24259956.
Moutzouri, Elisavet; Elisaf, Moses; Liberopoulos, N. Evangelos (2011). "Hypocholesterolemia". Current Vascular P
harmacology. 9 (2): 200 12. doi:10.2174/157016111794519354. PMID 20626336.
Dogliotti, L; Tampellini, M; Stivanello, M; Gorzegno, G; Fabiani, L (2001). "The clinical management of neuroend
ocrine tumors with long-acting repeatable (LAR) octreotide: comparison with standard subcutaneous octreotide thera
py". Annals of Oncology. 12 Suppl 2: S105 9. doi:10.1093/annonc/12.suppl_2.s105. PMID 11762334.
Squires, Sally (2006-01-24). "Weighing a Pill For Weight Loss". Washington Post. Retrieved 2007-07-06. While th
e Food and Drug Administration (FDA) still must approve the switch, the agency often follows the advice of its expe
rts. If it does, Orlistat (xenical) -- currently sold only by prescription -- could be available over-the-counter (OTC) lat
er this year. But it's important to know that the weight loss that's typical for users of the drug -- 5 to 10 percent of tot
al weight -- will be less than many dieters expect. And many consumers may be put off by the drug's significant gast
rointestinal side effects, including flatulence, diarrhea, and anal leakage.
"Frito-Lay Study: Olestra Causes "Anal Oil Leakage"". Center for Science in the Public Interest. February 13, 1997.
Retrieved 2007-07-07. The Frito-Lay report states: "The anal oil leakage symptoms were observed in this study (3 t
o 9% incidence range above background), as well as other changes in elimination. ... Underwear spotting was statisti
cally significant in one of two low-level consumer groups at a 5% incidence above background." Despite those probl
ems, the authors of the report concluded that olestra-containing snacks "should have a high potential for acceptance i
n the marketplace."
"The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug". Newsweek. June 25, 2007. Archived fr
om the original on 2007-06-18. Retrieved 2007-06-21. GlaxoSmithKline has a tip for people who decide to try Alli, t
he over-the-counter weight-loss drug it is launching with a multimillion-dollar advertising blitz keep an extra pair
of pants handy. That's because Alli, a lower-dose version of the prescription drug Xenical, could (cue the late-night t
alk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be g
ood for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accide
nt is worth it.
Traoret, C J; Lokko, P; Cruz, A C R F; Oliveira, C G; Costa, N M B; Bressan, J; Alfenas, R C G; Mattes, R D (2007
). "Peanut digestion and energy balance". International Journal of Obesity. 32 (2): 322 8. doi:10.1038/sj.ijo.080373
5. PMID 17912269.
 Hollis, James; Mattes, Richard (2007). "Effect of chronic consumption of almonds on body weight in healthy huma
ns". British Journal of Nutrition. 98 (3): 651 6. doi:10.1017/S0007114507734608. PMID 17445351.
Place, A. R. (1992). "Comparative aspects of lipid digestion and absorption: Physiological correlates of wax ester di
gestion". The American Journal of Physiology. 263 (3 Pt 2): R464 71. doi:10.1152/ajpregu.1992.263.3.R464. PMI
D 1415629.
Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook: Gempylotoxin, FDA
"Reported medical side-effects of Olestra according to Procter and Gamble studies". Center for Science in the Publi
c Interest. Archived from the original on 2007-07-02. Retrieved 2007-06-21. Olestra sometimes causes underwear st
aining associated with "anal leakage." Olestra sometimes causes underwear staining. That phenomenon may be caus
ed most commonly by greasy, hard-to-wipe-off fecal matter, but occasionally also from anal leakage (leakage of liqu
id olestra through the anal sphincter).
Lindkvist, B (14 November 2013). "Diagnosis and treatment of pancreatic exocrine insufficiency". World Journal of
Gastroenterology. 19 (42): 7258 66. doi:10.3748/wjg.v19.i42.7258. PMC 3831207. PMID 24259956.
Rubio-Tapia, A; Hill, ID; Kelly, CP; Calderwood, AH; Murray, JA; American College of, Gastroenterology. (May
2013). "ACG clinical guidelines: diagnosis and management of celiac disease". The American Journal of Gastroente
rology. 108 (5): 656 76, quiz 677. doi:10.1038/ajg.2013.79. PMC 3706994. PMID 23609613.
Azer SA, Sankararaman S (January 2021). "Steatorrhea". National Center for Biotechnology Information, U.S. Nati
onal Library of Medicine. PMID 31082099. Retrieved 3 October 2021.
External links
Classification
D
ICD-10: K90ICD-9-CM: 579.8MeSH: D045602
vte
Diseases of the digestive system
Authority control: National libraries Edit this at Wikidata
Germany
Categories: FecesDiarrheaGastrointestinal tract disordersDiseases of intestinesConditions diagnosed by stool testSy
mptoms and signs: Digestive system and abdomenColorectal surgerySteatorrhea-related diseases
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