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Fat stool: causes and therapy

Fat stool: causes and therapy



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Fatty 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 diseases such as inflammatory bowel disease or, in the worst case, pancreatic cancer. Therefore, a visit to the doctor is strongly recommended at Fettstuhl.

Definition

In the professional world, a fat stool is a pathologically fat increase in the stool. The stool contains a high proportion of nutritional fats, since these are only insufficiently absorbed in the digestive tract. The stool appears brightly colored, sticky, voluminous, foamy and shiny, accompanied by a particularly pungent smell. From a fat loss of ten grams per day in the bowel movement, according to the definition of pathological fat stool.

Oily bowel movements

The symptoms of the fatty stool are primarily characterized by the excretion of particularly fatty faeces. This often lubricates conspicuously in the toilet bowl. Oily bowel movements are often accompanied by indigestion, abdominal pain, bloating, diarrhea and other symptoms depending on the causes of the fatty stool.

In addition to the impaired fat digestion, there is often a problem with protein digestion, which can lead to further complaints. The fat stool is 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 juice produced by the liver and stored in the gallbladder plays an important role) cannot be processed adequately by the so-called lipases (special enzymes) of the intestine and pancreas, which leads to an excretion of Dietary fats resulting from bowel movements.

Possible causes of fatty stool

In general, malabsorption or the inadequate absorption of dietary fats through the intestinal wall into the lymphatic and bloodstream is the cause of the fatty stool. This malabsorption can in turn be triggered by various diseases, ranging from rather harmless food intolerances to pancreatic cancer (pancreatic cancer).

Gluten intolerance

One of the possible causes of fatty stool is so-called celiac disease (gluten intolerance), which - due to hypersensitivity to components of gluten - causes inflammation of the small intestine. The associated damage to the intestinal tissue can have a significant impact on the processing of nutrients. Dietary fats are also no longer sufficiently absorbed and remain undigested in the digestive tract.

The accompanying symptoms often occur in celiac disease

  • Loss of appetite,
  • Diarrhea,
  • chronic fatigue,
  • Nausea and vomiting.

Affected children often suffer from impairments in physical development (too little weight gain and reduced length growth), while adults often have more unspecific symptoms such as general weakness, nervousness, tooth damage or skin problems.

Diseases of the pancreas

The pancreas makes a significant contribution to fat digestion by providing the necessary enzymes. If the function of the organ is impaired, too little digestive enzymes are produced and the fat cannot be digested to the required extent. This is the case, for example, with so-called exocrine pancreatic insufficiency.

Pancreatic insufficiency can be caused by acute, chronic and hereditary diseases of the organ. The insufficient production of enzymes on the one hand causes considerable digestion disorders and, on the other hand, may damage the intestinal mucosa. The so-called villi experience significant tissue shrinkage, 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.

Pancreatitis

Exocrine pancreatic insufficiency is relatively often caused by inflammation of the pancreas (pancreatitis). However, this inflammation of the organ not only leads to significant impairments of the pancreatic function in the long term, it may also cause a reduced release of digestive enzymes in the acute stage.

Typical accompanying symptoms here - in addition to the oily stool - are acute abdominal pain that can radiate up to the back in the belt area and a particularly striking feature of pancreatitis: hematoma (bleeding) in the flank area. Furthermore, those affected often suffer from non-specific symptoms such as constipation, fever, nausea and vomiting.

Pancreatic cancer

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 secretions are released directly into the duodenum via the ducts) and the endocrine (release of hormones into the blood) glandular cells. A large part of the pancreatic tumors affects the exocrine gland tissue and here in particular the so-called pancreatic head. In addition to the fatty stool, pancreatic cancer usually shows a 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 necessary for fat digestion, a blockage of the bile ducts by a gall stone can also lead to disturbances in the processing of food fats and a corresponding fat content in the stool. The formation of gallstones sometimes proceeds without further complaints, but can also cause symptoms such as severe pain in the upper abdomen, flatulence, nausea and vomiting, and persistent loss of appetite. Those affected may develop jaundice and have elevated liver function tests.

Inflammation of the bile ducts can also cause impairment of the bile discharge and thus cause an increased fat content in the bowel movements. Acute inflammation of the bile ducts is often caused by bacterial infections. In addition to the fatty stool, typical symptoms are unilateral pain in the right upper abdomen, fever (with chills in some cases) and jaundice. If there is a severe purulent inflammation of the bile duct, shock conditions, impairment of kidney function and disorders of the central nervous system also threaten.

Other causes of greasy bowel movements

After surgical removal of parts of the small intestine, fat digestion can be impaired in such a way that undigested food fats are excreted with the bowel movements. The location and length of the removed small intestine section have a significant impact 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 favors corresponding deficiency diseases. Removing larger sections of the small intestine usually results in significant weight loss.

The possible triggers of an increased fat content in the stool also include side effects of certain drugs. In particular, the medicinal treatment of obesity with Orlistat often results in fatty stool. The active ingredient inhibits the fat-degrading enzymes, which means that the dietary fats ingested can no longer be processed sufficiently. In addition to orlistat, greasy bowel movements can also be caused by special antibiotics, for example.

Diagnosis

In the diagnosis, in addition to a detailed survey of the symptoms, the diet, existing medical conditions etc., the appearance and fat content of the bowel movements should first be checked as part of a stool examination. If this is significantly increased, the search for the possible causes begins. Depending on the possible underlying diseases, numerous different diagnostic methods are used here.

For example, if gluten intolerance is suspected, a blood test for detectable antibodies is performed (so-called serological tests), which can usually be used to determine the disease relatively clearly. In addition, tissue samples from the small intestine or duodenum are to be taken to clearly confirm the diagnosis of gluten intolerance.

To check for a possible exocrine pancreatic insufficiency, the so-called secretin-pancreozymin test, in which the release of the pancreatic enzymes is measured with the help of a probe in the duodenum, is recommended for a diagnosis that is as reliable as possible. However, the method is relatively complex and rather unsuitable for quick diagnosis. Here, stool examinations can help, in which the excretion of fats (increased in pancreatic diseases) or pancreatic enzymes (reduced in pancreatic diseases) is analyzed via bowel movements. In order to achieve a meaningful result, the stool examinations must be repeated several times. If there are doubts about the result, there is no way around a secretin-pancreozymin test.

Even with inflammation of the pancreas, there is usually a significantly reduced concentration of the pancreatic enzymes in the bowel movement, so that a stool examination may provide the first indications of the inflammation of the organ. In addition, in the case of chronic pancreatitis, elevated levels of special pancreatic enzymes (amylase, lipase) can be detected in the blood. In addition, ultrasound and X-ray examinations, computed tomography (CT) and magnetic resonance imaging (MRI) can be used to determine pancreatic calcifications, which are considered to be typical signs of pancreatitis.

In the case of pancreatic cancer, the tumors can usually be diagnosed relatively clearly using ultrasound examinations, CT and MRI. If a clear diagnosis is not possible on the basis of these procedures, a so-called endoscopic retrograde cholangiopancreatography (ERCP) can provide information, in which contrast media can be injected directly into the bile ducts with the help of an endoscope for a special X-ray examination. This examination may also provide clues to blockage of the bile ducts by gallstones or inflammation of the bile ducts. In the case of pancreatic cancer, certain tumor markers often appear in the blood serum, which can be detected in the course of a corresponding blood test.

In addition to the diagnostic methods mentioned, a physical examination with palpation, tapping and eavesdropping on the chest and abdominal area is generally also possible in order to derive first indications of the causes of the fatty stool.

Fat stool treatment

Most diseases that can trigger an increased fat content in bowel movements urgently need medical care. This applies in particular to the diseases of the pancreas, bile ducts and intestine shown. However, a doctor should also be consulted if you are intolerant to gluten or medicinal products. Which treatment approaches enable a successful therapy of the fatty stool depends on the respective causes of the fatty stool.

Treatment for gluten intolerance

Treatment for gluten intolerance is primarily based on a lifelong gluten-free diet. By avoiding gluten, the intestinal mucosa 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, corn, buckwheat or soybeans.

In the case of processed foods and finished products, it must be ensured that no ingredients containing gluten are included. Due to the extensive damage to the mucous membrane, dairy sugar digestion is also impaired in many people with gluten intolerance, which is why the diet initially also temporarily provides a low-lactose diet in which milk and milk products are replaced by soy milk. With strict adherence to the diet, the fat stool should disappear after a relatively short time. If those affected continue to suffer from greasy bowel movements, gluten intolerance may not have been the sole cause of the symptoms.

Treatment of pancreatic diseases

If greasy, light-colored stool is caused by a pancreatic disease, medical care should be given immediately, as life-threatening consequences may result. 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 are prepared in the medicinal products in such a way that they can resist gastric acid and only work in the small intestine. In the case of an underactive pancreas, 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, an intravenous liquid is provided as an immediate medical measure to prevent the acute risk of a volume deficiency shock. Since those affected by pancreatitis usually suffer from considerable pain, pain therapy is also of particular importance, 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, as part of the therapy, changes in blood values ​​are compensated with the help of infusions. If bacterial infection is suspected to be the cause of pancreatitis, antibiotics may also be used. If gallstones are the cause of the complaints, they can be removed with the help of the ERCP. In the case of complications such as bleeding, infections or cysts, surgical intervention to remove the dead tissue or cysts often remains the last option. Since pancreatitis is often associated with excessive alcohol consumption, abstinence from alcohol is an essential part of therapy.

Treatment of pancreatic cancer usually involves surgical removal of the tumors. However, many ulcers cannot be removed in this way, so that the patients undergo chemotherapy. In addition, so-called mistletoe therapy is also used more often in conventional medicine, which on the one hand helps to alleviate the symptoms and on the other hand significantly improves the chances of recovery.

Additional surgical interventions may also be provided for symptom relief. For example, a 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 can only have a positive impact on the symptoms of those affected.

Gallstones and bile duct inflammation

As soon as gallstones cause fatty stool and other health problems, they should be removed 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. Also, the gallstones must not exceed a certain size (five millimeters) so that drug-based dissolution is possible.

In the case of acute or chronic inflammation of the gallbladder or biliary tract, drug lysis of the gallstones is generally excluded. The same applies to carcinoma of the gallbladder, inflammation of the liver, inflammation of the pancreas and pregnancies. Since chenodeoxycholic acid often leads to considerable side effects, ursodeoxycholic acid, which is almost free of side effects, is mostly used today.

All in all, the lysis of the gallstones offers several advantages over other treatment methods, since the functionality of the gallbladder can usually be maintained in the course of the therapy, there are no operational risks and the affected persons remain able to work even during the treatment. In addition to drug lysis of the gallstones, mechanical dissolution can also be performed using extracorporeal shock wave lithotrypsy, in which the stones are crushed with shock waves.

However, both the medicinal and the mechanical dissolution of the gallstones form new gallstones relatively often after 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. In most cases, this is done with the help of a minimally invasive procedure, the so-called laparoscopic surgery. Complications are extremely rare with such interventions and the gallbladder stones can definitely be removed.

To remove the gallstones from the bile ducts, the ERCP already explained can also be used. If the bile ducts are inflamed, endoscopic treatment (ERCP) can also be performed to restore the bile flow. In most cases, inflammation of the bile duct is treated with antibiotics. If these treatment methods have no effect, the liver can also be increasingly damaged and for those affected in the end stage of the disease, only a liver transplant may be the last option.

Treatment of fat indigestion

If fat digestive disorders after bowel surgery are the cause of the greasy bowel movements, those affected must also follow a special diet. Foods rich in carbohydrates and a proportion of medium-chain fatty acids in the triglycerides of 50 to 75 percent are recommended here. If possible, the diet should be changed before the actual bowel surgery, also to compensate for existing deficiency diseases. In case of doubt, those affected are provided with liquid food or tube food.

After the operation, the digestive tract begins to adjust to the shortened length of the intestine. In order to get 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 with a gastric tube is usually started immediately after the operation. The digestive tract's conversion processes can take up to a year to complete before the intestine has adjusted to the new conditions, both functionally and structurally.

Fat stool after an intestinal operation usually requires individually tailored nutritional therapy. If the patient already shows 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 time. To prevent deficiency diseases, regular checks of the electrolyte, calcium, magnesium, phosphate, folic acid and zinc values ​​are provided. The blood level of vitamin B12 should also be checked continuously and, if necessary, compensated by additional administration. Overall, adherence to a strict diet is not spared for most patients with the so-called short bowel syndrome after an intestinal operation, whereby the nutritional therapy must be adapted to the individual symptoms of those affected.

Fettstuhl - naturopathy and holistic medicine

Although there is no way around conventional treatment for most diseases that can be the reason for the greasy bowel movements, naturopathy offers numerous possibilities to support a successful therapy.

For example, in the case of diseases of the pancreas, various naturopathic treatments can be used that relieve symptoms and contribute to the general strengthening of the organ. So ear acupuncture, Bach flower therapies or foot reflex zone therapies should stimulate the self-healing powers of the pancreas. Homeopathy also offers various preparations to improve pancreatic function. The use 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 the digestive juices.

Basil, thyme, juniper, rosemary, oregano and marjoram are also said to have a digestive effect, which can help to avoid high fat levels. Various herbal teas also have a positive effect here. Herbal medicine is also familiar with numerous medicinal plants containing bitter substances, such as gentian, wormwood and rhubarb root, which are combined with other medicinal plants as tea or in the recipe according to Maria Treben (as so-called Swedish bitter). In this way, the medicinal plants are said to bring about an increased production of stomach acid, bile juice and pancreatic enzymes, which contributes to the improvement of digestion.

Nutritional therapy is generally given particular importance in the naturopathic treatment of the possible underlying disease of the fatty stool. In fact, the complaints can be avoided after a relatively short time if you follow a strict diet. It is not only the right choice of food that plays a key role in the success of the therapy, but also the type of intake or eating behavior. So-called "gnashing" - special chewing technique in which the food stays in the mouth for as long as possible - offers a good opportunity to significantly improve the pre-digestion of the food in the mouth and thus make the digestive tract easier. It is also advised not to drink during the meal, since the liquid mixes with the digestive juices that are formed, reducing their effectiveness. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • 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, page 500-504, 2016, hogrefe.com
  • Kaspar Truninger: Clarification of chronic diarrhea; in: Praxis, Volume 05, page 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.: Low Gastrointestinal Conditions: Malabsorption Syndrome; in: FP Essential, Volume 483, page 20-24, August 2019, PubMed
  • Samy A. Azer, Senthilkumar Sankararaman: Steatorrhea; in: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2019, PubMed


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