Steatorrhea: What Your Floating Stools Mean

What those bulky, oily stools are telling you

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Bulky, oily, foul-smelling stool that tends to float on top of the water in the toilet –– a condition known as steatorrhea –– is a sign of malabsorption. Many people with untreated cystic fibrosis have steatorrhea, which is often the symptom that ultimately leads to their diagnosis.

Steatorrhea can also be caused by gastrointestinal infections, bacterial overgrowth, certain medications, and digestive conditions such as Crohn's disease and celiac disease.


What Causes Steatorrhea?

Steatorrhea occurs when the body cannot absorb dietary fats. Normally, when a person eats fatty food, the fat is broken down by lipase, a digestive enzyme that is produced and secreted by the pancreas. The digested fat is absorbed by the body, and any unused byproducts of fat metabolism are expelled within the stool.

For most people with cystic fibrosis, fat absorption does not work correctly because cystic fibrosis interferes with the pancreas’ ability to secrete digestive enzymes, which leads to a condition known as pancreatic insufficiency. When a person with pancreatic insufficiency eats fatty food, the fat passes through the digestive system without getting broken down or absorbed by the body. It mixes with the stool as it travels through the intestines, and then gets expelled in its undigested form. This is what causes the characteristic bulky, oily, foul-smelling stools.

Other Causes of Steatorrhea

Like with pancreatic insufficiency, there are other conditions that can cause decreases in lipase and bile, resulting in floating stool. These conditions include: 

  • Chronic pancreatitis: Inflammation of the pancreas commonly associated with alcoholism, diabetes, and gallstones. 
  • Pancreatic cancer: A deadly form of cancer affecting the pancreas. 
  • Sclerosing cholangitis: Inflammation and scarring of the bile ducts, sometimes seen in patients with ulcerative colitis. 
  • Choledocholithiasis: Caused by gallstones in the common bile duct. 

How Steatorrhea is Treated

Once the problem is diagnosed, it is easy to treat with pancreatic enzyme replacement supplements. The supplements, which contain pancreatic enzymes derived from pigs, are taken by mouth anytime foods are eaten. The enzyme supplements are designed to dissolve in the small intestine, where they digest fats and other nutrients so the body can absorb them.

With pancreatic enzyme replacement, the problem of steatorrhea is immediately corrected because the body breaks down and absorbs fats just as it does in a person without pancreatic insufficiency. If steatorrhea comes back after treatment is started, contact your physician. This may be a sign that the enzymes are not working as they should. It could mean the enzymes are expired or have been stored improperly or it could mean that another brand of enzymes might work better.

For most people steatorrhea clears up on it's own. If your steatorrhea may be caused by another condition, speak to your doctor about your concerns. Dietary changes can help reduce fat in stools. If problematic stools are being caused by a different digestive disorder, treating the disorder will help eliminate excess fat from stools. 

Learn More:

How To Deal With Floating Stool

How to Tell the Difference Between Healthy and Unhealthy Stool

What Causes Mucus in Stool? 


Lisowska, A.,Kaminska, B., Grzymislawski, M., et al. "Unresponsive or non-compliant steatorrhea in cystic fibrosis?" Journal of Cystic Fibrosis 2006 5:253–255 19 October 2008.

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