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.
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 excreted in 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 excreted in its undigested form. This is what causes the characteristic bulky, oily, foul-smelling stools.
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, because this is 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.
Source:
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.
