Greasy stools (steatorrhoea)

Greasy stools, medically called steatorrhoea, occur when the gut fails to absorb dietary fat, so unabsorbed fat ends up in the stool. The stools are typically pale, bulky and oily-looking, may float, leave an oily film or be difficult to flush, and often smell particularly foul. Fat absorption needs two things working together: pancreatic enzymes (especially lipase) to break the fat down, and bile from the liver and gallbladder to emulsify it, all acting on a healthy small-bowel lining. A problem at any of these steps causes steatorrhoea. The commonest causes are pancreatic — chronic pancreatitis or other causes of exocrine pancreatic insufficiency, where too little enzyme is made — and small-bowel diseases that damage the absorptive surface, such as coeliac disease. Bile problems (blockage of bile flow) also cause it. Because fat carries the fat-soluble vitamins A, D, E and K, ongoing steatorrhoea can lead to deficiencies of these, and to weight loss. A very high-fat diet or certain fat-blocking medications can cause a milder, expected version. Persistent greasy stools are a meaningful sign that warrants looking for the cause.

• Exocrine pancreatic insufficiency — chronic pancreatitis, cystic fibrosis; too little enzyme to digest fat.
• Coeliac disease and other small-bowel diseases — a damaged absorptive lining.
• Bile flow problems — blockage of the bile duct or reduced bile.
• Small intestinal bacterial overgrowth.
• Fat-blocking medications or a very high-fat diet — a milder, expected cause.

Persistent greasy, pale, oily stools call for looking at the digestive causes of fat malabsorption. Fecal elastase checks pancreatic enzyme output (a low result points to the pancreas), and coeliac serology (anti-tTG with total IgA) screens for coeliac disease. Fat-soluble vitamin levels (A, D, E, K) and markers such as albumin help gauge the nutritional impact, and liver and bile-duct tests are checked if a bile cause is suspected. Depending on results, imaging or endoscopy with small-bowel biopsy may follow. Mediora.AI can surface a low pancreatic elastase, positive coeliac markers, or low fat-soluble vitamins from your results to point toward the cause; the assessment belongs with your doctor.