Soft, foul-smelling stools that float, stick to the side of the bowl or are difficult to flush away may indicate increased fat in the stools, called steatorrhea. Stools are sometimes also pale.
Although these stools can result from eating a very fatty meal, if stools take on this appearance regularly, there may be an underlying problem in the GI tract, most commonly the pancreas, gallbladder, or liver.
Lipase, a digestive enzyme produced by the pancreas, and bile salts from the liver are needed to break down and absorb fat. Any condition that results in decreased lipase or bile salts can cause steatorrhea such as:
- Pancreatic insufficiency
- Chronic pancreatitis - may be due to alcoholism or gallstones. Symptoms may include bouts of abdominal or back pain, and later, abdominal bloating, changes in stools, weight loss, diabetes.
- Pancreatic cancer - the fifth leading cancer in the United States. Symptoms may include abdominal pain, weight loss, loss of appetite, metallic taste in the mouth, diarrhea.
- Sclerosing cholangitis - symptoms may include fatigue, itchy skin, right sided pain, fever/chills, jaundice, dark urine, pale stools. Often associated with ulcerative colitis.
- Choledocholithiasis (obstruction of the bile duct by gallstones)
- Bacterial overgrowth - unwanted bacteria in the small intestine deconjugate bile acids interfering with fat absorption. Causes include hypochlorhydria, chronic stress, diabetes, immune deficiency, inadequate fiber, and use of oral contraceptives and other medications.
Steatorrhea can also be caused by infections, medications, or conditions that disrupt the absorptive lining of the intestines, such as Crohn's disease and celiac disease.
Fat-soluble vitamin deficiencies may develop over time. The fat soluble vitamins are vitamin A, vitamin D, vitamin E, and vitamin K. Signs may include: night blindness, acne, and lowered immune function (vitamin A deficiency) and excessive bruising or bleeding (vitamin K deficiency).
Besides fat, floating stool can also be caused by excess gas (e.g. after eating bean burritos). This type of stool is common and is accompanied by flatulence.
Address any change or abnormality in bowel movement with your physician immediately, as it can be a sign of a serious disorder.