Passing fatty stools

Many questions relating to this unusual problem have led to the discussion of this topic this week. Fatty stools refer to human excrement that is perceived as fatty and foul-smelling; stool that floats in the meniscus of water in the water closet. Many such stools are usually very smelly, and they may also be pale in colour or yellowish with a tendency to resist flushing when you attempt to flush them down a toilet after relieving yourself.

The stools may also be somewhat foamy as well, and as was described in Gulliver’s Travels by Jonathan Swift, they used to have a tendency to be associated with the high and mighty in society. It was because of this satirical tendency of that novel that the publication was banned in England for many years due to the perception that it reflected a certain jibe at the ruling class.

This condition is technically described as steatorrhoea. It can be passed after eating a meal rich in fat, such as a combination of dodo (fried plantain) and fried eggs. The use of butter, margarine, or cheese, either as a food additive or in cooking, can produce similarly fatty stools. Sometimes, it is a harbinger of serious illness such as liver disease.

Stool is usually made up of various undigested nutrients contained in whatever it is we eat. These include salts, protein, and fibre. Besides, it also would contain mucous, dead cells, particularly from the intestinal tract, and any other kind of waste the body does not need and wants to get rid of.

Because of the composition of such stools, steatorrhoea is not often seen as a health problem unless the passage of those kinds of stools has become rather persistent. However, when a particular individual or family feeds consistently on food compounds that are either difficult to digest or are, in fact, indigestible, fatty stools will be the result. Some of these food substances are oily fish, fatty foods such as the local examples already named above, vegetables like spinach, whole wheat products and certain edible oils like mineral oil and castor oil.

On a whole level of notoriety is the eating of certain nuts, often with the skin or shell intact. Very frequently, eating such nuts can cause profound constipation, but in many other cases, fatty stools are the result of their consumption. In some parts of the world where children are taught early to eat sunflower seeds, many of them would eat these seeds whole with severe consequences.

Over time, many people will inevitably find out that certain types of food they consume are most likely to be responsible for the nature of the stools they pass. If there is such an observed linkage, it is in the person’s best interest to make a notification of it and, if possible, to do so in writing, in case a doctor has to be consulted at some point.

Other behavioural attitudes that are most likely to result in the passing of such stools include chronic and heavy alcohol consumption. This, in addition to the dietary peculiarities mentioned earlier, is responsible for the majority of the cases of passing fatty stools that should be of no medical consequence. However, certain health challenges can make this situation worrisome. Some of these conditions are not curable, while others can be treated properly, which should help such patients to heal.

Disease conditions like cancer of the pancreas, amyloidosis, celiac disease, and cystic fibrosis, unfortunately, have no cure. On the other hand, they are mercifully rare conditions. The same is true of an infectious condition like HIV/AIDS.  Treatable conditions like primary biliary cholangitis, which is an infection involving the branches of the various parts of the gall bladder and its drainage system, and infestations like giardiasis can also cause this kind of stool to be passed.

Furthermore, conditions which cause inflammation in the pancreas, such as viral infections, trauma, especially from road traffic injuries and significant alcohol drinking, can generally be treated with adequate attention and the deployment of relevant medications. Therefore, acute or chronic forms of pancreatitis fall into this category. The same is true of intestinal infections, such as the notorious bacteria called Clostridium difficile.

Ultimately, this condition can also be treated using acceptable antibiotic combinations. In some cases, though, steatorrhoea may also be a consequence of the use of certain types of medications, and if this kind of consequence is observed, the affected patient would do well to inform the healthcare expert who prescribed the offending medication.

On the whole, the symptoms of this unusual condition are typically straightforward. The stools are bulky and contain clumps of fat or noticeable oil separation from the rest of the stool. Such stools appear to be covered in a thick, greasy film that floats and refuses to flush down a toilet. It may also contain a lot of mucus and may appear pale, yellowish or orange. Green-looking stools have even been described in some individuals.

People who pass stools like this often complain about abdominal cramps, passing excessive amounts of flatus, and constantly belching. Such people also experience bloating and a tendency to lose weight. Over a long period of time, steatorrhoea could result in dehydration and malnutrition even in adults. In such a scenario, further complications could develop, especially if the patients have underlying medical conditions such as chronic pancreatitis or celiac disease.

Such long-term suffering can lead to anaemia as well as deficiencies in certain critical nutrients like zinc and all the fat-soluble vitamins, which help to worsen the anaemia. These vitamins are known as Vitamins A, D, E, and K, as well as Vitamin B12. When children suffer from this condition, they suffer from a poor growth rate.

The skin will get bruised with ease in any sufferer, leading to frequent bleeding following even trivial injuries, and their bone health will be poor, with a tendency to fracture with relative ease because of poor calcium absorption. Some of these patients would also suffer from involuntary muscle contractions, seizures, and a tendency to walk like a duck in a pattern called ataxia.

The diagnosis of this condition will typically start with a scheduled visit to a hospital where doctors will try to obtain a clear history of the condition and what might have led to it. Typically, a general baseline full blood count is necessary to determine what effects the condition has had on the person’s blood picture. The next thing to do is to assess the amount of fat in the stool, called the faecal fat test.

While some doctors may use the 24-hour faecal fat test, it is more usual to do this evaluation after 72 hours. Other symptoms manifested by the patient will determine what other investigations should be conducted, especially with relation to possible intestinal infestations and the presence of celiac disease and Crohn’s disease, where specialised X-rays will be required, as well as endoscopic techniques with accompanying biopsy.

These investigative modalities will often help to clinch the diagnosis. Typically, therefore, the treatment offered to any patient will depend on the cause. As emphasised earlier, some of these conditions unfortunately have no cure, but their ramifications can be managed with the proper amount of information and a cooperative patient.

Questions and answers

If only dead people could see what medical students do to their bodies during anatomy practicals, they might wake up and beat them up. I cannot be a medical doctor.    0806********

Well, to be honest, healthcare work is not for the fainthearted, especially as it relates to the part of it which is invasive and heals often by the works of the hands. At the beginning of the study of modern medicine, the early pioneers had to resort to grave robbery, where they exhumed dead bodies for the responsible study of the human body and for the overall benefit of mankind. Many of those earlier trailblazers were labelled as criminals, and many were prosecuted and punished severely. Today, that aspect of the learning process is very formal, with officially sanctioned means of acquiring dead bodies legitimately for the anatomy dissection rooms. Even in my own class back then, there were those who could not bear that kind of trauma and were forced to leave the programme altogether to pursue other courses. Thank you very much for your contribution.

Good evening, doctor. What could be responsible for my nine-month-old baby having coughed off and on over the past three weeks? He doesn’t have a fever, and he plays and eats well, but this cough is very concerning, and it is so terrible at night to the extent that he finds it difficult to sleep. That sleeplessness is affecting me too, and it is affecting the quality of my work. What should we do, please?              

AWell, this might happen during this time of the year when the season is on the verge of changing from the dry season to the rainy season. Although this transition varies significantly in different parts of the country, it is generally true. Therefore, most times, this kind of cough would be due to a virus. In that regard, it is useful to give your baby supportive care with Vitamin C syrup and Paracetamol syrup to ease chest pain. More specifically, though, he should be taken to see a doctor and be offered a proper examination. After that has been done, the pathway to effective treatment for this particular kind of cough will be sufficiently clear.

Good day, doctor. I recently suffered from what appeared to be an allergy, and afterwards, I discovered some things around my mouth that seemed like small pimples. There were quite a number in the upper part of the mouth that I believe is called the palate, but I do not know if it is the soft palate or the hard palate. I will send you some of the pictures I took from the reflection in my bathroom mirror when I opened my mouth to see what was wrong. I have just been using mouthwash, and my attempts to get my GP (General Practitioner) to refer me to an ENT surgeon have met a brick wall. A few days after I took these pictures, I was lying down, and something oily entered my mouth; I think one of the swellings ruptured. It was tasteless. I have a picture of that as well and will send it to you, too. Do you know what this could be? How should I get treated, please?        +447*******

I see that your number is foreign. These images are indicative of some kind of inflammation and may be the consequence of a ruptured retention cyst. Usually, these are benign conditions and may not even require any treatment. Some of these lesions will resolve on their own. They may also be caused by the drinking or eating of hot drinks or hot food, way above what could be classified as normal. However, it is important for you to keep your mouth clean by using an antiseptic mouthwash and anti-inflammatory medications like Paracetamol, Ibuprofen, or Tylenol. In the end, you will probably not need to see an ENT surgeon if these swellings, called bullae, resolve with the above-recommended mouth care strategy.

Good morning, Sunday doctor. There is something bothering me so much about my son, who is now about 2 years and 5 months. He plays a lot, does not eat, does not seem interested in any food, and I think he is losing weight. He used to be chubby and weighed almost 4 kg at birth. Now, his weight is between 12 and 13 kg. I have tried various types of multivitamin supplements and appetite stimulants, but nothing has changed. I don’t know what is happening to him. Should I deworm him?       0705*******

Issues of childhood weight are complex and largely determined by genes. If his parents are of average size, meaning you and his father, or slim in build, your children are hardly likely to look robust in the way that you might appreciate. And so, it is not enough to administer a worm expeller to him because there is no information that he has failed to gain weight or is losing the same or appears to be weak and easily tired. You said he was always playing; that is a sure sign of good health. With a weight of between 12 and 13 kg at the age of 2 and a half years, that qualifies as an average weight. There is probably nothing wrong with your son, and it is likely that you are the one who is obsessed with him getting to be on the big side.

Good day, doctor. Please, I have been recently struggling to maintain my energy levels as I find myself getting tired easily. So on the advice of a doctor, I went to a lab to do some tests he recommended, and when I showed him the results, he told me that I have low blood count, but that all I needed was an iron supplement, as in a blood tonic. I have been using that now for more than one month, and just today, I went to do another test at my dad’s HMO hospital because there are times when it appears as if I want to fall. They told me that my blood was still low and that they would admit me for a blood transfusion. I am confused and scared, doctor, and I don’t know what to do. Please, I need your advice, and I will share the results with you below.  Thank you, sir.        091******

The doctor who asked you to run these tests served you well. You have normal kidney function based on the values in your result panel. You are positive for H.pylori. Your Hb of 10.6 g per cent is fair and acceptable for a Nigerian female teenager because I can see from your results that you are a 17-year-old girl. That roughly translates to a PCV (packed cell volume) of 32 per cent. There is no justification for the proposed blood transfusion, and you have a right to refuse it. Besides, if you experience heavy menstruation during your periods, your haemoglobin concentration can also look like this. First, you must take therapy for the H.pylori infestation that you have. Then, the diminished iron component of your red blood cells can be treated with good iron supplements.

Hello, doctor. Please pray hard because the worst has happened. A medical doctor was arrested recently for drug trafficking. That is very bad news. I am in shock. What do you say about it? Thanks.                             081*******

Thank you very much for your comments, but this does not call for any specific prayers. It is not the first time it has happened either in Nigeria or elsewhere in the world. Remember that this is still an allegation. The facts of the case must be established, and a conviction obtained, before anyone can make comments about this. In the end, it is important to note that there are good elements and bad ones in every walk of life.

Doctor, I want to thank you very much and appreciate you also for the immense work you are doing for the people. God will bless you with more strength and knowledge. Amen. The only problem with that is that, recently, we do not even get to read your column sometimes for several weeks at a stretch. But my question today is that my skin just became covered this morning with rashes as I woke up. They are very itchy. There are many of them on my legs, as you will be able to see in the pictures I am sending. I have Loratadine at home; please, can I take it?                                                                    090*******

Thank you very much for your prayers and kind words. We appreciate you. If you have Loratadine at home, it probably means that you know how to use it, so you can take it. But these rashes look like an elaborate response to an unfriendly object that came in contact with you while you slept. There may be certain bugs in your bedding, so it is not enough to use Loratadine, although its immediate use will probably reduce or stop the itching. You will need to know what has caused this skin reaction so that it can be properly treated.