Malabsorption is a condition where the small intestine is unable to properly absorb nutrients and fluids from food. This can lead to a variety of gastrointestinal symptoms and changes in bowel movements. Here is an overview of what you may notice if you have malabsorption issues affecting your poop.
Diarrhea
One of the most common symptoms of malabsorption is diarrhea. This is because when nutrients cannot be absorbed properly, there is more fluid that stays in the intestines. This extra fluid causes watery, loose, or even urgent stools.
In malabsorption diarrhea, you may notice:
- Watery, loose stools
- Needing to go more frequently
- Urgent need to have a bowel movement
- Inability to control bowel function
If you have persistent diarrhea due to malabsorption, it can lead to dehydration and electrolyte imbalances over time. Seeking treatment for the underlying condition is important.
Steatorrhea
Another common symptom of malabsorption is steatorrhea. This refers to poop that is frothy, foul-smelling, floats, and appears greasy or shiny.
This occurs when there is improper digestion and absorption of fats. The undigested fats make the stool appear oily and frothy. It may have a distinctive foul, fishy odor as well.
Steatorrhea occurs because fats require proper digestion by bile salts and enzymes. When this process is impaired, the fats are not absorbed and remain in the intestines, leading to these distinctive changes in stool.
Pale or discolored
Malabsorption can also lead to stools that are an abnormal color. Stools may appear:
- Pale or clay-colored
- Grayish
- Greasy and shiny
- Black or tarry
Pale stool can indicate a lack of bile production. Bile gives stool its normal brown color. Without it, stool may look gray, pale, or clay-colored.
Black or tarry stool can indicate bleeding in the upper GI tract. Always seek medical care if you notice this stool color.
Floating stools
Increased gas and fat content from malabsorption can lead to stools that float. Normally, stool sinks. But poorly digested nutrients and extra gas bubbles can cause stools to float when you flush the toilet.
Floating stools may also smell particularly foul and look greasy or shiny due to higher fat content.
Foul smelling
Malabsorption often leads to stools that have an extremely foul, unusual odor. This is caused by:
- Increased bacteria from undigested food
- Extra gas production
- Undigested fats
Stools may smell sickly sweet, gassy, sulfur-like, or distinctly rotten and fishy. If your stools suddenly have a strange odor, it should be checked out.
Oily anal leakage
Some people with malabsorption have issues with oily anal discharge or leakage. This is due to an excess amount of fat in the stool. The oil may leak out and stain underwear.
Anal leakage can be embarrassing and difficult to manage. Using pads or wipes, medication, and diet changes can help reduce this symptom.
Other abnormalities
Some other potential changes that may occur with malabsorption stool include:
- Mucus or stringy material
- Undigested food
- Blood
- Change in stool size – smaller, larger, or narrow
Severe symptoms like blood or black stool require urgent medical care. Notify your doctor if you notice persistent changes in stool.
What causes these poop changes?
There are a few key factors that lead to abnormal poop with malabsorption:
- Fat malabsorption – Poor fat breakdown leads to fatty, foul smelling stool.
- Carbohydrate and protein malabsorption – Can cause acidic stool pH and more gas production.
- Transit time changes – Food moves rapidly through colon, leading to watery stool before digestion is complete.
- Medication effects – Some drugs like antibiotics alter gut flora, affecting digestion.
- Structural changes – Disease processes can damage the GI tract lining needed for nutrient absorption.
- Bacterial overgrowth – Excess bacteria ferment unabsorbed food, increasing gas production.
Working with your doctor to determine the underlying cause of malabsorption is key. This can help guide the proper treatment approach.
Common causes of malabsorption
Some common causes of malabsorption leading to abnormal stool include:
| Cause | Description | Symptoms |
|---|---|---|
| Celiac disease | Autoimmune reaction to gluten damages small intestine lining | Diarrhea, steatorrhea, weight loss |
| Crohn’s disease | Chronic inflammatory bowel disease causes ulcerations | Diarrhea, abdominal pain, blood in stool |
| Cystic fibrosis | Thick mucus obstructs pancreas and bile ducts | Foul-smelling, greasy stools |
| Pancreatic insufficiency | Pancreas unable to produce digestive enzymes | Frequent, oily stools, weight loss |
| Bacterial overgrowth | Excess bacteria in small intestine compete for nutrients | Diarrhea, bloating, gas |
| Radiation enteritis | Damage to small intestine from radiation therapy | Chronic diarrhea, bleeding, malabsorption |
| Short bowel syndrome | Surgical removal of small intestine | Oily stools, dehydration, malnutrition |
| Medications | Antibiotics, antacids, and other drugs can alter digestion | Varies on drug. Can include diarrhea. |
When to see a doctor
Make an appointment with your healthcare provider if you experience:
- Prolonged diarrhea lasting over 2 weeks
- Severe symptoms of dehydration from diarrhea or vomiting
- Inability to maintain weight due to chronic stool changes
- Bloody or black tarry stool
- Fever, abdominal pain, or other severe symptoms
Seeking timely treatment for malabsorption can help prevent complications from nutritional deficiencies and dehydration.
Tests and diagnosis
To diagnose the cause of malabsorption, the doctor may order:
- Medical history – Discussion of your symptoms and health history.
- Physical exam – Checking for signs of malnutrition, swelling, or abdominal tenderness.
- Blood tests – Checking levels of protein, vitamins, electrolytes, kidney and liver function.
- Stool tests – Testing for blood, undigested fat, or infectious organisms like bacteria, parasites, or viruses.
- Imaging – CT, MRI, ultrasound, or X-ray to look for structural abnormalities.
- Endoscopy procedures – Upper endoscopy, colonoscopy, or capsule endoscopy to view the GI tract lining.
- Biopsies – Taking tiny tissue samples to test for damage, inflammation, or gluten sensitivity.
Determining the underlying cause guides the proper treatment plan. Your doctor will work with you to manage symptoms and promote absorption.
Treatments
Treatment options for malabsorption depend on the cause but may include:
- Diet changes – Avoiding foods that trigger symptoms. A dietician can help develop an appropriate diet.
- Supplements – Vitamin B12, iron, calcium, magnesium, zinc, and other nutrient supplements.
- Medications – Antibiotics for bacterial overgrowth, anti-inflammatories like corticosteroids, anti-diarrheal medicines.
- Pancreatic enzyme therapy – Replacing digestive enzymes.
- Surgery – Treating structural GI issues. For short bowel syndrome, surgery may be done to optimize remaining small intestine.
- Nutrition therapy – Hospitalization for IV nutrition may be required in severe malnutrition.
Seeing a gastroenterologist who specializes in malabsorption can help develop the most effective treatment plan for your needs.
Outlook and complications
With treatment, some types of malabsorption can be well-managed, especially if the underlying cause can be corrected. However, malabsorption is a chronic condition for many people.
Potential complications include:
- Dehydration
- Electrolyte imbalances
- Vitamin and mineral deficiencies
- Malnutrition and weight loss
- Severe diarrhea
- Intestinal blockages
- Bacterial overgrowth
- Liver disease
Close monitoring and proactive treatment are important for malabsorption. Work closely with your healthcare team.
Coping and lifestyle adjustments
Making certain lifestyle adjustments can help you better cope with malabsorption:
- Avoid trigger foods – Certain poorly absorbed carbs and fats may worsen symptoms.
- Eat smaller meals – Large volumes are more difficult to digest.
- Substitute formula or shakes – For nutrition if eating normal volumes is difficult.
- Try probiotics – To aid digestion. Talk to your doctor first.
- Exercise regularly – To help manage weight and support digestion.
- Drink more fluids – Prevent dehydration from fluid losses.
- Consider mental health support – A therapist can help manage emotional aspects of chronic illness.
When to contact your doctor
Consult your physician or gastroenterologist if you experience:
- Blood in stool or black/tarry stool
- Prolonged vomiting or diarrhea
- Unexplained weight loss
- Worsening of symptoms
- Difficulty managing nutrition requirements
Ongoing care with a knowledgeable gastroenterologist can help optimize symptom management and quality of life for malabsorption issues.
The bottom line
Malabsorption can lead to changes in stool including diarrhea, foul smell, oiliness, gas, and discoloration. Work closely with your doctor to determine the cause and implement appropriate dietary, lifestyle, and medical treatments. Proper management can help restore nutrient absorption and allow you to live well with this condition.