Oily Stools, Diarrrhea, and Blood in Stool

[fachad]

I'm a 36yr old male, no family history of serious GI problems.  I'm having a few recurring symptoms that I am concerned about

Last year I tried taking fish oil and/or flax seed oil for the Essential Fatty Acid (EFA) benefits.  These gave me severe diarrhea, with floating oil, even at just 1 gram per day.  (Typically, people are taking 6 or 12 grams EFA per day.)

Odd thing is I can eat a Big Mac and fries, about 70 grams of "bad" fat, with no problem - no diarrhea or oil in stool.  But 1 gram of "good" fat, and I have cramping, diarrhea and oily stools.  I can actually see an iridescent sheen on the water and an oil slick in the toilet bowl.

I have also noticed an increasing frequency of blood in my stools.  It is bright red; sometimes just on the TP; other times it looks like a 1/4 cup in the toilet bowl.  

I had someone tell me a few years back that bright red blood is no problem because it's hemorrhoids, but it has become more frequent, and also I have alternating bouts of diarrhea and severe constipation.

I have let this go awhile, because I considered the intolerance for good EFA oil to be an oddity of my personal physiology, and the bright red blood to be merely hemorrhoids.  Now I am getting concerned.

Other than follow up with my physician, do you have any suggestions as to what this could be?

What could cause my intolerance for good fat, while letting me eat bad fat with (short term) impunity?

Are these symptoms related, or just seperate issues?

Thanks.

[Kevin Pho, MD]

The most common cause of bright red blood in the stool in your age group would be hemorrhoids.  However, there is always the possibility of cancer, polyps or inflammatory bowel disease.  

For that reason, I would consider some sort of endoscopy - either colonoscopy or flexible sigmoidoscopy to be sure.  No amount of blood in the stool is normal.  

Regarding the oily stools, you may want to inquire about fat malabsorption - this can be evaluated with a quantitive fecal fat test which can be discussed with your physician.  I would also test for chronic pancreatitis which can lead to malabsorption and fatty stools.

Biliary tract obstruction, cholestatic liver disease, and bacterial overgrowth can also lead to maldigestion problems. Small bowel mucosal disease or surgical resection of the small bowel, gluten-sensitive enteropathy (celiac sprue) are also common causes of malabsorption in the United States. Whipple's disease, tropical sprue and Zollinger-Ellison syndrome are less common conditions that can lead to malabsorption.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[debi1959]

A related discussion, Stools that look like dark old car oil, no smell, just burns really bad. was started.