From the Guidelines
Pale stools are primarily caused by a lack of bile in the stool or malabsorption conditions such as cystic fibrosis or pancreatic insufficiency, which can lead to fat malabsorption and steatorrhea. According to a study published in 2017 1, chronic pancreatitis is a condition that can cause pancreatic exocrine insufficiency (PEI), leading to malabsorption of fats and resulting in pale, bulky stools. This condition can be caused by various factors, including excess alcohol consumption, pancreatic obstruction, and cystic fibrosis. The study also notes that symptoms of PEI may include fatty diarrhea, bloating, abdominal cramping, and abdominal pain.
Some key points to consider when evaluating pale stools include:
- Malabsorption conditions such as celiac disease or cystic fibrosis can cause pale, fatty stools (steatorrhea) 1
- Pancreatic problems, such as chronic pancreatitis, can interfere with proper digestion and lead to malabsorption 1
- Certain medications, particularly some antibiotics, antacids containing aluminum hydroxide, and anti-diarrheal medicines can also lighten stool color
- Dietary factors, such as a diet high in white foods and low in colored vegetables, can result in lighter stools
It is essential to seek medical attention if you experience persistent pale stools, especially when accompanied by other symptoms such as dark urine, jaundice, abdominal pain, or significant weight loss, as these could indicate serious underlying conditions requiring treatment. The gold standard treatment for PEI is the administration of exogenous enzymes (pancreatic enzyme replacement therapy, (PERT)), which can help reduce fat malabsorption and achieve normal nutritional status 1.
From the Research
Causes of Pale Stools
- Pale stools can be caused by a lack of bile salts in the stool, which can be a result of liver disease or bile duct obstruction 2, 3, 4, 5, 6
- Liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and chronic hepatitis can cause pale stools due to the liver's inability to produce enough bile salts 2, 4, 6
- Bile duct obstruction can also cause pale stools by preventing bile salts from reaching the intestine 3, 5
- Certain medications, such as ursodeoxycholic acid, can affect bile acid metabolism and potentially cause pale stools 2, 3, 4, 5, 6
- Cystic fibrosis-related liver disease can also cause pale stools due to the abnormal bile acid metabolism and liver dysfunction 3, 5
Liver Disease and Bile Acid Metabolism
- Ursodeoxycholic acid has been shown to improve liver function and bile acid metabolism in patients with chronic liver disease 2, 3, 4, 5, 6
- The enrichment of bile with ursodeoxycholic acid can improve biochemical markers of liver function in patients with chronic active hepatitis 4
- Long-term treatment with ursodeoxycholic acid can arrest the progression of liver disease and improve liver function in patients with cystic fibrosis-related liver disease 5
- The long-term evolution of liver bio-chemistries during prolonged treatment with ursodeoxycholic acid in biochemically non-advanced primary biliary cirrhosis has been shown to be maintained up to 15 years 6