These are all symptoms of exocrine pancreatic insufficiency (EPI), a condition that occurs when your body can’t properly digest proteins, carbohydrates, and, in particular, fats, according to The National Pancreas Foundation (NPF). People who have cystic fibrosis or chronic pancreatitis are at risk for developing EPI as are those who’ve had surgery to remove all or part of the pancreas, says Stephen Kim, MD, a gastroenterologist and clinical professor in the division of digestive diseases at the David Geffen School of Medicine at UCLA. If you’re hesitant to talk to your doctor about what’s going on behind that firmly locked bathroom door, don’t be. Instead, use the tips below to kickstart the conversation.
Spotting the Symptoms of EPI
“The classic symptom of EPI is steatorrhea, or fatty stools,” says Tyler Stevens, MD, a gastroenterologist and the director of the Pancreas Clinic at the Cleveland Clinic. That’s a result of the body’s inability to digest and absorb fat in the small intestine; when fat is not properly absorbed, your stools may become greasy and smelly, he explains. Floating stools that are hard to flush are telltale signs of steatorrhea. You may also experience other digestive symptoms, including:
Weight loss from malabsorptionDiarrheaBloating and crampingFrequent flatulence
Going into detail about these symptoms may make you cringe, but it’s important to be open with your healthcare provider. “My advice would be to get over the embarrassment and be as descriptive as possible,” Dr. Stevens says. “If you don’t explain your symptoms, it may be hard for the physician to diagnose and treat EPI and other conditions.” Gastroenterologists are no strangers to bodily functions, so there’s no reason to be shy, Dr. Kim adds. “We talk about bowel movements and gas all the time with our patients.”
One Man’s Journey With EPI
Mark Swartz, 71, a retiree from Palm Springs, California, developed EPI more than a decade after he underwent surgery for a noncancerous bile duct tumor. The operation, called a Whipple procedure, took out a third of his pancreas, part of his small intestine, and his entire gallbladder. In the years after the surgery, Swartz developed type 2 diabetes and also noticed changes in his stools. But it wasn’t until later that he started having cramps after he ate, along with frequent bouts of putrid-smelling flatulence and diarrhea. “The smell was so foul. I can’t describe it other than the smell of a dead body,” says Swartz, one of Kim’s patients. Swartz knew these problems were due to some kind of digestive disorder, so he investigated his symptoms online. He put two and two together and suspected EPI. Most important, he freely shared all the details about his symptoms with Kim, who was able to make a quick diagnosis. Although Swartz understands why some people may be embarrassed to talk about their bowel movements, he urges you to “spill the beans” so you can be treated promptly and feel better. To ease the embarrassment, he suggests using clinical words rather than slang ones. “Instead of saying ‘poops’ and ‘farts,’” he says, “say ‘stools’ and ‘flatulence.’”
After an EPI Diagnosis
To treat EPI, your doctor will likely prescribe pancreatic enzyme replacement therapy (PERT). When taken with meals and snacks, these supplemental digestive enzymes help your body absorb the nutrients in food, according to the NPF. If you’re taking the right dose and following the medication’s directions, you’ll be able to eat a wide range of foods. You can also experience a much-needed boost in your nutrition and will start feeling better, Stevens says. (Sticking to a low-fat diet may lessen the amount of digestive enzymes you need, adds Kim.) Just be sure to call your doctor if your symptoms start getting worse during treatment, says Kim. Over time, your pancreas may not function as well as it once did, so your dose may need to be changed.
