The gallbladder produces and stores the digestive fluid bile, but chronic gallstones or other health issues may require the removal of your gallbladder. One of the most common side effects of gallbladder removal is diarrhea. Learn more about diarrhea after gallbladder removal surgery and some potential remedies below.
Diarrhea After Gallbladder Removal Surgery
Diarrhea after gallbladder removal surgery is relatively common. Some studies suggest that as few as 1 in 100 individuals develop diarrhea after gallbladder removal surgery, while others suggest that frequency may go as high as 1 in 3 individuals.1 While the diarrhea should be short-term for most cases, some people may experience chronic diarrhea for several years.
Experts believe that it is caused by increased bile levels entering the large intestine. Without the gallbladder to regulate bile production and storage, the liver sends a steady stream of bile into the small intestine.
The small intestine has a limited ability to absorb the bile back into the system, forcing it to send some of the bile, in the form of bile acids, into the large intestine. The bile acts as a laxative, resulting in loose, watery stools. Along with diarrhea, bile acid malabsorption may result in bloating, abdominal pain, and incontinence.
Diarrhea caused by bile acid is often diagnosed as Irritable Bowel Syndrome-Diarrhea subtype (IBS-D) but is more accurately diagnosed as bile acid malabsorption.
However, one study found among multiple patients who have had gallbladder surgery is that the diarrhea is multifactorial. These patients still had diarrhea even though they were being treated for bile acid malabsorption.6
One possible reason why diarrhea happens is that without a large supply of bile acids available to process meals, the body is less able to process and absorb fatty meals. This leads to steatorrhea or fatty diarrhea.7
Medication for Diarrhea After Gallbladder Removal Surgery
Medication for diarrhea after gallbladder removal surgery may be effective in reducing symptoms. One of the most common treatments are bile acid resins which absorb excess bile acid. Talk to your doctor to determine the right medicine to help with diarrhea after gallbladder removal surgery.
Bile Acid Sequestrants
Bile acid sequestrants or binders are a type of resin that bind to bile acids and prevent them from interacting with the intestines.2 Common bile acid sequestrants include cholestyramine, colestipol, and colesevelam.3
While typically used for lowering LDL cholesterol, several studies suggest that bile acid seqeustrants may act as effective medicine to help with diarrhea after gallbladder removal surgery. In one study involving 26 patients experiencing postcholecystectomy diarrhea, cholestyramine in doses of 2 to 12 grams per day helped to normalize bowel movements in 23 of the patients. Suspending treatment led to a recurrence of diarrhea in 39 percent of the patients.4
In a smaller case study, 6 out of 8 patients with postcholecystectomy diarrhea showed elevated stool bile acids. Administering oral cholestyramine at 4 to 16 grams per day reduced bowel movement frequency in all 6 participants within 72 hours of initial treatment. Diarrhea recurred in all 6 patients following the cessation of cholestyramine.5
Side effects are generally limited. For some, bile acid binders may work too well and cause constipation. Bile acid sequestrants may also interfere with the absorption of other medications and nutrients, so talk to your doctor to determine if bile acid sequestrants are right for you.
Digestive Enzymes
Digestive enzymes are microscopic powerhouses that break down food and help with absorption of nutrients. As mentioned earlier, gallbladder removal surgery can result in impaired digestion of fats because bile is no longer released in large amounts during meals. Instead, bile is release constantly and slowly.
The lack of bile can cause indigestion and diarrhea because it impairs fat absorption, leading to a type of diarrhea called steatorrhea or fatty diarrhea. Digestive enzymes containing lipase can help your body break down and absorb fats. One study involving 178 children found that digestive enzyme supplementation for post-cholecystectomy syndromes reduced symptoms of dyspepsia, abdominal pain, and steatorrhea during the first week.7
While this study utilized prescription digestive enzymes, there are over-the-counter digestive enzymes that may be able to produce the same results such as DrFormulas Digestive Enzymes.
Diet and Lifestyle
In conjunction with medication and digestive enzymes, changes to your diet may help to reduce symptoms of diarrhea after gallbladder removal surgery.
- Consider a low-fat diet. High-fat, greasy, fried foods may be difficult for your gut to handle following a gallbladder removal. Instead, eat low-fat (containing 3 grams of fat or less per serving) or fat-free foods.8
- Gradually increase the fiber in your diet. Fiber helps to normalize bowel movements while feeding your gut bacteria. However, go slow on your fiber intake, as too much too soon may exacerbate your diarrhea, as well as cause bloating and abdominal cramps. Focus on soluble fiber, like barley and oats. 8
- Eat smaller and more balanced meals more frequently, in order to mix better with available bile. Maintain small servings of lean protein, whole grains, fruits, and veggies. 8
- Try to avoid foods that may irritate your gut, thereby worsening your diarrhea. This includes dairy products, caffeine, and foods high in added sugar. 8
While gallbladder surgery may have side effects, there are some remedies to help with diarrhea after gallbladder removal surgery. Combined with diet changes, this changes can help support digestion reduce diarrhea.
Sources:
- https://www.mayoclinic.org/tests-procedures/cholecystectomy/expert-answers/gallbladder-removal/faq-20058481
- https://www.medicinenet.com/diarrhea_gallbladder_removal/ask.htm
- https://www.medicinenet.com/bile_acid_sequestrants/article.htm#how_do_bile_acid_sequestrants_work
- https://www.ncbi.nlm.nih.gov/pubmed/1449156
- https://www.mdedge.com/familymedicine/article/64484/gastroenterology/postcholecystectomy-diarrhea-what-relieves-it
- https://link.springer.com/article/10.1007/BF01296685
- https://cyberleninka.ru/article/n/fermentoterapiya-kak-pervyy-etap-lecheniya-postholetsistektomicheskogo-sindroma-u-detey
- https://www.mayoclinic.org/tests-procedures/cholecystectomy/expert-answers/gallbladder-removal-diet/faq-20057813
About the Author:
Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.