What to do about irritable bowel syndrome after gallbladder removal

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Some people who have had their gallbladder removed , a procedure known as a cholecystectomy, have persistent digestive problems. These symptoms usually include abdominal pain or an urgent need to go to the bathroom after eating. Here you will find out why this could be happening and what you can do about it.

Get Medical Information / Cindy Chang

Life with and without gallbladder

It is safe to live without a gallbladder, which is one of the reasons gallbladder removal is generally recommended to treat gallbladder problems . The main function of the gallbladder is to store bile (a substance necessary to digest fat) and to release bile in the small intestine in response to a meal that contains fat.

Without the gallbladder, the liver continues to produce bile, but instead of going to the gallbladder for storage, the bile passes into the common bile duct and then into the small intestine.

Complications of gallbladder removal

In most cases, the body adjusts to the loss of the gallbladder. However, there are several potential problems that can arise after the gallbladder is removed.

Postcholecystectomy diarrhea

About 25% of people who have their gallbladder removed will have intermittent problems with diarrhea , a condition known as post-cholecystectomy diarrhea.

This problem arises because without the gallbladder, there is nothing to regulate the amount of bile that enters the small intestine. As a result, more bile can lead to more frequent and liquid bowel movements. Fortunately, for most of these people, this problem will resolve itself over time.

Sphincter of Oddi dysfunction

If you experience persistent upper abdominal pain after gallbladder removal, you can talk to your doctor about a possible sphincter of Oddi (SO) problem.

The sphincter of Oddi is a valve located in the small intestine that regulates the flow of bile and pancreatic juice. A very small number of people may experience sphincter of Oddi dysfunction (SOD), a functional gastrointestinal disorder (FGD). With SOD, the sphincter does not relax properly, preventing bile and pancreatic juice from entering the small intestine.

OED is characterized by pain in the central and upper right abdomen that lasts at least 30 minutes and extends to the back or shoulder.

This type of pain usually appears shortly after eating. Some people complain of nausea and vomiting. The painful symptoms of SOD are thought to be the result of excessive accumulation of juice in the ducts.

SOD is seen more frequently in patients undergoing cholecystectomy or in patients with pancreatitis. It is difficult to estimate the true prevalence of SOD after gallbladder removal, as studies report that the prevalence ranges from 3% to 40%. SOD can be treated with medications or procedures known as endoscopic retrograde cholangiopancreatography (ERCP).

IBS after gallbladder removal

Although, interestingly, many people with IBS report that their IBS started after the gallbladder was removed, there is not much clinical research on it. However, researchers have begun to study a condition called bile acid malabsorption (BAM) and its relationship to chronic diarrhea.

People who have had their gallbladder removed may be at risk for developing BAM, a condition in which the way the body processes bile acids is altered. Research on this topic is still scarce, so it is best to consult a doctor to diagnose and correct this problem.

An accurate diagnosis is essential to formulate the correct treatment plan. The American College of Gastroenterology (ACG) cautions that BAM tests are limited in the United States and the tests are not fully validated. In some cases, persistent diarrhea after gallbladder removal can be relieved with a class of medications known as bile acid binding agents (also known as "bile acid sequestrants"), including:

The ACG currently advises against the use of these drugs for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), citing a lack of research. However, ACG experts understand that these medications may be helpful in some cases, so recommendations for their use should be left to the discretion of the physician.

When to contact your healthcare provider

If you have persistent problems with abdominal pain and / or diarrhea, you should consult with your healthcare professional for an accurate diagnosis. The range of possibilities to solve your current problems is quite diverse:

  • Common bile duct stones
  • Chronic pancreatitis
  • Dyspepsia
  • IBS
  • pancreatic cancer
  • GRASS

If you have a fever, chills, or signs of dehydration, see your doctor right away.

Managing symptoms through diet

If your gallbladder is not involved in digestion, you may need to change your eating habits. If you recently had your gallbladder removed, you can follow a bland diet until your diarrhea symptoms start to go away.

The gallbladder's job is to help you digest fatty foods, so eliminating them can make those foods problematic for you. By returning to your "normal" diet after surgery, you can limit or avoid:

  • Fried foods : French fries, onion rings, mozzarella sticks.
  • Fatty foods : fatty meats, cheese, ice cream, butter, sauce, chicken skin, pizza, oils.
  • Foods that cause gas : beans, broccoli, milk.
  • Spicy foods : curry, hot sauce, hot peppers.

Incorporating potentially problematic foods back into your diet can help you figure out what's bothering you without causing you too much discomfort.

While these guidelines don't necessarily have rigorous science behind them, you may find the following tips helpful:

Remember that while controlling your symptoms is not fun, there are several factors (such as your diet) that you can control.

Frequently asked questions

How do digestive enzymes help with IBS symptoms after gallbladder removal?

Digestive enzymes are supplements that help break down the food you eat for easier digestion, which can also help with some of the common symptoms of IBS, such as diarrhea.

How do probiotics help with IBS symptoms after gallbladder removal?

Probiotics can help maintain healthy gut bacteria and aid in digestion. Some studies also point out that probiotics can help lower cholesterol levels, which is beneficial for people who no longer have a gallbladder.

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