What to Do About IBS After Gallbladder Removal

Some people who have had their gallbladders removed—a procedure known as a cholecystectomy—find themselves dealing with ongoing digestive problems. Typically, these symptoms include abdominal pain or the urgent need to run to the bathroom after eating. Here you will find out why that might be happening and what you can do about it.

Life With and Without a Gallbladder

It is safe to live without a gallbladder, which is one of the reasons gallbladder removal is typically the recommended treatment for gallbladder problems. Your gallbladder's main job is to store bile (a substance needed for digesting fats) and to secrete bile into your small intestine in response to ingesting foods containing fat.

Without your gallbladder, your liver continues to produce bile, but instead of it being sent to the gallbladder for storage, the bile passes into your common bile duct and then makes its way into your small intestine.

Complications of Gallbladder Removal

Most of the time, the body adapts to the loss of the gallbladder. However, there are a few possible problems that people may experience following gallbladder removal.

Postcholecystectomy Diarrhea

Approximately 25% of people who have had their gallbladders removed will experience recurrent problems with diarrhea, a condition known as postcholecystectomy diarrhea.

This problem results from the fact that without the gallbladder, there is nothing to regulate the amount of bile that passes into the small intestine. The resulting higher amount of bile can create stools that are watery and more frequent. Luckily, for most of these individuals, this problem will resolve itself slowly over time.

Sphincter of Oddi Dysfunction

If you are experiencing ongoing upper abdominal pain following gallbladder removal, you may want to speak with your doctor about a possible problem with your sphincter of Oddi (SO).

The sphincter of Oddi is a valve found within the small intestine that regulates the flow of bile and pancreatic juices. A very small number of people may experience sphincter of Oddi dysfunction (SOD), a functional gastrointestinal disorder (FGD). In SOD, the sphincter does not relax as it should, preventing the bile and pancreatic juices from entering the small intestine.

SOD is characterized by pain in the central and upper right regions of the abdomen that lasts for at least 30 minutes and radiates to the back or shoulder.

This type of pain generally occurs a short time after eating. Some people report nausea and vomiting. The pain symptoms of SOD are thought to be the result of the excess accumulation of the juices in the ducts.

SOD is most often seen in postcholecystectomy patients or in those who have pancreatitis. It's hard to gauge SOD's actual prevalence after gallbladder removal as studies report prevalences ranging from just 3% up to 40%. SOD can be treated with medication or a procedure known as endoscopic retrograde cholangiopancreatography (ERCP).

IBS Following Gallbladder Removal

Although, anecdotally, numerous people with IBS report that their IBS began following removal of their gallbladder, there is not a lot of clinical research on the subject. However, researchers have begun looking into a condition called bile acid malabsorption (BAM) and its relationship to chronic diarrhea difficulties.

People who have had their gallbladders removed may be at risk for BAM, a condition in which there is dysfunction with the way that bile acids are processed within the body. Research on this topic is still light, so it's best to work with your doctor to diagnose and resolve this issue.

An accurate diagnosis is necessary so you can get the right treatment plan. The American College of Gastroenterology (ACG) warns that testing for BAM is limited in the United States, and testing is not completely validated. In some cases, ongoing diarrhea following gallbladder removal may be helped by a class of medications known as bile acid-binding agents (aka. "bile acid sequestrants"), including:

• Questran (cholestyramine)
• WelChol (colesevelam)
• Colestid (colestipol)

The ACG does not currently recommend use of these drugs for diarrhea-predominant irritable bowel syndrome (IBS-D), citing a lack of studies. Still, the experts at ACG realize that these medications may be helpful in some cases, advising their use should be left to the discretion of the patient's medical provider.

When to See Your Doctor

If you are experiencing ongoing problems with abdominal pain and/or diarrhea, you should work with your doctor to get an accurate diagnosis. The range of possibilities for your ongoing problems is fairly varied:

• Common bile duct stones
• Chronic pancreatitis
• Dyspepsia
• IBS
• Pancreatic cancer
• SOD

Managing Symptoms With Diet

Without your gallbladder participating in the process of digestion, you may need to change your eating habits. If your gallbladder was only removed very recently, you may want to eat a bland diet until your diarrhea symptoms start to ease.

The gallbladder's job is to help you digest fatty food, so having it removed can make these foods problematic for you. Once you're back on a "regular" diet after surgery, you may want to limit or avoid:

• Fried foods: French fries, onion rings, mozzarella sticks
• High-fat foods: Fatty meats, cheese, ice cream, butter, gravy, chicken skin, pizza, oils
• Foods that cause gas: Beans, broccoli, milk
• Spicy foods: Curry, hot sauce, hot peppers

Gradually re-introducing potentially problematic foods into your diet can help you learn what bothers you without creating too much discomfort.

Although there isn't necessarily hard science behind these recommendations, you might find the following tips to be helpful:

• Eat small meals frequently throughout your day
• Try a probiotic
• Try a digestive enzyme

Remember, although coping with symptoms is no fun, there are a few factors (such as your diet) that are in your 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 to make absorption easier, which may also help with some common IBS symptoms like diarrhea.

How do probiotics help with IBS symptoms after gallbladder removal?

Probiotics can help healthy gut bacteria maintain appropriate levels and aid in digestion. Some research also notes that probiotics may help lower cholesterol, which is helpful for people who no longer have gallbladders.