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 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.

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 is sent into your "common bile duct" and then makes its way into your small intestine.

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.

1. Postcholecystectomy Diarrhea

Approximately 20 percent 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 and the 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.

2. 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.

The "sphincter of Oddi" (SO) 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.

The Rome III criteria for SOD describes its symptoms as "episodes of moderate to severe steady pain" in the central and upper right regions of the abdomen that lasts for at least 30 minutes. 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. Although up to 20 percent of postcholecystectomy patients will report ongoing upper abdominal pain, only a small percentage will actually have SOD. SOD can be treated with medication or a procedure known as endoscopic retrograde cholangiopancreatography (ERCP).

Although anecdotally I have heard numerous stories from IBS patients who report that their IBS showed up 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 a dysfunction as to how 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.

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

An accurate diagnosis can lead to the optimal treatment plan. In some cases, ongoing diarrhea following gallbladder removal is helped by a class of medications known as "bile acid binding agents," including:

• Cholestyramine (Questran)
• Colesevelam (WelChol)
• Colestipol (Colestid)

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. For ongoing problems, there are certain foods that you can eat and others that you should avoid when you don't have a gallbladder.

Although there is 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.