Diarrhea After Gallbladder Removal

Why It Occurs and What Treatments Can Help

Diarrhea after gallbladder removal is a common experience. In fact, chronic diarrhea—defined as three or more watery stools per day that last for a month or longer—is something up to 25% of all people who have a cholecystectomy, or gallbladder removal surgery, will experience.

For most people, diarrhea following cholecystectomy will get better with time, but it can be a slow and frustrating process.

This article looks at the causes of chronic diarrhea after gallbladder removal surgery. It also explores how diet, lifestyle changes, and medications can help control symptoms and possible complications of chronic diarrhea.

Woman sitting on bed holding stomach, head bowed
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Why Gallbladder Removal Causes Diarrhea

There are several reasons why people have chronic diarrhea after gallbladder removal. The first has to do with the function of the gallbladder itself and what happens when the organ is removed.

The gallbladder is a small organ where bile is stored before it is released into the small intestine when needed. Bile is a yellowish-brown fluid produced by the liver that aids in the digestion of fatty acids known as lipids.

When the gallbladder is removed, bile is no longer stored; it is instead released into the small intestine in a steady flow. This interrupts the normal loop by which bile acid is meant to move from the liver to the small intestine and back to the liver.

Because of this, the intestines are overloaded with bile that cannot be properly reabsorbed, referred to as bile acid malabsorption (BAM). Excess bile, in turn, draws abnormally high levels of water and salts from the bloodstream into the intestine, causing bile acid diarrhea.

The interruption of the loop also "takes the brakes off" the speed by which digestion normally occurs. As a result, the time it takes for food to move through the gut and exit the body is accelerated, leading to watery and poorly formed stools.

Around six of every 10 people who undergo gallbladder removal will experience chronic bile acid diarrhea.

Possible Complications

For most people, diarrhea is an annoyance rather than a serious medical problem. For those who undergo cholecystectomy, the symptom can become persistent and lead to chronic dehydration.

Chronic dehydration is when your body uses more fluids than you take in on an ongoing basis. As a result, your body is forced to function with less water, putting strain on organs like the kidneys and circulatory system that work in a loop to keep the body functioning normally.

This can lead to complications like:

When to Seek Medical Help

Seek immediate medical care if watery diarrhea persists for more than two days without improvement and/or is accompanied by:

  • Little or no urination
  • Severe weakness
  • Dizziness or lightheadedness
  • Excessive thirst
  • Dry mouth with sunken eyes
  • Severe abdominal or rectal pain
  • Black or bloody stools

What to Eat to Improve Chronic Diarrhea

To help combat diarrhea, many healthcare providers recommend the BRATTY diet, which stands for bananas, rice, applesauce, tea, toast, and low-fat yogurt. The probiotic bacteria in yogurt may help to improve symptoms of diarrhea. Supplementing your diet with high-fiber foods may also bring relief.

Fiber is important because it adds bulk to your stool and may help firm it up. If you find fiber to be helpful in slowing your episodes of diarrhea, you may consider supplementing your diet with over-the-counter productions like Metamucil (psyllium).

Just be careful not to overdo it with the fiber, and drink plenty of water to avoid the opposite problem: constipation.

There are certain foods you should also avoid if you have acute or chronic bouts of diarrhea following cholecystectomy:

  • High-fat foods
  • Fried and greasy foods
  • Fatty sauces and gravies
  • Spicy foods, like curries an
  • Fast foods, like burgers and pizzas
  • Whole-fat dairy, including milk and cheese
  • Processed meats, like hot dogs, sausage, and bacon
  • Caffeinated foods, like coffee, black tea, colas, and chocolate
  • Cakes, cookies, and pastries
  • Alcoholic beverages

In addition to a low-fat, high-fiber diet, eat smaller snack-sized meals six times per day rather than three big meals. This can help you avoid overloading the gastrointestinal tract with foods that it may not be able to properly digest.

Mananging Pain of Chronic Diarrhea

While you are waiting for diarrhea after gallbladder surgery to improve, you may experience pain, discomfort, or burning in and around the anus. Diarrhea contains both bile and stomach acid, both of which are very irritating to the skin.

Consider the following tips for personal care to improve comfort:

  • Pat gently rather than wipe after a bowel movement. This will clean the anus without being abrasive. Baby wipes are a great way to gently clean without causing more irritation. You can always put them in the refrigerator for extra soothing.
  • Consider using cooling wipes such as medicated pads with witch hazel to cool the fire.
  • Soak in the tub if your rectal area is very sore from constant diarrhea. There are many products that are meant to soothe irritated skin as a bath additive.
  • Apply a thick protective ointment to the sore area. It will provide a barrier between your sensitive skin and the bile/gastric acids that are causing the irritation. You can also use ointments that are designed for diaper rash, as they tend to be thick and long-lasting.
  • Start a food diary. By writing down what you eat and when, you may find certain foods that help relieve diarrhea and others that make it worse.

Medications

One of the more commonly used prescription medications for diarrhea after gallbladder removal is Questran (cholestyramine). This medication is a bile acid sequestrant, a type of medication typically used for high cholesterol that works by binding bile acid in the gut.

For people with diarrhea after gallbladder removal, this medication can also dramatically reduce the severity and frequency of diarrhea. It is available in an artificially sweetened "light" version for people with diabetes. The medication comes in a packet and is taken as a drink after being added to water.

If cholestyramine plus diet and lifestyle modifications are not effective, there are additional prescription medications like Viberzi (eluxadoline) that can slow the motility (movement) of the bowel and ease diarrhea.

Milder cases of diarrhea may benefit from over-the-counter anti-diarrheal medications like Imodium (loperamide) or Pepto-Bismol (bismuth subsalicylate).

Summary

Chronic diarrhea is common after gallbladder removal surgery (cholecystectomy) due to the unobstructed flow of bile into the small intestine. The removal of the gallbladder eliminates the organ that is meant to store and regulate the secretion of a digestive fluid known as bile.

Diarrhea caused by cholecystectomy can be treated with a high-fiber, low-fat diet as well as fiber supplements and both prescription and over-the-counter medication. Over time, the diarrhea may start to settle, but it can take a long time.

A Word From Verywell

Diarrhea after gallbladder surgery is both common and troublesome. If you or a loved one is experiencing this complication after surgery and are unable to control it, ask your healthcare provider for a referral to a gastroenterologist, a medical specialist who deals with chronic diarrhea and other digestive tract disorders.

Frequently Asked Questions

  • How long does diarrhea last after gallbladder removal?

    After gallbladder removal, diarrhea can last anywhere from a few weeks or longer. Some people who undergo gallbladder removal surgery may experience chronic diarrhea, which is defined as having abnormal stool (watery or loose) that persists for over four weeks.

  • Is it common to find blood in stool after gallbladder surgery?

    No. Changes in stool frequency and consistency are normal after this surgery, but finding blood could be a sign that something is wrong. A healthcare provider should be contacted immediately.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  7. Zhao R, Wang Y, Huang Y, et al. Effects of fiber and probiotics on diarrhea associated with enteral nutrition in gastric cancer patients: A prospective randomized and controlled trialMedicine (Baltimore). 2017;96(43):e8418. doi:10.1097/MD.0000000000008418

  8. Altomare DF, Rotelli MT, Palasciano N. Diet after cholecystectomy. Curr Med Chem. 2019;26(19):3662-5. doi: 10.2174/0929867324666170518100053

  9. International Foundation for Gastrointestinal Disorders. Anal Discomfort and How to Deal With It.

  10. U.S. National Library of Medicine, DailyMed. Label: Questran-Cholestyramine Powder, for Suspension.

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Additional Reading
  • Digestive Diseases Information Clearinghouse. Diarrhea.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.