Why does diarrhea develop after gallbladder removal?
Diarrhea can develop in up to 36% of people who have had their gallbladders removed [1,3,4].
The bile, which is formed in the liver, is normally stored and concentrated in the gallbladder. After meals, the bile is squeezed from the gallbladder into the small intestine where it helps to digest fat. After gallbladder removal, the bile cannot be stored in the gallbladder, so it constantly flows into the intestine, even when there is no food in it, so it can irritate it and trigger urgent watery diarrhea .
What does green or yellow diarrhea mean?
When the bile travels through the intestine, the normal intestinal bacteria gradually change its color from green to bright yellow and finally to the usual brown color in the stool. After gallbladder removal, the bile constantly flows into the intestine and stimulates its motility, which makes the bile travel faster and appear in the stool in its original green or yellow color. Also, because of the increased intestinal motility, water travels through the intestine faster, less of it is absorbed and more of it appears in the stool.
NOTE: Green or yellow diarrhea can also occur in other conditions with increased intestinal motility.
How long does diarrhea after gallbladder removal last?
Diarrhea after gallbladder removal in most cases lasts for 4-8 weeks, but in some, it can become chronic and persist for several years [1,8].
How can you know if diarrhea is triggered by gallbladder removal?
In diarrhea after gallbladder removal, less bile acids from the bile will be absorbed, so more of them will appear in the stool, which can be detected by the 75SeHCAT test .
Rarely, a retained stone or stricture in the bile duct after gallbladder removal blocks the delivery of the bile into the intestine. This results in improper digestion and absorption of fats, which therefore appear in the stool and make it white, sticky and floating. This is called steatorrhea, which can be detected by the fecal fat test.
The following drugs and supplements can help to control diarrhea after gallbladder removal [1,14]:
- An over-the-counter anti-diarrheal drug loperamide
- Bile acid binders:
- Cholestyramine (common side effects: stomach pain, nausea, vomiting, heartburn) [2,3,5]
- Colestipol and colesevelam (fewer side effects than cholestyramine) [1,2]
- Diphenoxylate and atropine 
- Blond psyllium – a dietary fiber supplement [6,7]
Probiotics may be moderately effective in controlling diarrhea in irritable bowel syndrome  and infectious diarrhea , but it is not clear if they also help in diarrhea after gallbladder removal.
To prevent or limit diarrhea after gallbladder removal :
- Have small and frequent meals, so the bile will mix with the food and will irritate the intestine less.
- Eat foods high in slow carbohydrates, such as whole-grain bread, brown rice and low-sugar breakfast cereals, and foods high in protein but low in fat, such as skinless poultry and fish, like cod, grouper, halibut and tilapia.
- Do not drink liquids during or after but between the meals.
Foods to Avoid
If you are experiencing diarrhea, bloating or excessive gas, limit :
- Foods high in fats, such as oils, cheese, butter, French fries, potato chips, chocolate, lard, gravies, fatty meats (bologna, sausage, chicken skin) and fish (salmon, sardines…), pizza, hamburgers, pies and nuts 
- Foods high in FODMAPs (Fermentable, Oligo-, Di- and Monosaccharides and Polyols)
- Foods high in soluble fiber: oats, barley, legumes, prunes, artichokes, asparagus, psyllium husk
- Foods high in lactose: milk, yogurt, sweet stout, whey powder
- Foods high in fructose: apples, pears, mangoes, honey
- Foods high in sorbitol: prunes, sugar-free chewing gum, low-calorie soft drinks
- Spicy foods
- Caffeinated beverages: coffee, tea, cola, energy drinks
- Chronic diarrhea: A concern after gallbladder removal? Mayo Clinic
- Danley T et al, 2011, Postcholecystectomy diarrhea: What relieves it? The Journal of Family Practice
- Sciarretta G et al, 1992, Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test PubMed
- Jensen SW, Postcholecystectomy syndrome, clinical presentation Emedicine
- Cholestyramine side effects Drugs.com
- Blond psyllium MedlinePlus
- McRorie, JW, Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 1, PubMed Central
- Gallbladder removal – laparoscopic – discharge MedlinePlus
- Yueh TP et al, 2014, Diarrhea after laparoscopic cholecystectomy: associated factors and predictors PubMed
- Farahmandfar MR et al, 2012, Post Cholecystectomy Diarrhoea—A Systematic Review SCIRP
- Cong D et al, 2013, Probiotics and irritable bowel syndrome PubMed
- Guarino et al, 2015, Probiotics for Prevention and Treatment of Diarrhea PubMed
- Vijayvargiya P et al, 2013, Diagnostic Methods for Bile Acid Malabsorption in Clinical Practice PubMed Central
- Bile acid malabsorption/diarrhea Patient.info
- I am looking for information on the foods that might exacerbate bile salt diarrhea HealthCentral