Diarrhea After Gallbladder Removal

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Published: February 11, 2017
Last reviewed: April 28, 2017

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 and then delivered into the small intestine where it helps to digest fat after the meals. After gallbladder removal, diluted bile constantly flows into the intestine and the bile acids from the bile trigger urgent watery diarrhea after the meals [10].

On the other hand, white, sticky and floating stools after gallbladder removal can result from a blockage of the common bile duct by a gallstone, which prevents the flow of the bile into the intestine and thus the digestion and absorption of fats.

What does green or yellow diarrhea mean?

It is the bile that gives the color to the stools. Normally, when the bile travels through the intestine, the intestinal bacteria change its color from green to bright yellow and finally to brown. After gallbladder removal, the bile that irritates the intestine stimulates its motility, so the bile travels through the intestine faster, and the bacteria do not have time to change the bile color from green or yellow to brown, so from here the green or yellow and loose stools.

How long does diarrhea last after gallbladder removal?

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 bile acids?

There is a test called 75selenium homocholic acid taurine (75SeHCAT), which detects an excessive amount of bile acids in the stool [13].

The stool test for fat is intended to check if diarrhea is from fat malabsorption, which can also occur after gallbladder removal.

Treatment

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 [2,3] (common side effects: stomach pain, nausea, vomiting, heartburn [5])
    • Colestipol and colesevelam (less side effects than cholestyramine) [1,2]
    • Diphenoxylate and atropine [4]
  • Blond psyllium (a dietary fiber supplement) [6,7]

Probiotics may be moderately effective in controlling diarrhea in irritable bowel syndrome [11] and infectious diarrhea [12], but it is not clear if they also help in bile acid diarrhea after gallbladder removal.

Diet

  • Have small and frequent (5 or more per day) meals, so the bile will mix with the food and will irritate the intestine less.
  • Eat foods high in slow carbohydrates, like 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.
  • Drink enough water. With diarrhea you can quickly lose a lot of water, which can result in dehydration; symptoms include thirst, dry mouth, dark yellow urine and profound fatigue. Check how to treat dehydration. In severe diarrhea, you may want to try oral rehydration solutions you can find in drug stores.
  • Do not drink liquids during or after but between the meals.
  • Reference: [15]

Foods to Avoid

If you are experiencing diarrhea, bloating or excessive gas, avoid or limit [1]:

  • Foods high in fats, such as oils, cheese, butter, French fries, potato chips, chocolate, lard, gravies, fatty meats (bologna, sausage, chicken skin), pizza, hamburgers, pies and nuts [9]
  • Foods that contain 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 and/or sorbitol: apples, pears, mangoes, honey
    • Foods high in sorbitol: prunes, sugar-free chewing gum
  • Spicy foods
  • Caffeinated beverages: coffee, tea, cola, energy drinks
  • Alcohol
  • References

      1. Chronic diarrhea: A concern after gallbladder removal?  Mayo Clinic
      2. Danley T et al, 2011, Postcholecystectomy diarrhea: What relieves it? The Journal of Family Practice
      3. Sciarretta G et al, 1992, Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test PubMed
      4. Jensen SW, Postcholecystectomy syndrome, clinical presentation Emedicine
      5. Cholestyramine side effects  Drugs.com
      6. Blond psyllium  MedlinePlus
      7. McRorie, JW, Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 1,  PubMed Central
      8. Gallbladder removal – laparoscopic – discharge  MedlinePlus
      9. Yueh TP et al, 2014, Diarrhea after laparoscopic cholecystectomy: associated factors and predictors  PubMed
      10. Farahmandfar MR et al, 2012, Post Cholecystectomy Diarrhoea—A Systematic Review SCIRP
      11. Cong D et al, 2013, Probiotics and irritable bowel syndrome  PubMed
      12. Guarino et al, 2015, Probiotics for Prevention and Treatment of Diarrhea  PubMed
      13. Vijayvargiya P et al, 2013, Diagnostic Methods for Bile Acid Malabsorption in Clinical Practice  PubMed Central
      14. Bile acid malabsorption/diarrhea  Patient.info
      15. I am looking for information on the foods that might exacerbate bile salt diarrhea  HealthCentral

 

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