Diarrhea After Gallbladder Removal

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Published: February 11, 2017
Last reviewed: July 14, 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. 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 [10].

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 [13].

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.

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 (common side effects: stomach pain, nausea, vomiting, heartburn) [2,3,5]
    • Colestipol and colesevelam (fewer 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 diarrhea after gallbladder removal.

Diet

To prevent or limit diarrhea after gallbladder removal [15]:

  • 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.

If you have diarrhea, drink enough water to replace the lost fluid. Drink as much as needed to prevent dehydration (thirst, dry, mouth, dark yellow urine).

Foods to Avoid

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

  • 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 [9]
  • 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
  • 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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