Some people who have had their gallbladders removed -- a procedure known as a cholecystectomy -- find themselves dealing with ongoing digestive problems. These chronic difficulties often lead a person to wonder if the gallbladder removal caused them to develop IBS. This overview of ongoing digestive problems following gallbladder removal may help you find a better understanding as to what is happening with your body since your cholecystectomy.
Life Without a Gallbladder
One of the reasons why gallbladder removal is typically the recommended treatment for gallbladder problems is that it is safe to live without a gallbladder. Your gallbladder's main job is to store bile (a substance needed for the digestion of fats), and to secrete bile into your small intestine in response to the ingestion of 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.
For most people, this new system works fine. However, approximately 20% of people who have had their gallbladders removed will experience problems with diarrhea, a condition known as postcholecystectomy diarrhea. This problem has been attributed to the fact that without the gallbladder, there is nothing to regulate the amount of bile that passes into the small intestine. This 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. However, a small percentage of people may continue to experience diarrhea on an ongoing basis.
Sphinter 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," a functional gastrointestinal disorder (FGD). In SO dysfunction, the sphincter does not relax as it should, preventing the bile and pancreatic juices from entering the small intestine. The Rome III criteria for SO dysfunction describe its symptoms as "episodes of moderate to severe steady pain" located 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 SO dysfunction are thought to be the result of the excess accumulation of the juices in the ducts.
SO dysfunction is most often seen in postcholecystectomy patients or in those who suffer from pancreatitis. Although up to 20% of postcholescystectomy patients will report ongoing upper abdomen pain, only a small percentage will actually suffer from SO dysfunction. SO dysfunction can be treated with medication or a procedure known as endoscopic retrograde cholangiopancreatography (ERCP).
IBS Following Gallbladder Removal
Although anecdotally, I have heard numerous stories from IBS patients who report that their IBS showed up following removal of their gallbladder, no one appears to have gathered any scientific data on the subject.
One older study looked at differences in SO functioning between patients with and without IBS who reported ongoing symptoms . The study population was quite small and I could find no evidence that the study was ever replicated, which would lend more credence to study results. Keeping this in mind, the study found no difference between the two groups in terms of how the SO was functioning when it was at rest. However, those with IBS were more likely to have an abnormal SO response to a specific hormone, cholecystokinin (CCK), which makes up the bile and pancreatic juices.
What to Do?
If your gallbladder was only removed very recently, you may want to eat a bland diet until your diarrhea symptoms start to ease. If you are experiencing fever, chills or signs of dehydration, you should contact your physician immediately.
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
- Pancreatic cancer
- SO dysfunction
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)
Self-Care for Chronic Problems
Without your gallbladder participating in the process of digestion, you may need to change your eating habits. You may find that you experience less distress by trying the following strategies:
- Eat small meals frequently throughout your day.
- Follow a low-fat diet.
- Try a probiotic.
- Try a digestive enzyme.
- Avoid trigger foods.
If It Is IBS
- IBS Treatment
- Chronic Diarrhea Treatment Guide
- IBS Medications
- Over-the-Counter Remedies for IBS
- Mind/Body Treatment for IBS
These articles discuss a condition called bile acid malabsorption (BAM) and its relationship to chronic diarrhea difficulties:
The following article discusses "dumping syndrome", a condition that may occur after weight loss or other gastric surgery:
Behar, J. "Functional Gallbladder and Sphincter of Oddi Disorders" Gastroenterology 2006 130:1498-1509.
Corazziari, E. "Sphincter of Oddi dysfunction" Digestive and Liver Disease 2003 35:S26-29.
Evans, P. et.al. "Abnormal sphincter of oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome The irritable sphincter" Digestive Diseases and Sciences 1995 40:1149-1156.
"Gallstones" National Digestive Diseases Information Clearinghouse (NDDIC) Accessed February 24, 2012.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.