Gallbladder Removal, Bile Malabsorption & IBS

  • Did your IBS start when you had your gallbladder or ileum removed? You may not even have IBS.

  • Chronic diarrhea, particularly without abdominal pain, following gallbladder removal, is typically caused by malabsorption of bile acids secreted by the liver.

  • These acids, normally stored in the gallbladder, are now dumped directly into the small intestines, causing chronic irritation and diarrhea.

  • It's a common side effect of surgery that patients often are not warned about in advance.

  • But - gallbladder surgery (or any other GI surgery) can also traumatize the enteric nervous system of your gut. This can lead directly to the development of IBS.

  • Wild card - there's also Idiopathic Bile Acid Malabsorption, a condition that can occur WITHOUT gallbladder removal.

  • What to do? Diarrhea from bile acid malabsorption can be treated with the prescription drug cholestyramine, which binds bile acids in the intestines and prevents them from reaching the colon. The good news is you don't have IBS. The bad news is you might have to take cholestyramine for the rest of your life. Ask your GI doctor if you may need this drug.

  • But - it's also possible that the surgery itself did in fact lead to the development of IBS.

  • For some people IBS follows an insult to the gut - dysentery, food poisoning, intestinal flu, abdominal surgery, even pregnancy. Long after physical recovery from the trauma to the GI tract, the nerves within the gut retain a "memory" of the insult and remain hyper-sensitive and prone to over- or under-reaction.

  • This leaves people with a permanently malfunctioning enteric nervous system, a brain-gut dysfunction in the form of Irritable Bowel Syndrome.

Tip Takeaway: For bile malabsorption and IBS, it's helpful to follow the low fat, high soluble fiber guidelines of the Eating for IBS diet. Fat stimulates bile production and worsens diarrhea. Soluble fiber helps absorb and bind bile in the GI tract and aids in its removal from the body.

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