Hi Johana and welcome!

Here's the thing: IBS that starts out right after having your gallbladder removed might not be IBS

Heather addresses this in a newsletter from July 2004, but here is the basic idea (boldface represents my emphasis):

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One of two scenarios is likely here: 1) you don't actually have IBS at all, but chronic diarrhea stemming from the effects of the gallbladder removal itself; 2) the gallbladder surgery traumatized the enteric nervous system of your gut and led directly to your development of IBS. Let's take each of the possibilities (neither one a happy outcome, I'm sorry to say) in turn.

If your symptoms are constant and urgent diarrhea, particularly without abdominal pain, and began immediately after you had your gallbladder or ileum (the last portion of the small intestine) removed, you could be suffering from a malabsorption of bile acids secreted by the liver. These acids, which are normally stored in the gallbladder, are now instead being dumped directly into the small intestines, causing chronic irritation and thus chronic diarrhea. This is a fairly common outcome following gallbladder surgery, though unfortunately it doesn't seem to be a side effect that patients are warned about in advance, nor do all GI doctors seem to be aware of the cause-and-effect that's at play here.

If your diarrhea does stem from bile acid malabsorption, a prescription drug such as Questran (generic name cholestyramine), which binds the bile acids in the intestines and prevents them from reaching the colon, can help this problem and should resolve your diarrhea quite quickly and effectively. The bad news is you'll probably have to take the drug for the rest of your life. The good news is you don't have IBS. As an aside, though, you'll probably find it helpful to follow the low fat, high soluble fiber guidelines of the IBS diet, as fat stimulates bile production and that can exacerbate your diarrhea, while soluble fiber helps absorb and bind bile in the GI tract and aids in its removal from the body.

On the other hand, it's also a very reasonable possibility that the abdominal surgery itself did in fact lead to the development of IBS. Your body may have no problems adjusting to your missing gallbladder or bile acid malabsorption; instead, you might now have a dysfunction of your gut's nervous system. Though no one clearly understands precisely what causes someone to develp IBS, there is mounting evidence that for some people the condition is precipitated by some type of grievous insult to the gut - dysentery, food poisoning, intestinal flu, abdominal surgery, or even pregnancy. Surgical removal of your gallbladder would certainly qualify as an insult to your gut.

This theory goes that even after full physical recovery from the traumatic event to your GI tract, the nerves within the gut retain a "memory" of the insult and remain hyper-sensitive to further stimulation, as well as prone to subsequent over-reaction. So, even though you may have recovered completely from the actual gallbladder removal and abdominal surgery, you could now be left with a permanently malfunctioning enteric nervous system, in the form of Irritable Bowel Syndrome.

If you've really been unfortunate, you could actually be suffering from both problems: bile malabsorption and IBS. There is a bright side, though, as a drug like Questran will seriously minimize the diarrhea you have from the bile acid irritation. And, the many different diet and lifestyle management strategies for IBS will help tremendously to get your other symptoms under control. You're probably at the worst point of the problem right now if you're just learning about what actually happened to you - from here on out, things should only get better!

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