Treatment for chronic diarrhea after gallbladder removal

Answer Section

It's not clear how many people develop the frequent loose, watery stools that characterize diarrhea after surgery to remove their gallbladders (cholecystectomy). Studies have found that up to 20% of people undergoing gallbladder surgery develop diarrhea.

In most cases, the diarrhea stops soon after the surgery. Rarely, it may last for years.

The cause of diarrhea after gallbladder removal isn't clear. Some experts believe that it results from an increase in bile, especially bile acids, entering the large intestine — which may act as a laxative.

Treatments you and your doctor may consider for controlling your diarrhea after cholecystectomy include:

• Anti-diarrheal medications, such as loperamide (Imodium A-D)
• Medications that impair absorption of bile acids, such as cholestyramine

Talk to your doctor about your options and whether additional tests are recommended. Generally, mild diarrhea after cholecystectomy is not cause for concern, but speak to you doctor if you are losing weight; have bloody diarrhea, diarrhea that awakens you from sleep, fever or significant abdominal pain; or have diarrhea lasting more than a few weeks.

You may also consider limiting foods that can make diarrhea worse, including:

• Caffeine
• Dairy products
• Greasy foods
• Very sweet foods

Answer Section

After having their gallbladder removed (cholecystectomy), some people develop frequent loose, watery stools. In most cases, the diarrhea lasts no more than a few weeks to a few months. There isn't a specific gallbladder removal diet that you should follow if you have this problem, but there are a few things you might consider.

First, it helps to understand why you're having diarrhea. Diarrhea after gallbladder removal seems to be related to the release of bile directly into the intestines. Normally, the gallbladder collects and concentrates bile, releasing it when you eat to aid the digestion of fat. When the gallbladder is removed, bile is less concentrated and drains more continuously into the intestines, where it can have a laxative effect.

The amount of fat you eat at one time also plays a role. Smaller amounts of fat are easier to digest, while larger amounts can remain undigested and cause gas, bloating and diarrhea.

Although there isn't a set gallbladder removal diet, the following tips may help minimize problems with diarrhea after you've had your gallbladder out:

• Go easy on the fat. Avoid high-fat foods, fried and greasy foods, and fatty sauces and gravies for at least a week after surgery. Instead, choose fat-free or low-fat foods. Low-fat foods are those with no more than 3 grams of fat a serving. Check labels and follow the serving size listed.
• Increase the fiber in your diet. This can help normalize bowel movements. Add soluble fiber, such as oats and barley, to your diet. But be sure to increase the amount of fiber slowly, such as over several weeks, because too much fiber at first can make gas and cramping worse.
• Eat smaller, more-frequent meals. This may ensure a better mix with available bile. A healthy meal should include small amounts of lean protein, such as poultry, fish or fat-free dairy, along with vegetables, fruits and whole grains.

You may also try limiting foods that tend to worsen diarrhea, including:

• Caffeine
• Dairy products
• Very sweet foods

Talk with your doctor if your diarrhea doesn't gradually go away or becomes more severe, or if you lose weight and become weak. Your doctor may recommend medicines, such as loperamide (Imodium A-D), which slows down intestinal movement, or medications that decrease the laxative effect of bile, such as cholestyramine (Prevalite). Your doctor may also suggest that you take a multivitamin to compensate for malabsorption of fat-soluble vitamins.