In some cases, a low-fat diet might not be the solution for you, after all. There’s a huge chance that if you had your gallbladder removed, you were probably looking for relief. It could be relief from the sharp pain in your upper abdominal region caused by a gallstone attack. It perhaps even sent you to the emergency room because you were desperate for the pain to end.


Luckily for you, the pain went away after the surgery, but unfortunately, you also got diarrhea during the process. Don’t worry; you’re not alone here. It happens to most individuals after gallbladder surgeries. While a lot of people resume their normal lifestyles and eating patterns shortly after the procedure, some aren’t that lucky.


Very few individuals (a non-trivial minority) experience problematic changes to their digestive functioning, diarrhea being the most common issue. Recent studies carried out show that this problem affects about 9% of humans post-surgery.

If you’re suffering from this problem or you know someone who is, you might want to check out the content below.

What’s Gallbladder?

It’s a small organ that stores and concentrates bile – a digestive fluid the liver produces to aid digestion of fats in the small intestine. Whenever you eat a juicy burger or something fatty, the gallbladder contracts and squirt the stored bile into your small bowel through the bile duct, it shares this duct with the liver. It’s also possible for the liver to secrete bile directly into the small intestine without the need for storage in the gallbladder.

What are Gallstones?

These are formed when the components of the stored bile start clumping together into little crystals. These stones might not be noticeable when they start forming, and it isn’t until they become too much that you become aware of their presence. Research shows that an estimated amount of 10-20% of Americans will develop the disorder at some point in their lives without even knowing about it.

Gallstone Attack

This occurs when the gallbladder contracts forcefully, projecting stones out of the bile duct in the process. And if it gets stuck along the way out, it could cause the individual severe pain and nausea. This gallstone attack is also known officially as “Biliary Colic.” And if these attacks become chronic or the person develops complications, like inflammation of the pancreas or infection of the bile duct, the gallbladder has to be removed.

What Causes Diarrhea After Gallbladder Removal Surgery?

A lot of people believe that post-surgical diarrhea is a result of the body’s inability to effectively absorb fat. But that isn’t always the case – if at all. What happens is that without the gallbladder to mete out squirts of bile when you eat meals with fats, the liver takes over. And when this happens, the liver sends out a steady trickle of bile into the small intestine all the time.


This process tends to overwhelm the small intestine’s limited ability to absorb them back in time for recycling, making it send some of the bile acids (the bile’s building blocks) into the colon. This practice is known as ‘Bile Acid Malabsorption’ or BAM for short, and it results in bile acid diarrhea. Coupled with diarrhea, some individuals tend to experience abdominal cramps/pain, bloating, and occasional bowel incontinence.


Who suffers the Risk of getting Bile Acid Diarrhea (BAD)?

Just like the acronym entails, Bile Acid Diarrhea is a terrible condition to develop. It’s not unique to individuals who just took out their gallbladders; the disorder also affects people who have removed sections of their small intestines (like those who have Crohn’s disease).


Recently, new research carried out revealed that a quarter or more of individuals diagnosed with diarrhea-predominant irritable bowel syndrome (IBS-D) might have BAD.


Metformin, which is a common drug used in treating type 2 diabetes, has also been shown to cause bile acid diarrhea in a subset of people. Another condition known as Small Intestinal Bacterial Overgrowth (SIBO) is also revealed to result in BAD too.

How Bile Acid Diarrhea is diagnosed

Presently, most doctors tend to diagnose based on your response to a trial of medication called bile acid sequestrant. It attaches to the irritating bile acids, allowing them to pass through the colon without causing any trouble. And if the drug improves or even eliminates your symptoms, you can be assured that you have BAD.


How to Treat Diarrhea after Gallbladder Removal Surgery

Luckily enough, bile acid diarrhea tends to resolve quickly when the people suffering from it start taking bile acid sequestrants. If you start noticing that they work too well start causing constipation, you could play around with lower or split doses until you find the right balance.


Sticking to a low-fat diet while following these medications could also provide even faster relief from your symptoms than either tactic would have done alone. Since bile acid sequestrants tend to interfere with the absorption of some drugs and vitamins, you might want to talk to your doctor on ways to space your medications to prevent interference.


FXR agonists (another class of medications) show great promise in the treatment of BAMs by instructing the liver to stop producing too much bile acid. Even though they don’t necessarily have the same side effects of the sequestrants and their delivery method is more appealing to patients (pill form), most people still find it unpleasant and repulsive to consume.