hi Nancy,

I've merged your other post (to me) in with this thread. That will keep all the bits and pieces together for you in one place, instead of having threads and posts (and replies) in different places. And also since they're related topics.

From the reading I've done so far, it seems that the problem of diarrhea after gallbladder surgery affects about 20% of persons who have their gallbladders removed. Although it's most likely to occur within the year of having the surgery, there are cases where the diarrhea comes on suddenly years after the gallbag has been removed. The "excess bile" theory is just that, a theory .. but the gastrointestinal experts seem to agree that it's a likely culprit for 5 - 10% of patients after gb surgery.


OK, here's a bit of explanation what is going on in the body:

Between meals, bile from the liver is stored in the gallbladder, a little sac beneath the liver. When you eat, the gallbladder squeezes and releases the stored bile into the small intestine to help with digestion. After food is digested and absorbed, the bile salts are reabsorbed at the end of the small intestine and recycled to be used over and over again. However, when the gallbladder has been surgically removed, the liver must make more bile, and more gets released into the small intestine between meals, because there's no place to store it. The increased amount of bile can sometimes overwhelm the small intestines' capacity to reabsorb the bile salts. The excess spills over into the large intestine, or colon, where bile salts act somewhat like a laxative or irritant, leading to diarrhea.

Why some patients develop this side effect after gallbladder surgery and others do not is still a mystery. Unfortunately, there's no way to predict before surgery who will develop this problem afterwards. Having this side effect does not reflect on the skill of the surgeon or how the surgery was done. It's really just bad luck.

Since there's no specific diagnostic test for this condition, your doctor must confirm her/his suspicion that bile salt diarrhea is the culprit by ruling out other possible causes of diarrhea such as infection, colitis, cancer, and others. Blood and stool samples will be taken, and usually a colonoscopy is done, so the dr. can visualize and likely take small biopsy samples of the lining of the large intestine (colon)

There's no cure for this problem, so treatment is usually geared to lessen the symptoms of diarrhea and urgency. The mainstay of treatment is Questran (detailed above) ... also called cholestyramine resin. There are other brand names as well .. Locholest, Locholest Light, Prevalite, Questran Light. It The dose required to treat this condition is less than for cholesterol-lowering, usually only once a day.

In addition to using Questran, some patients with bile salt diarrhea find that they are helped by the use non-prescription medications to lessen diarrhea such as Imodium. Imodium can be safely taken several times a day. The main side effect, of course, would be constipation. Some patients find that the use of fiber supplements may help make the bowel movements more formed.

You especially want to ensure that you're well-hydrated. You're losing fluids with the diarrhea, and minerals too, especially potassium. You are likely digesting and absorbing at least some of the fat you eat, since the problems of the bile salt irritation aren't happening until the large intestine, and fat absorption takes place in the small intestine. So, do ensure that you're eating adequate fat. A tablespoonful of oil is better than a teaspoon Eat the skin with the chicken, and use whole eggs, not just egg whites. Egg yolks are rich in lecithin, which helps the liver to process fats into fatty acids (not the same as the bile function )

Doreen