Nutritional Absorption After Gallbladder Removal

The gallbladder serves mostly as a storage unit for bile, which is released from the liver to digest fats so they can be absorbed. During gallbladder surgery, your surgeon removes the gallbladder, usually because it has filled with gallstones. Gallstones can travel from the gallbladder into the bile duct and lodge there, blocking the flow of bile. If bile can’t reach the small intestine, fats can’t be broken down and absorbed.

Bile Production

Bile is produced in the liver and stored in the gallbladder. When you eat, the gallbladder contracts and squeezes bile through the common bile duct to the small intestine, where it breaks down fats. Fats are then absorbed into the bloodstream and utilized or stored for use as energy. Bile is a necessary part of fat breakdown and absorption, even after gallbladder removal. Since the liver produces bile, bile production is unaffected by gallbladder surgery, but because the gallbladder no longer stores excess bile, more is released into the small intestine. The common bile duct may enlarge to hold excess bile.

Bile Release After Surgery

After gallbladder surgery, more bile is constantly produced and released into the small intestine because the gallbladder no longer stores bile for release during a meal. Bile salts are normally reabsorbed and reused; after gallbladder removal, the amount of bile salts in the intestine may be more than can be reabsorbed. The excess bile can end up in the large intestine or colon, where it causes stool urgency and frequency that occurs right after eating, called bile salt diarrhea 1.

Postoperative Diet

For the first few weeks after gallbladder surgery, your doctor will most likely recommend a low fat diet to reduce the stress of bile production right after surgery. However, most people can resume a normal diet within four to six weeks after surgery, unless complications such as bile salt diarrhea develop 1. If diarrhea is a problem, restricting caffeine, dairy products and refined sugars in addition to fats may help control diarrhea. If diarrhea continues after the first six weeks, talk with your doctor about medications that may help treat bile salt diarrhea 1.

Complications

Chronic diarrhea can affect your ability to absorb nutrients. Following a low fat diet may help reduce diarrhea. Medications such as:

• the cholesterol lowering agent cholestyramine resin
  
• which is a powder that you mix with water
  
• or Colestid
  
• a tablet
  
• can help reduce symptoms by absorbing bile
  
• removing it in the stool

Over-the-counter anti-diarrheal medications may also help.