Question Title: Diet after gall bladder removal

After several abdominal surgeries and receiving blood transfusions,
I began having severe abdominal attacks. I had my gall bladder
removed after a nuclear medicine test that revealed my gall bladder
was not functioning which was causing the attacks. It was recommended
that I have the deseased gall bladder removed. During the laproscopic
procedure, intenstinal adhesions were also noted. Since its removal,
my digestion has been notably slow and uncomfortable accompanied
by gas, bloating, and mild intestinal pain.

Is there a special diet that a person with no gall bladder should
be adhering to and could that be related to my digestive problems?

Thank you
Kate
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Dear Kate:

It is not uncommon to have temporary digestive difficulties after gallbladder removal (cholecystectomy). The main reason is usually a difficulty in handling fats in the diet. Fat and certain fat-soluble vitamins require bile in order to be absorbed. When the gallbladder is present, it stores bile that the liver makes. During a meal, the gallbladder contracts, releasing a pool of bile into the intestine that is used for fat absorption. After cholecystectomy, bile is still produced by the liver, but is released in a continuous, slow trickle into the intestine. Thus, when eating a meal that is high in fat content, there may not be an adequate amount of bile in the intestine to properly handle the normal absorption process.

The change in intestinal bile concentration during high-fat intake may cause diarrhea or bloating, because excess fat in the intestine will draw more water into the intestine, and because bacteria digest the fat and produce gas. Some studies suggest that diarrhea after cholecystectomy may also be caused by excess bile in the intestine between meals, because bile is released into the intestine continuously.

A few points should be emphasized:
1. Most persons do not have digestive difficulty after cholecystectomy.
2. When it does occur, post-cholecystectomy diarrhea is temporary in most persons.
3. There is usually no "malabsorption," in the sense that the amount of intestinal bile is sufficient to absorb the fat and vitamins necessary to remain healthy. (otherwise, we would not remove gallbladders with relative impunity.)
4.
There may be other reasons for bloating and abdominal discomfort after cholecystectomy. The most common-and in fact the most common reason after any abdominal surgery-is post surgical adhesions or motility problems of the bowel. Motility problems are usually seen in the immediate post-surgical period, and generally resolve. Adhesions, or intra-abdominal scars, are a later complication of abdominal surgery, and can cause recurrent difficulties.

The treatment for digestive problems after cholecystectomy of course depends on the reason for the problem. The options are too numerous to detail. As an initial measure, you may want to try a low-fat diet. I suggest discussing your problem with your surgeon.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution, please call 1-800-653-6568, our Referring Physicians Office and make an appointment to be seen with Dr. Tamir Ben-Menachem of the Division of Gastroenterology, one of our experts in the treatment of gastrointestinal and biliary disorders.
HFHS M.D.-tbm
Keyword: cholecystectomy
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