Persistent Diarrhea - began three years ago following removal of Gall Bladder

[Theresa__0__0]

  I am a 30 year old female who has been suffering from diarrhea since I had my Gall Bladder removed.  Since fatty foods bring on the problem, I avoid them as much as possible.  I'm very good about my die(-other people compliment me on my will power).  This usually keeps the problem under control.  However sometimes I get diarrhea after eating even when the meal is small and low fat.  Occasionally, I will feel cramping and the diarrhea will be "explosive" for lack of a better term.  Usually it is just soft stool or runny like water.
  For the past two weeks I have been having problems with diarrhea on a daily basis.  I think I have only had 2-3 normal stools in the past 2 weeks. Twice in the past two weeks I "lost control" when at the time I thought I just passing gas.
  I do not have a temperature but have been experiencing feelings of warmth and sweat break outs.  I feel a little achey (achy) in the shoulders and have headaches daily.  I attributed the headaches to a TMJ problem I have( I recently had some dental work done).  
  It's like I have flu-like symptoms but they are so vague and I do not have a temperature.  What could be causing this severe and persistent diarrhea?  It's an embarrassing problem to have at work.  Any ideas or suggestions.

Dear Theresa,
Postcholycystectomy diarrhea is felt to be caused by bile acids being dumped into the colon. These bile acids stimulate water secretion causing diarrhea. It would seem logical that the most appropriate class of medication that would be helpful to control this type of diarrhea, would be a bile acid resin binder. Cholestyramine (Questran, Prevalite) is usually helpful in this regard but can have a gritty taste and cause nausea, abdominal bloating and constipation. It can also interfere with the absorption of a variety of medications and vitamins over the long term. You should be aware that there is a powder form of Questran called Questran light (for oral suspension) which is supposed to be better tolerated. Another bile acid resin binder is colestipol (Colestid). Colestipol is available as granules, flavored granules or tablets and is also only available by prescription. The granules can be mixed with breakfast cereals and juices for better compliance. These medications are usually required for prolonged periods, but if you obtain significant relief, you can titrate the medication to the lowest dose needed to control your symptoms. If you do not receive any benefit from the bile acid resin binding agents you may want to try anti-diarrheal agents such as Immodium or Lomotil to see if they are effective (after consulting your primary physician).
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 see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: postcholycystectomy diarrhea, bile acid binding agents