Gallbladder issues can cause diarrhea.
The gallbladder is a small, pear-shaped organ located beneath the liver. Its primary function is to store and concentrate bile, a digestive fluid produced by the liver. When the organ is not working correctly, the regulated flow of bile into the small intestine can be disrupted, leading to digestive problems, including chronic diarrhea. This connection between a dysfunctional gallbladder and loose stools is due to the role of bile in the digestive process.
The Gallbladder’s Role in Digestion
The liver produces about 27 to 34 fluid ounces of bile every day, which is a yellowish-brown liquid composed mainly of water, bile salts, cholesterol, and pigments. Bile helps the body process fats because water alone cannot dissolve them. Between meals, the gallbladder acts as a reservoir, concentrating the bile by removing water and electrolytes.
When fatty food enters the small intestine, a hormone signals the gallbladder to contract and release this concentrated bile. The bile travels through a duct into the first section of the small intestine, where it emulsifies, or breaks down, large fat globules into smaller droplets. This process is necessary for digestive enzymes to work effectively, allowing the small intestine to absorb fats and fat-soluble vitamins, such as A, D, E, and K.
How Malfunction Causes Digestive Distress
When the gallbladder is diseased due to gallstones, inflammation, or dysfunction, the normal release of bile into the small intestine is compromised. If bile flow is blocked or erratic, fats are not properly emulsified and move through the digestive tract undigested. This inadequate fat digestion can cause a type of loose, greasy, or pale stool known as steatorrhea.
The primary cause of diarrhea from a malfunctioning gallbladder is often Bile Acid Malabsorption (BAM). When bile acids are not reabsorbed in the lower small intestine, they pass into the colon. The presence of excess bile acids in the colon irritates the intestinal lining and acts as a laxative, triggering the colon to secrete extra water. This influx of water and rapid transit time results in frequent, urgent, and watery bowel movements.
The diarrhea linked to gallbladder disease is frequently triggered after eating a meal high in fat, as this signals the gallbladder to release bile. The chronic presence of bile acids in the colon leads to the classic symptoms of BAM, including abdominal cramps, bloating, and the urgent need to use the restroom.
Diarrhea Following Gallbladder Removal
Diarrhea can arise specifically after a cholecystectomy, which is the surgical removal of the gallbladder. Without the gallbladder acting as a storage tank, bile flows continuously and directly from the liver into the small intestine. This constant flow overwhelms the small intestine’s capacity to reabsorb bile acids.
For approximately 20 to 30% of patients, this continuous flow leads to Bile Acid Malabsorption (BAM), causing diarrhea similar to that experienced with a diseased gallbladder. The excess bile acids reach the colon, pulling water into the bowel and creating watery, urgent stools. This condition is sometimes categorized under Post-Cholecystectomy Syndrome (PCS) when digestive issues persist.
For most people, the body adjusts to the continuous bile flow within a few weeks or months, and the diarrhea resolves. However, for some, the condition can become chronic and persist for years, requiring ongoing management.
Treatment and When to Consult a Doctor
The management of bile-related diarrhea often begins with dietary modifications, especially reducing the intake of high-fat foods. A low-fat diet reduces the amount of bile the body needs to release, which lessens the amount of bile acids reaching the colon. Increasing the intake of soluble fiber, such as that found in oats and bananas, can also help bulk up the stool and slow down intestinal transit.
If dietary changes are insufficient, medical interventions are available, primarily Bile Acid Sequestrants (BAS). These medications, such as cholestyramine or colestipol, work by binding to the excess bile acids in the intestine. This binding prevents the bile acids from irritating the colon and causing diarrhea.
It is important to consult a healthcare provider for any persistent change in bowel habits. Immediate medical attention is necessary if symptoms are severe or accompanied by warning signs. These concerning symptoms include severe abdominal pain, a high fever or chills, blood in the stool, or jaundice.