Bile Salt Malabsorption after Cholecystectomy

Bile Salt Malabsorption - what is it ? Doctors everywhere are always eager to remove the gallbladder because they think its not necessary to have a it. You'll soon see why the doctor are wrong to remove this organ because it IS necessary to keep it.

Basically, bile is a secretion or juice made by the liver and it drains into the gallbladder. When you get Bile Salt Malabsorption or diarhea and gastro problems to be more exact it's because the bile is constantly dripping into the digestive system and not getting collected in the pouch called the gallbladder for storage to be used later when you have some fat in your meal which will then squeeze some out to breakdown the fat.

The bile contains bile salts. If you get a bit too much, your digestive system will become irritated specially when there is no fat to be broken down or specially in an empty digestive system. People who dont have any problems is because they dont make too much bile and they are lucky or they are eating enough fat for the bile to break it down.

This is why people who have problems with digesting fats after having the GB removed i.e. constantly rushing tothe toilet after eating with diarrea are given 'bile salts' to be taken with food. But having more than the required amount freely flowing in the digestive system which is made by the liver can cause the problem of rushing to the toilet many times during the day. The free flow of bile which contains bile salts is what causes the diarrhoea, constant rush to the tollet, explosions and accidents.

Therefore, as you can now see taking out the gallbladder is not the problem to the solution because the bile which contains bile salts has nowhere to be collected, the storage sack - the GB is gone and the liver will constantly make bile and it will drip or trickle in to the digestive system. Prescribing bile salts is not the answer for everyone as it cannot be absorbed by all and prescribing anti-diarrhoea meds will only temporarily stop the symtoms - again its not the answer. Also, taking these meds on a long term basis will likely to cause secondary side-effects and long term problems (see the leaflet(s) inside the box).

Another problem is, if you constantly have diarrea soon you could develop piles. If you get to third degree piles for embarrassment of not going to the doc and showing your bottom eventually you'll need surgery inside your bottom (through the sh*t-hole) and the recovery is extremely painful for weeks. (dont beleive what the doc says).

So, basically, either way whether you have the bladder out or have piles (hemmoroids) you are likely to suffer from a life of almost constant for some, diarrhoea and for some faecal incontience.

So, what is the solution ? doctors could if they wanted to, develop artificial gallbladders but they wont do it unless the patients/public put pressure on them (because it will cost them, they dont want to spend money, they just want to use a quick solution). There is nothing doctors and scientiest cant do these days. In the meantime if you think you have either GB disease or piles, is lead a careful life with very healthy eating to slow it down.

So, as you can see the doctors are wrong in deciding to remove the gallbladder, it IS a necessary organ. Instead they could take it out but put in a artficial one or take the stones out of the gallbladder.

I have just found this discussion. Have been searching as I have considerable pain in my stomach and back and I wondered if it was a complication of having my gall bladder removed 18 months ago. I had preferred not to have it out and had coped for five years with mild pain and some bouts of serious pain following a naughty eating event. However I then began having really bad pain more regularly until finally one night of having excruciating pain for seven hours without respite I was carted off to A&E.

The upshot was that I had a very large stone removed from my bile duct and a few weeks later my gall bladder was removed. I was told that my gall bladder was full up with stones and some were HUGE! I have alternating constipation and diarrhoea but not to the extent that some of you have. It's just the constant gnawing pain in my stomach that is extremely difficult to live with. I agree with Trex that it is better not to have it out but the pain I was getting was much worse even than childbirth so I went along with it. I can't turn the clock back and not have the operation so more positive comments would be helpful.

Pain in stomach and back could have other causes, things to consider are SOOD (Spinchter of oddi), whether new stones have formed directly anywhere in the biliary system and pancreatis, etc. The best way to know is get some feedback and knowledge on it by doing some blood works and scans and then take it from there.

While you're waiting try cutting out all fatty food - that includes ready-made sanwiches which include mayo and othre junk, eat natural organic fresh fruit and veg what u can tolerate, this way you can know whether its the biliary system.

You might want to try some ACV to see if it clears up.

You could join the Bile Salt Malabsorption group on Facebook which is very supportive. People share ideas, medicines and give good advice.

Hope you begin to feel better real soon.

Hi Stella.

I had my gall bladder out in Dec 2012. I was get lots of pain and I got pancreatitis once.

6 months later I noticed I was getting pain sometimes where my gallbladder used to be. Sometimes the radiating pain around my back (that I used to get b4 removal) and also my left side (which I later found out 4 months later, was where my spleen is, as a ct scan showed a slightly enlarged spleen).

After a bout of gastroenteritis in Sept 13 I kept getting very loose bowels me times still vomit or nauseous months later. In Dec 2013 I'm requesting to have a dairy allergy test as I notice this makes we worse.

I am also under investigation for crohns disease as a bit of a family history.

I do have a dairy allergy but still get upset tummy even though I cut this out my diet.

I haven't tried to lose weight. I'm always the same...slightly overweight.

Maybe I have this bile salt malabsorbtion thing too. Hopefully not Crohns.

My husband thinks all these new problems I'm having are since removal of my gallbladder. I'm not sure if it crohns or just these new allergies I'm getting (thinking fish doesn't agree with me anymore).

I still don't know what the enlarged spleen is about months later.

At a loss, anyone any ideas. Dr's don't seem to be even speculating

Thanks

I have my gallbladder removed about 15 years ago. The following year I was diagnosed with IBS which was thought to be stress related. When I gave up my job the symptoms disappeared. Since then I have had odd bouts but nothing to worry about. The last 9 months I have had chronic diarhoea and been diagnosed with both lymphocytic collitis and bile salt malabsorption. I have been on steroids for weeks and colestyramine. Sometimes it seems as though the treatment is working and then I have a really bad day again. Does anyone know of other treatments - medical or alternative - that has worked for them?

I had my terminal ileum removed almost 30 years ago - this can provide similar symptoms to gall bladder diarrhoea because bile salts are not absorbed (terminal ileum missing), and I was diagnosed with severe bile salt malabsorption two years ago. Questran helped, but left me feeling run down and gave me rashes, so I gave up on that. I tried Colesevalam recently, which also helped, was more palatable than Questran, but seemed to give me mild headaches, possibly a rash, and so with a preference to not take medication unless essential I looked for other treatments. There is little written about terminal ileum removal, so I searched for natural treatments for gall bladder removal and discovered that some folks found that taking psyllium husk a great help.

I have tried psyliium for the last week and it has worked extremely well for me. Powdered flakes (mixed in a large glass of water) left me with a slightly sore throat, but capsules (I have used Solgar, but there are plenty of other manufacturers) don't seem to have any side effects so far. You must take them with a large glass of water, and they may not work for everybody, but from my limited experience (and judging by reviews on other websites) they may help others with bile salt malabsorption diarrhoea. They may also not be without side effects / risk - worth doing your own research, possible risk of blockage especially if not enough water taken with them. I'm always a little sceptical since I've found natural supplements before that have only worked temporarily, but in 30 years this is the most promising development for me and I hope it can help others too. There may be a malabsorption of other nutrients issue with taking psyllium, but I have been taking other multivitamins etc a couple of hours before psyllium and not only have my bowels been the most settled in 30 years I am feeling energetic / no side effects. My tongue actually looks healthy too, first time I can remember. With all the caveats, so far I'd strongly recommend psyllium - apparently great for bile salt malabsorption, diarrhoea, constipation, even piles. Best of luck all.

Hi Phil

Your post is very informative, there is a Facebook page called Bile Salt Malabsorption - perhaps you should join it and put this post on there to help the people there.

kind regards

Hi designergirl, thanks. I don't have a Facebook account, but I'm very happy for someone else to paste my suggestion there on the Bile Salt Malbsorption page. Thanks.

Very best of luck

Phil

Thank you so much Phil, I will do so right now.

kind regards

Fran

Having been diagnosed at age 32, with ulcerative colitis/Crohn's disease. Prescribed steroids (Prednisolone) in 1969, I have suffered many years of diarrhoea, unable to enjoy eating out because of the fear that I would need to 'GO' within 10-15 minutes of eating. When ever I did venture out shopping, I had to be sure of the location of Ladies Loos. My greatest fear was that I would end up an incontinent old lady!

However, my partner (a retired Consultant Physician) did some research on my behalf.

The result was a diagnosis of Bile Acid Malabsorption (or Bile Acid Diarrhoea).

A very gracious Gastroenterologist agreed with his diagnosis and prescribed Colesevalam tablets (Cholestagel) in 2013. The result was simply amazing - I take three tablets (they are a bit like 'Horse Pills'!) 4 hours after taking my other medication and everything is normal.... no more rushing to the loo after eating. I can enjoy foods I would never have risked before and I have that wonderful sense of freedom. The hospital Consultant admitted that she had little knowledge of the condition and it is so frequently mis-diagnosed. Cholestagel has been proven to be the answer although it is usually prescribed to lower colesterol.

Thanks for this Jill - great info!!

Thanks Fran for posting on Facebook, and, yes, Jill, it seems that many gastroenterologists are unfortunately unaware of bile salt malabsorption problems. I am very grateful that I eventually came into contact with one who sent me for a SeHCAT scan which detects this condition (and, to the extent it helps anybody else, the consultant decided on this course of action because of my Crohns/terminal ileum removal).

I get the impression that even when diagnosed, GPs do not like to prescribe Colesevalam because it is very expensive. Regarding my post above, Colesevalam suited me much better than Questran, but I was keen to find a non-pharmaceutical alternative (accepting that natural supplements can also have side-effects). Perhaps because my symptoms may be less severe than those described by others on this forum, I was fortunately able to risk experimenting a little. Although I couldn't be happier with the success of psyllium husk, I'm also considering trying Calcium Carbonate. I have read elsewhere that it is another useful supplement for absorbing bile salt, but having not yet tried this or researched side-effects I can't vouch for its efficacy. Absent these natural supplements though, I suspect that I would still be experimenting with Colesevalam dosage - it does the job of binding bile salts (eliminating bile salt diarrhoea) and if folks are suffering and unaware this medication exists there are plenty of reviews and studies that suggest that it works. For what little it's worth though my preference was to try the psyllium as a non-pharmaceutical alternative, hopefully with lesser or no side-effects, and fortunately it has so far worked very well.

If anybody else has tried calcium carbonate, or psyllium, I'd be keen to hear their experiences. Thanks.