Bile Diarrhea

Bile diarrhea or bile acid diarrhea is an unusual but well-known complication or outcome of gallbladder surgery. It can affect people of all age groups and is common in both men and women. So, let us try to understand what causes bile diarrhea and how it can be treated.

Causes
Bile is a thick yellow fluid secreted by the liver, that helps in fat digestion. During the meals, this liver bile is stored in the gallbladder, a small sac underneath the liver which squeezes and releases these stored bile salts in to the small intestine that aids in digestion. Once the food is digested, the bile salts are reabsorbed at the end of the small intestine and recycled to be used again and again. Now, when the gallbladder is surgically removed, the liver has to secrete more bile salts, and more salts are released between meals since there is no place to store them. This increased amount of bile salts can sometimes overwhelm or overpower the small intestines' capacity to reabsorb them. The excess spills over into the large intestine, or colon, where bile acts somewhat like a laxative, which eventually causes bile acid diarrhea and abnormal bile bowel movements.

Symptoms
Although the symptoms may vary, quite often many patients suffer persistent diarrhea after their gallbladder removal. The condition is so worse, that the patient experiences an urgency and watery diarrhea instantly after having meals. The condition can be extremely embarrassing especially at work or while dining with friends, as the person may have to stop and head for the closet bathroom before finishing the meal. Hence, making people reluctant to have meals away from their home.

Diagnosis
Usually there is no particular tests for bile diarrhea, however, the doctor may ask about the patient's medical history and various changes in the bowel habits. The patient may have to undergo some blood and stool tests, to determine the underlying cause. In some cases, the doctor will examine the lining of the colon through colonoscopy, to ensure that colitis and cancer are not present.

Treatment Options
Treatment for bile diarrhea can not eradicate the disorder from root, but can lessen the symptoms of diarrhea and urgency. Cholestyramine resin is the most effective medication that helps controlling the bile salts diarrhea symptoms. The medication comes in a powdered form and is dissolved in 6 oz. of water before consuming. It should never be ingested or inhaled in dry form. Locholest, Locholest Light, Prevalite, Questran and Questran Light are the different formulations available in the market.

Cholestyramine resin also comes in the tablet form called Colestid, that works by reducing the blood cholesterol by trapping and inactivating bile salts in the intestine, hence, avoiding their reabsorption. The medication should only be taken under a doctor's supervision and its recommended dosage is usually once a day. But if you are taking other medications as well, ensure that there at least 1 - 4 hours of time interval before or after consuming cholestyramine, as it may reduce the effectiveness of other medicines. It is also known to decrease absorption of other vitamins and minerals in the body, hence, taking a multivitamin supplement every morning will help overcoming the deficiencies. Along with these medications, patients suffering from bile diarrhea should be given low fat diet, to avoid diarrhea symptoms and urgency.

Unfortunately, there is no way to prevent bile diarrhea from happening, as one can not predict its occurrence before and even after surgery. Hence, this side effect does not reflect on the ability of the surgeon or how the surgery was conducted. But fortunately very less patients develop this ailment, in fact studies show that only 5% of patients suffer bile diarrhea after the surgery due to prior medical history or some unhealthy eating habits.