Is your gallbladder causing your gut and IBS symptoms?

Do you still have your gallbladder? Could your gallbladder, or lack of one, be causing your IBS symptoms?

This article will break down where things may go wrong with and without a gallbladder to cause symptoms, and how that will impact IBS treatment. Unfortunately for many, they are seeing results from IBS treatment because of this very reason, so I hope this sheds light on that for you.

Let’s start from the beginning with what the gallbladder is and what it does

The gallbladder is a small organ (around the shape of a pear) and is located on the right side of your abdomen below the liver. The gallbladder is unique in that although it does have a function to perform within the body, you can (technically) live without it.

The gallbladder’s main function is to store bile (made by the liver) until it is needed for digestion, then it slowly releases it as you need it. Ultimately, it serves to prevent excess or unnecessary bile from being released into the small intestine when it may not be needed.

Just like any living organ, the gallbladder can sometimes malfunction. Symptoms of a malfunctioning gallbladder are very similar to IBS symptoms. Abdominal pain (upper right side or middle), pain after meals, nausea, cramping, diarrhea, vomiting and clay-colored stools are common symptoms associated with a gallbladder “attack.”

If you determine that it truly is your gallbladder that is malfunctioning, it’s important to also determine the underlying reason why. There are multiple reasons why your gallbladder may be malfunctioning, including:

biliary dyskinesia (when the gallbladder doesn’t release the bile properly)
choledocholithiasis (when gallstones get stuck in the common biliary duct)
cholecystitis (inflammation of the gallbladder)
pancreatitis (Inflammation of the pancreas)

In a nutshell, there can be a problem with:

Motility (movement)
A blockage
Presence of inflammation

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The presence of a blockage within the gallbladder is one of the most common reasons for malfunction. These blockages are caused by gallstones.

Gallstones (hard deposits within the bile) can get stuck inside the gallbladder or the biliary ducts and can cause nausea, bloating, vomiting and/or sharp abdominal pain (again, very similar to IBS). If you have gallstones, your healthcare provider may recommend your gallbladder be removed.

But it’s important to understand that surgical removal of your gallbladder has more side effects than are often communicated (mostly GI-related) and requires dietary changes post removal. It would be helpful to ask your healthcare provider to review the non-surgical options available to you that can get rid of the gallstones without having to deal with the aftermath of losing your gallbladder.

Some of those non-surgical options include:

Medication: some medications can be used to dissolve gallstones. But obviously, side effects of these medications would need to be considered.
ECSWL: Extracorporeal Shock Wave Lithotripsy: uses shock waves to break down the gallstones (can do the same thing with kidney stones)
Endoscopic Drainage: Use an endoscope to pass a wire through the common bile duct into the gallbladder and it helps it resume normal drainage.

If the presence of inflammation has been determined as the cause of malfunction, you don’t have to jump to removal as your first option either. Individualized care with a registered dietitian to explore dietary treatment approaches is the best first step to take in this situation.

Your dietitian will assess your current diet for possible triggers and help you modify your intake as needed to help reduce symptoms as inflammation ideally resolves on its own. It may help to look for causing of inflammation, including infections, smoking, etc. with your doctor.

Some ways this could be done are by:

Decreasing intake of high-fat foods
Reducing alcohol intake and smoking cessation (if applicable)
Incorporating Mediterranean Diet principles

The Mediterranean Diet is a plant-forward diet encouraging the daily intake of fruits, vegetables, whole grains, nuts and seeds. It focuses on healthy fats from fish and oils instead of red meats. These unsaturated (healthy) fats can help reduce inflammation and damage done from inflammation in the body.

If you have already had your gallbladder removed and are experiencing worsening symptoms, don’t be discouraged!

Approximately 25% of people who have their gallbladders removed report frequent, recurrent issues with diarrhea. This is because, now that the gallbladder is removed, there is now nowhere for excess bile to be stored and slowly released as needed so more bile is released into the intestines. This excess in bile produces watery stools that are often frequent and urgent. For most individuals, this condition resolves itself over time. For those with IBS (most likely IBS-D) this can make symptoms worse.

There is an area of research that is gaining more attention (but still little as of this moment) and maybe the actual reason symptoms worsen after gallbladder removal. BAM stands for bile acid malabsorption. This is a condition that involves a dysfunction in the way your intestines process/reabsorb bile acids. In normal, healthy individuals, after bile is released into the intestines to help digest meals containing fat, the bile acids are reabsorbed and taken back to the liver where they are recycled.

This process can happen up to 6 times in a 24-hour period. So normally, a very small amount of bile acids stays in the large intestine. But if you have BAM, there is a dysfunction in the resorption process and therefore you have more bile acids in your large intestine, which causes diarrhea. This can be improved by the use of certain medications that help bind the bile so it is removed more slowly.

Treatment options should be based on the primary cause of the gallbladder attack, which is why a thorough investigation into your symptoms and GI tract are key. Having a registered dietitian as part of your healthcare team is essential whether you are post gallbladder removal or trying to get a correct diagnosis and plan in place.

If you’re interested in working with a dietitian on our team, you can start with a consult call here.

And what about bile?

Bile can play a role in digestive symptoms and gut function, even outside of gallbladder function. Learn more about the role of bile in the The Gut Show episode below. You can also listen on iTunes or Spotify.