Obviously, you can survive without a gallbladder. Otherwise, gallbladder removal (cholecystectomy) would not be such a common surgery. In fact, over 600,000 people in the U.S. have their gallbladders removed yearly. However, surviving without an organ and living a healthy life without it are two very different things.
Following a cholecystectomy, you are more prone to developing certain health problems. For example, you are at greater risk of developing a fatty liver, diarrhea, constipation, biliary issues, indigestion and developing deficiencies of essential fatty acids and fat soluble nutrients. Bile, which is necessary for digesting fats and proteins and metabolizing fat soluble vitamins and minerals, is no longer stored and concentrated in the gallbladder. This can lead to unpleasant symptoms.
When your body is void of a gallbladder, bile freely flows from the liver to the bile duct, exiting through the sphincter of Oddi into the duodenum (the first part of the small intestine). The high-water content of bile is no longer removed and overly concentrated bile is not conjugated in the gallbladder.
Change in bile chemistry isn’t the only thing that occurs after cholecystectomy. Surgeries are never perfect and fool-proof. Therefore, human error can bring about injury to the ducts. Adhesions (scar tissue) can form following surgery and some people are more prone to developing them. A remnant cystic duct (the duct that once connected the gallbladder to the common bile duct) may cause problems. Also, dramatic changes may occur within the liver itself due to the absence of a gallbladder.
Any health issues or symptoms arising because of gallbladder removal is called postcholecystectomy syndrome. Postcholecystectomy syndrome describes the appearance of symptoms after cholecystectomy. It is widely estimated 10-15% of the population experience some form of postcholecystectomy syndrome, but Merck Manual estimates anywhere from 5-40% of cholecystectomy patients are afflicted. Isn’t it interesting that a seemingly disposable organ could wreak such havoc on our bodies once it is removed?
The most common causes of postcholecystectomy syndrome relate to the change in bile flow and concentration, complications from surgery (i.e. adhesions, cystic duct remnant, common duct injury), retained gallstones or microscopic gallstones (biliary sludge), effect on sphincter of Oddi function, and excessive bile that is malabsorbed in the intestines. Jensen, et al described in their research paper, Postcholecystectomy Syndrome, over 60 different etiologies of postcholecystectomy syndrome.
Diagnosing Postcholecystectomy Syndrome
If you are experiencing troubling symptoms following a cholecystectomy, talk to your gastroenterologist or primary care doctor. He/she will likely order blood work, specifically liver function tests. In addition, you may want to ask that your vitamin and pancreatic enzyme levels be tested, since bile is required to metabolize fat soluble vitamins like vitamins A, D, E and K; and some postcholecystectomy issues affect pancreatic enzyme output.
Depending on the results of your bloodwork, your doctor may order an imaging study (x-ray, ultrasound, MRI, or CT scan), a functional test (gastric emptying study or small bowel follow-through) or a procedural test (endoscopy, colonoscopy, barium enema). If these tests are inconclusive, your doctor may want to conduct a more in-depth procedural test like an endoscopic ultrasound or Endoscopic Retrograde Cholangiopancreatography (ERCP) to get a better look at the ducts, liver, and pancreas. In rare cases, your doctor may recommend exploratory surgery.
There are also alternative tests a naturopath or functional medicine practitioner could offer, i.e. comprehensive stool analysis, or hormone and nutritional tests. Keep in mind that for some postcholecystectomy patients, the answers to your symptoms may not be revealed in typical bloodwork, scans, or procedures. Tests are not fool-proof for all patients. Many patients have disabling symptoms and their bloodwork and scans are normal. “Normal” test results can come as a relief. However, when you do not get an answer to your woes, it can be quite frustrating. This does not mean, though, you can’t treat your symptoms.
Treating Postcholecystectomy Syndrome
The most common postcholecystectomy issue is bile acid diarrhea. Because bile is being dumped and no longer processed, the intestines receive an excess of bile or bile that is difficult to reabsorb. This may cause moderate to severe diarrhea in some people, especially after eating.
Ask your gastroenterologist or primary care doctor about prescribing cholestyramine, a bile acid binder. It will bind the bile acids and, in most cases, reduce this form of diarrhea. Always pay attention to side effects like constipation, bloating, or flatulence to gauge how much cholestyramine is appropriate for your individual situation. If the cause of your diarrhea originates from bile, cholestyramine will likely help you. If the cause of your diarrhea is from irritable bowel syndrome (IBS) or another cause, this therapy will not be effective. For other forms of diarrhea, you may need an IBS-specific medication or natural therapy.
Another postcholecystectomy issue, mostly affecting women, is Sphincter of Oddi Dysfunction (SOD). SOD symptoms are upper right quadrant pain, nausea/vomiting, bowel, and other issues. For more information on this condition, read my article, Sphincter of Oddi Dysfunction, or go to the SOD Awareness and Eduction Network website. In addition, I published The Sphincter of Oddi Dysfunction Survival Guide this past summer.
Microscopic gallstones and biliary sludge can cause problems too, but is difficult to diagnose unless you have an ERCP. If you have constipation, upper right quadrant pain, and nausea, you may have biliary sludge. If you and your doctor suspect this, he may want to prescribe ursodeoxycholic acid, which reduces the cholesterol content in bile. Alternatively, an ERCP can clean out the duct.
Consult with a natural health practitioner if you’d rather go the holistic route. He/she can prescribe the essential fatty acids Omega 3 and 6 (bile is needed to convert these fatty acids), digestive enzymes, a bile replacement supplement, homeopathic remedies, and/or herbs (ex. dandelion, milk thistle, turmeric, peppermint, and bitters). In addition, chiropractic, acupuncture and Chinese medicine, and other natural therapies have helped people with postcholecystectomy syndrome.
General Diet and Lifestyle Remedies
After I had my gallbladder removed, I had to change my eating habits to avoid unpleasant symptoms. Overeating spelled disaster for my strained liver, pancreas, and ducts. It is best to try to eat several small meals a day or eat smaller portions at breakfast, lunch, and dinner. Going too long without eating is also bad as our bodies signal bile to be released at certain times of the day. Not eating can lead to bile acid diarrhea and intestinal discomfort.
Don’t eat fast. Instead, chew your food thoroughly and take your time. This will benefit your entire digestive tract and organs so they don’t have to work as hard. Your digestive system starts in your mouth where enzymes are released to start the digestion process. Taking the time to allow these enzymes to mix with your food is essential for proper and thorough digestion.
Eat a low-fat diet. This does not mean you should avoid all fats. Instead, be mindful of the amount of fat grams you ingest, especially saturated fats. The Mayo Clinic recommends keeping fat intake under 3 grams per meal and snack. Greasy, fried food may no longer be your friend. It is wise to hold off on re-introducing fatty foods high in saturated fats. If you don’t, you may experience pain, gas, or diarrhea. Some of the worst offenders, besides fried foods, are cheese, fatty luncheon meats or sausages, hot dogs, fatty pieces of steak, dark meat portions of poultry, butter, and all oils except medium-chain triglycerides (MCT) oils. MCT oils, i.e. coconut and palm kernel oil, do not require bile for digestion.
The juice of certain vegetables can do wonders for the liver and biliary system. Beets, apples, and ginger all support bile formation. Beets are probably the best vegetable for your liver as they contain important liver healing substances, including betaine, betalains, fiber, iron, betacyanin, folate, and betanin.
Betaine is the substance that encourages the liver cells to get rid of toxins. Additionally, betaine acts to defend the liver and bile ducts, which are important if the liver is to function properly. Additionally, beets have been linked to the healing of the liver, a decrease in homocysteine, an improvement in stomach acid production, prevention of the formation of free-radicals in LDL, and the prevention of lung, liver, skin, spleen, and colon cancer.
Apples contain malic acid which helps to open the bile ducts that run through your liver and reportedly soften and release the stones. Apples are also high in pectin. Ginger is reported to increase gut motility and bile production. You can add ginger to food dishes or eat it raw. I prefer to juice ginger and drink a small amount of the extract. The extract can also be added to juiced fruits and vegetables. Be careful, though, as it is spicy and pungent. You only need a small amount.
Other foods reported to protect the liver and increase bile production are bitter foods such as dandelion and mustard greens, radishes, artichokes, fruits high in vitamin c, and cruciferous vegetables such as broccoli, cauliflower, and cabbage.
Stay tuned for my next book, Living Well Without a Gallbladder: A Guide to Postcholecystectomy Syndrome, which will be published Summer 2017.
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This article was published originally on January 30, 2017.
It is 2023 I had my gallbladder taken out on January the 10th. Four days went by and all of a sudden I just blew up like a big balloon. I went to call the paramedics to come and get me and take me to the hospital, all I was asking them for was zofran for nausea and morphine. When I called my doctor on Friday it was another doctor that was supposed to fill in for him for the weekend. She never called me at all so I went through four emergency rooms asking for morphine and zofram. They thought that I was a morphine addict I am 69 years old and I am a retired builder, I also loved renovating houses and I did that until I couldn’t do it no more. I went into Emory emergency room again severe pain The doctor had left a 2 mm stone in my bile duct, on his documentation he said he looked, if he would have looked he would have seen this. Doctors have malpractice insurance and guess what The lawyers won’t touch this case at all. Still waiting for the next surgery for them to take the stent out of my bile duct. At this point I do not trust no one except for God. I hope this never happens to anybody that reads this post. I was referred to this doctor from my primary care doctor. Who I love and he looks and he takes care of me. This other doctor made a big mistake and it just about killed me. I used to weigh a 137 lb now I weigh 124. Going by a strict diet right now. I hope this never happens to anybody in their life, but things like this happen all the time. Not looking forward to the next surgery at all, but it has to happen, they’re going to take the stent out of my bile duct. I have never had pain like this in my life One day I pray this will all be over. Thank you for letting me post this on this app. Only God can deal with these problems that we have, he has the power over all. This is all I have to say about this situation, and I pray no one goes through this much pain at all. Denise.
I had open gallbladder removal surgery 6 months ago and the Dr had to use some of my small intestine to use and I still can’t laugh cough or sneeze without it hurting
I have had my gallbladder removed in March 2022 I am in cntain pain in my side and pain in my back it is so sore I have got tests done they are clear cannot stick this pain can I buy your book I book shop not good at Internet take care thank you
Eight month ago had Gb removal from day one I have been having stinging pain at the site ,back pain on my left side had ct scan found nothing this terrible regret having this surgery corl
I wonder why I am having pain where my liver is. It’s been 2 weeks since my surgery for gallbladder removal and I also had a ct scan showing irritated liver and she said it was a little big. Also said my liver enzymes was slightly elevated. Anyone have these troubles ?
Yes though I have not had any scan or aftercare. Thank you I might call my gp,I have alsort of pain since my op nearly two weeks this Friday.
2 weeks after having my gallbladder removed I started having the same pain in my upper right side again, it’s a Constant pain that doesn’t go away until I get home and start to relax and then it goes away. It mainly bothers me more when I am working . I don’t know what else to do about the pain.
I’m having the exact same problem! I just had a ct scan to see if I had a hernia. Just found your comment. Aside from the vomiting I’m not better off from having mine out.
I had gb surgery in 2015, now I have to carry extra clothes, every meal goes through me, and I hurt between my breast bone and have trouble breathing. can’t walk because I can’t get my breath. never had that before. I was walking 10 miles a day. now I can’t breath to go to mailbox
I have similar symptoms withexceesive acid reflux. I went on plant based diet and it helped a lot. I find that drinking sage tea and eating oatmeal everyday helps with the constipation and acid reflux.
I had gallbladder removed over 10 years ago. Over the years my symptoms have got worse. I have terrible bloating where I look 6 months pregnant all the time. I have excessive belching which is just plain air. I have constipation. Dietary changes have not helped me. Low fat and low fodmap diet. I also find it hard to lose weight. Anyone else suffering with this? Doctors are not helping.
Had GB removed only because Dr. said wasn’t functioning,only at 2 % never any pain. Had removed
And hasn’t been right since, can’t eat anything diarrhea, even when I don’t know I have to go. Middle
Of the night while walking for excerise. Never know when I will have a bowel movement.
I had gallbladder surgery 10 months ago. Now iam feeling burning pain in stomach like ulcer. How can I treat this .
My gallbladder surgery it’s been going on six years and I have diarrhea so bad I can’t work a public job anymore because of it I retired 2018 had a complete hysterectomy and my diarrhea is worse now . I am 59 years old in July I will be 60 years old, I have arthritis now . Nothing has helped
Try eating raw beef and drinking raw milk for a week. Have nothing else except water, see how you fare.
Why these foods? They are, when raw, the most easily digested, most nutritious foods on earth.
When your digestive system has calmed down try adding other enzyme rich foods like raw oranges, bananas and berries.
Later you can try adding boiled peeled potatoes and home-made sour-dough bread if you’d like.
From there on out, if your system remains calm you can probably eat a little of what ever your body craves. I wish you health!
I had my gb removed in January of this year. I had one gallstone and sludge and the gb was irritated. They removed the gb and I felt great for 3-4 months. Then I began feeling sick. Minor nausea, upset stomach, diarrhea. Doc gave me cholestyramine for the bile diarrhea and that is now controlled. I still feel somewhat sick to my stomach on and off though with tenderness and a stinging/burning pain in the upper right quadrant. All tests of stool, bloodwork, colonoscopy, endoscopy and xray have come back normal. Doctor says there is nothing wrong with me. I wonder if I might have some sludge in the bile ducts? I might get this book and see if I can help with dietary changes. I waste so much time researching this and thinking about why I feel bad and the doctor is no help.
Try castor oil pack over the liver and add a supplement. I use Beta plus by Biotics. Ox bile helps significantly.
Hope that helps
is your buring on your right flank? i have that same issue might be sphincter of oddi type 3 most people take nerve pain medicine like gabapentin or also cud be chrons close to the ilelium. so confused it bugs me makes me sweat at night.
I had my gall bladder removed about 10 years back by laparoscopic surgery. Before the removal, my biliary duct was cleaned of any sludge. I had no problems after that. More recently on CT scan, pneumobilia was noted. The doctor says it is no problem. Will it turn into some problem in future? The air bubble in the duct must be reducing the flow of bile into my dudenum. What is the effect of that?
would love to be able to read replies to previous comments
Brooke, have you come across any homoepathic remedies for dealing with Postcholecystectomy Syndrome.
I am looking for research on this matter and have not come across anything.
I had my gull bladder removed 8 years ago. My life has been hell ever since. I get this bad stabbing pain where the abdominal incision is, doctors can’t pin out what is it. Life has been on hold for 8 years, I won’t have children because I’m afraid and I can’t work. So disappointed because my surgeon said I would be pain free after my surgery.
Was your surgery an open surgery? It could be abdominal adhesions (Scar-tissue). There is a youtube video by Dr. Fatah Entabi on abdominal adhesions. Adhesions.org also has a lot of information on abdominal adhesions.
thank you for this article, it is very informative, well written and easy to understand, i appreciate it much!!
I’m confused on one item in this article. It says that after gallbladder removal bile is dumped into the system as a constant stream which can cause problems to the lining of the gut. But then it says in the last part of the article what to eat to encourage bile production….beets, ginger, apples. My question is why would I want to eat these things if it’s going to encourage more bile to be going straight into my gut?
Thanks! I’m going to get your book as I have constant lower abdomen pain for a year now (it started 1.5 years after GB removal)
I read that even though bile is produced constantly there is never very much at one time. So when you eat you don’t get a lot of bile to help digest food adequately like you did when you had a gallbladder.
Where can I get your book?
Living Well Without a Gallbladder is now available on Amazon, Barnes and Noble, Ibooks, and more. Just plug in the name to the search area for these stores. It is available in paperbook and ebook formats.
Thank you for this article. I have a question for you. I had my gallbladder removed back in 2010 with no side effects what so ever, actually never felt better…. Until the past four months I have been in the ER multiple times due to dehydration and stomach issues. Have recently been diagnosed with a duodenal ulcer, esphagatis and gastritis. I had someone tell me that they went thru the exact same thing a couple of years after they had there gallbladder removed too and told me that she drank a case of water that had alkaline in it and in 12 days she was back to her self. I am just wondering if you have heard of this and know it it good for you. Sorry, but I can not get into a gi specialist for another week and I am so tired of feeling this way.
Thank you for input, I really appreciate it
I got your book , and it is given me good advice about a lot of things thank you
Thank you for this article and your work! I’m looking forward to your book.