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Digestive Health Special Report

Life Without a Gallbladder

Although 20.5 million Americans have gallstones -- small, hard concretions or stonelike structures that form in the gallbladder -- 70 to 80% don't experience any symptoms. If you're in the other, less fortunate group, in which your gallbladder is irritated or inflamed and causing you pain, your doctor will likely recommend removing the gallbladder entirely -- a procedure known as cholecystectomy. Here’s what you should expect …

Cholecystectomy is a simple surgery, nearly always performed laparoscopically (through small incisions in the abdomen), and the recovery time is just a few days. But what happens once you recover? After all, the gallbladder must serve some important function, right? It does, but you can certainly live a normal life without it. Your gallbladder is similar to your appendix or your spleen -- it's a useful organ, but it's not indispensable.

What Does the Gallbladder Do? The gallbladder is well named: This small, pear-shaped structure located underneath the liver stores bile, also known as gall. Produced by the liver, bile breaks down large fat molecules into smaller ones as the first step in fat digestion. Normally, bile flows from the liver into the gallbladder, where it is stored until you eat. Then a hormone signals the gallbladder to release a pool of bile into the small intestine, where it begins to break down the fat in the foods you've eaten. After the fat is absorbed, the bile is absorbed as well and is carried back to the liver for reuse.

Normally, the gallbladder does a very good job of keeping bile in its natural semiliquid form. The inner lining of the gallbladder secretes hydrogen ions into the bile, which keep it acidic enough to prevent it from hardening. Water and electrolytes from the digestion process also dilute the bile, while salts attach to cholesterol molecules in bile and keep them from crystallizing.

But sometimes these systems fail -- perhaps there is too much cholesterol or bilirubin (a pigment that comes from hemoglobin) in the bile or the gallbladder doesn't empty as it should -- and gallstones form. A speck of calcium in bile becomes coated with either cholesterol or bilirubin, and the bile, which is normally sludgelike, begins to crystallize.

If your gallbladder is removed because of gallstones, you won't miss it greatly, since the gallbladder doesn't produce anything needed for digestion. Your liver will still produce bile, and your intestines will still use it to break down fat. But instead of being stored in the gallbladder and released in a rush when you eat a fatty meal, bile will continuously drip from the liver directly into the small intestine.

For many people with gallstones, a fatty meal triggers a sharp pain. If you've had a cholecystectomy, that same meal may trigger another problem: diarrhea. The severity of the problem can vary greatly: Sometimes the diarrhea goes away shortly after surgery, sometimes it improves over time, and other times it remains a chronic problem.

The good news is that any diarrhea or bloating that occurs will be much less painful and problematic than the gallstone attacks that prompted you to have surgery. Even better news: It may resolve on its own, and if not, it can be treated.

Antidiarrheal medications like loperamide (Imodium) can help, as can a high-fiber diet, which adds bulk to your stool. Another solution is medications commonly used to treat high cholesterol: bile acid sequestrants such as cholestyramine (Questran), which bind to bile and prevent it from being absorbed in the small intestine and returned to the liver for recycling.

Dietary factors haven't been proven to worsen cholecystectomy-related diarrhea, but if you find that the following foods intensify your symptoms, you may want to avoid them: spicy foods, milk or other dairy products, high-fat foods, caffeine or alcohol.

Otherwise, you can live a normal life after having your gallbladder removed. Exercise is safe and encouraged once you've recovered. If you have diarrhea that doesn't improve, talk with your doctor. Persistent diarrhea can be a sign of an unrelated problem, such as irritable bowel syndrome.

Posted in Digestive Health on December 7, 2009

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