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Cholecystectomy, the removal of the gallbladder, has a way of causing one of two extremes in bowel regularity. Either you have to go all the time, and you tend to have green watery poop, or you get really constipated, maybe even wondering if you will ever relieve yourself again.

The reason your bowel function changes after you have your gallbladder taken out is that you no longer have a reservoir of bile. When you have an intact, functional gallbladder, it can store the green unpleasant substance (leaking bile can cause a burning sensation) to deliver a dump to the bowel when you eat a fatty meal. That's part of what bile does: It helps fats dissolve in the mostly-watery environment of the bowel. With the help of bile, globules of fatty acids can be absorbed the the bloodstream and sent to the cells that use or store them. But if you don't have a reservoir of bile, you may not have enough bile to dissolve the fat digested out of your food so it can be taken into the bloodstream.

Undissolved fat tends to float on top of the other liquids in your bowel. When it is finally forced out of your bowel through bowel movement, it will float at the top of the toilet bowl. This fat also tends to have a strong odor. Because the fat your body can't absorb doesn't mix with the rest of your waste products, you tend to get a kind of cement of fiber with a head of smelly fat. It's not a pleasant experience.

Changes in bowel function after gallbladder surgery tend to follow a predictable pattern:

  • The first few days after the surgery you aren't likely to have much bowel movement. Chances are you didn't eat much just before you had your gallbladder taken out. If you are a typical resident of the English-speaking world, you don't get a lot of fiber in your diet, and it may usually take three to four days for your bowel movements to restart simply because you haven't been eating. People who eat fiber-rich diets may poop as soon as 18 hours after eating, but most people in the modern world don't get as much fiber as they need.
  • If you have laparoscopic surgery, your belly will be bloated with the carbon dioxide injected to give your surgeon a clear view of your gallbladder. It takes two or three days for this to subside.
  • After you have been eating for a few days, you may experience diarrhea. That's because your liver is still making bile and the inflammation to the bile duct, which is still there, has held it back. (It's also possible to have gallstones outside your gallbladder, but your surgeon will have at least noticed them.) You get squirts of bile that cause you to have to race to the toilet with squirts of greenish feces.
  • You stop making green feces as your bile duct also heals. At this point, you may become constipated as your liver adjusts the schedule on which it makes bile.

Managing constipation after cholecystectomy involves the usual eating more fiber and drinking more water, with an added restriction. You just can't eat fat like you used to. If you do, you'll tend to get constipation. You can get so constipated that your bile duct gets backed up and bile doesn't get through to its destination in the duodenum (the small intestine just below the stomach). When it does finally get into the gut, you'll have a sudden urge to go but your abdominal muscles may have to work extra hard to remove the impacted feces. The result is intense abdominal pain.

There is a relatively simply way to avoid this problem. Follow your diet. Eat small meals. Stay away from burgers and fries, butter and chips. The first time you are constipated. do everything you can to get regular again, and be absolutely, positively sure you don't eat too much or eat a lot of fat. It's much better to treat a small case of constipation early than a bad case of constipation late.


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