I had my gallbladder removed three weeks ago. I am having diarrhea, and it is pale yellow. Is this common?

P.B.

Diarrhea after gallbladder surgery (cholecystectomy) is common. The function of the gallbladder is to store bile, which contains digestive salts made by the liver. During meals, the gallbladder releases the stored bile salts into the intestine to help with digestion. After food is digested and absorbed in the intestine, the bile salts are also reabsorbed and recycled. Following a cholecystectomy, the liver must make more bile salts, and more are released between meals because there is no place to store them. The increased amount of bile salts can sometimes overwhelm the intestines' capacity to absorb them. In turn, the unabsorbed bile salts can prompt the colon to secrete fluids, leading to diarrhea. This scenario is benign, and it does not get worse.

Interestingly, some patients who tended to be constipated before their surgery are actually happy about this side effect. Certain medications, such as Questran, that bind the excess bile salts can be given to patients who experience severe diarrhea.

In your case, since the diarrhea occurred so soon after the surgery, other factors must also be considered. These include new medications you may be taking or an infection that may have been acquired in the hospital. You should discuss your symptoms with your doctor, who will do the appropriate diagnostic testing.

Other gastric symptoms are also common after cholecystectomy, and are often lumped together under the term "post-cholecystectomy syndrome." The most common symptoms include right-sided abdominal pain, flatulence, bloating and nausea. The reason for these symptoms is unclear, but generally they have no relation to the surgical procedure. Often they were present before the operation and may have been the reason that diagnostic tests were done in the first place. They may have been mistaken for gallbladder symptoms, which leads to the operation. But since gallstones are so common, finding them does not necessarily mean that they are the cause of a patient's symptoms -- so removal of the gallbladder may not eliminate the problems after all. In some cases, these are new symptoms and may indicate disease in another organ that must be investigated.