Hello Group,

I found most of my diarrhea is due to not having a gall bladder.  Some people get along fine after gall bladder surgery, and some do not.  I am one of the ones who does not.  the problem is called Bile Acid Malabsorption (BAM).  The solution is a drug for cholesterol called Welchol.  The use of Welchol for BAM is an off-label use, but many doctors who are familiar with this problem will prescribe it.

Got another solution for BAM?  Be glad to hear it.

MisterT

Hi and welcome,

Sorry that you have to deal with Bile Acid Diarrhea after having your gallbladder removed. Welchol, Cholestyramine (Questran) and Colestid are really the only treatments that I have heard of.

Thanks Jeff!  It is amazing so many doctors have no idea how to treat this.

 

Gastroenterologists generally know that they should rule this out before a diagnosis of IBS, but it seems unless you bring it up they often don't investigate this. There is a diagnostic test called a SeHCAT test which could be used to rule it out. Sadly, I've never heard anyone that has had that.

Good evening, I am a 34-year-old girl and 4 years ago I had my gall bladder removed.
 A year after the removal, morning diarrhea started with what I ate. This lasted about 6 months. 
I had a colonoscopy and a gastroscopy and everything was clear. 
After a year the problem started again and now I'm like this every day with what I eat in the morning.
 I learned about cholestyramine from foreign forums because here in Greece not all doctors know about it. 
I finally bought it and started it 1 month ago from one sachet a day. 
The diarrhea stopped, but the stools are definitely 2-3 during the day. 
Before the removal of bile I had nothing with the intestine. What are we going to do ? it's a hassle..

Edited November 27, 20232 yr by Asimina

Dear Asimina,

Diarrhea after gallbladder removal is unfortunately a risk. It is referred to as BAM (Bile Acid Malabsorption). You are definitely not alone.

Cholestyramine is often prescribed for this. There is a medication that helps with diarrhea, but not for people without a gallbladder.

1. Have you considered increasing the amount of cholestyramine you are taking?

2. Have you considered using loperamide to stop the diarrhea? You would have to figure out the right amount you need without making you constipated.

I had the lab Sehcat done it was the lab draw and of course it was high. Therefore I was started on welchol. It's help some but I still have some issues. Was given questran but I am afraid of getting diarreah again. It it better than welchol?

Also should I take Imodium everyday with welchol?

4 hours ago, cristina said:

I had the lab Sehcat done it was the lab draw and of course it was high. Therefore I was started on welchol. It's help some but I still have some issues. Was given questran but I am afraid of getting diarreah again. It it better than welchol?

That's very good that you were diagnosed properly with a SeHCAT test. Many are not.

I have never used welchol, but have used questran. I find when you get the questran dosage right it is constipating. If welchol is like questran than I don't believe you will need imodium with it. It might make you too constipated.

1 hour ago, Jeffrey Roberts said:

That's very good that you were diagnosed properly with a SeHCAT test. Many are not.

I have never used welchol, but have used questran. I find when you get the questran dosage right it is constipating. If welchol is like questran than I don't believe you will need imodium with it. It might make you too constipated.

I was really tested per my request. Like a lot others I was told I had IBS-D which all they gave me didn't work. I also had all kinds of tests and even a colonoscopy. Of course they didn't find anything wrong and since my symptoms didn't go away I did some research and found out about BAM due to gallbladder removal. Never heard of that before. I urge anyone with those symptoms to push the test or even try bile acid binders. Thanks for the input about the Imodium

I had debilitating IBS-D for years.  I was getting close to abandoning my 20+ year teaching career because my flare-ups were so severe that I literally could not do my job. Then, the pandemic hit, and I was able to work from home.  I managed to keep my work-from-home gig for two years, but eventually, like many others, I was ordered back to the physical classroom.  I started combing the internet for a miracle cure because I knew I would not be able work at a job where bathroom access is very limited. I read about BAM and wondered if it could be the cause of my symptoms. I scheduled an appointment with my GI doctor and asked her if she would prescribe cholestyramine. She agreed to let me try it and also prescribed Align probiotic.  I take Align every morning and cholestyramine powder in juice once in the a.m. and once with dinner.  The improvement in my symptoms is extraordinary.  I teach every day with no problems, and I actually have a social life.  I still have some trigger foods that I avoid, but for the most part, I am normal.  I am taking the time to post because I am hoping that others who are suffering can benefit from my experience.  I strongly recommend cholestyramine and Align. If you are suffering with IBS-D, I suggest that you at least give this protocol a try.

On 11/27/2023 at 8:30 AM, Asimina said:

Good evening, I am a 34-year-old girl and 4 years ago I had my gall bladder removed.
 A year after the removal, morning diarrhea started with what I ate. This lasted about 6 months. 
I had a colonoscopy and a gastroscopy and everything was clear. 
After a year the problem started again and now I'm like this every day with what I eat in the morning.
 I learned about cholestyramine from foreign forums because here in Greece not all doctors know about it. 
I finally bought it and started it 1 month ago from one sachet a day. 
The diarrhea stopped, but the stools are definitely 2-3 during the day. 
Before the removal of bile I had nothing with the intestine. What are we going to do ? it's a hassle..

Hi Asimina 

well done on figuring it out 

I have  someone in greece who would benefit from this medication . do you know if celesevelam and or chloestyramine is available in greece and if yes under what names? any tips on how to get them at a cost effective way ?

regards julie

 

I am 76. Had my gall bladder out in 2020. 6 months after I started having IBSD issues. 3 Gastroenterologists later I was still suffering.  Finally my PCP prescribed cholestyramine.  The right dosage took a while.  But it helped. Didn’t realize you had to stay on it forever.  Question? Does anyone have incontinence and urgency?   It’s awful.  Humiliating.  Embarrassing. ☹️

Hi I am 67 and I was finally diagnosed with BAM after suffering for over 20 years with faecal incontinence. A former nurse who had become my friend diagnosed me having listened to my medical history I was treated for cervical cancer in 2003.  I went to my GP armed with her notes and after a SeCat scan it was confirmed. Colevaselam tablets have transformed my life. I do still have episodes triggered I think by eating over my 40 grams of fat per day. The one side effect of the medication is smelly wind which is so embarrassing and I wondered if anyone has any suggestions about how to reduce the smell? I keep wondering if I should stop reduce the amount of fruit and vegetables in my diet as I wonder if maybe they cause the foul smell, it seems worse when I got to bed and lie down. Any suggestions would be greatly appreciated. 

s 

On 6/30/2024 at 5:55 PM, julie halliwell said:

Colevaselam tablets have transformed my life

How wonderful to hear. The bile acid sequestrant does seem to make you very gassy., I have never had an odour with it so that's unfortunate. I agree, when lying down a lot of gas is released.

Hi people,

I'm have to share this info and my story. I have had BAM for 3 years now and been dealing with constantly thinking about being near a toilet every time I eat something. I have been taking cholestyrelamine before I eat but the fact that you have to figure out how much to take every time and the fact that you don't really know if you are gonna need a toilet within approximately 10 to 60 minutes is life draining. I have been so irritated and just not myself since I got the diagnosis.

I June 2024 I went to the doctor because I wanted to loose some weight and my BMI was just within the limit for getting Wegovy in Denmark. I didn't know what to expect but I can tell you that I wasn't expecting what happened.

Since I started Wegovy in June I haven't used the medine Cholestyrelamine at all and I'm not running to the toilet all the time and I can again eat in public without thinking about where the nearest toilet are.

I have gotten my life back and I'm happier than ever. Im cured.

The way I see it is that normally people reabsorp about 95% of their bile acid and I reabsorped about 5 %.

If you see your intestines as a conveyor belt and the reabsorption percentage as workers the you have 95 workers working at the conveyor belt going at a normal speed picking up the bile acid. But I had only 5 workers at my conveyor belt doing the same job. Therefore getting diarrhea every single time I ate.

But after I started on Wegovy something happened.

One of many benefits with Wegovy is that the food pass through the intestines slower that usual and therefore getting my 5 workers at my conveyor belt more time to pick up my bile acid from the intestines before the food passes through which means no more diarrhea.

I don't know if it can work for everyone, but it's worth a try. We have a diagnosis that at this time can't be cured.

Hope it can help some people out there like it did me.

I finally got my life back.

 

BAM is not commonly diagnosed in the United States because the SHeCat test isn't FDA approved and is very expensive. There are only about 4 facilities in the USA that will administer the test. I had my gallbladder out years ago. No real problems. Some bouts that were diagnosed as IBS-D. But I had a partial Nissan Fundiplication in November 2023 and I've never been the same. Full blown BAM. Lost 35 pounds in a year and I was not overweight to begin with. So what I have learned during this journey is that sequestrants can quit working. They can also cause diarrhea. Someone mentioned semiglutides. There are research articles that concur this can be effective. It is not an option for me because I'm already struggling with weight loss. There are a few other treatments out there that offer liver and pancreatic support. If you are in America, you will need to take charge of treatment. My GI and my GP both told me they'd never had anyone with this. I told them both that they had, but the diagnosis wasn't correctly made. I've been lucky that both my doctors have embraced this and are researching it. And just for context, I don't live in rural America. I'm in a major metropolitan area. 

I can sympathize with your situation as I too suffer with the weight loss issue. No matter how hard I try I can't even get to 110. Started this journey several years ago and am only at 103.5 now and I'm 5'2 1/2" tall. I'm very concerned now that it's really taking a toll on my system due to it being deprived of nutrients. I am not as fortunate as you as I have yet to find a doctor who gives a damn. I mean really why do they even become doctors? All they want to do is shove medication at you. I just found out that I have osteoporosis as well. My newly acquired PCP is not even concerned with my weight loss but instead tried to push me towards taking Boniva for the osteoporosis. It has the absolute worst reviews is very expensive. I don't have medical insurance to cover prescriptions which is another issue. I have worked all my life and now I don't even have insurance to cover prescriptions. Currently I'm looking into metabolic issues to hopefully give me some relief. I thought I was anemic and my doctor is almost refusing to test me for it! Do you believe that? I did all the work for her with regard to research and told her what I needed and she said ok. I then left her office only to find out that she lied. I'm totally giving up on this so-called traditional medicine. She has already given up on me after 1 visit and recommended I see a homeopathic doctor which I cannot afford. This road we're on in awful. I'm praying that somehow Robert F. Kennedy, Jr. puts us all on the road to recovery. Wishing you the best. 

@Jeep Girl I completely sympathize with you. Primary care physicians deal with a lot of issues and usually aren't experts on everything. I too have been pushed aside despite my own research that I have presented. It's frustrating as hell.

I too am underweight. It's something that I have to constantly work on. I'm 5' 9" and 130 lbs so I get the constant worry about it. No doctor has ever been concerned about my weight though my GI doctor always remarks at how think I am. I recently discovered OWYN protein drinks and they help me maintain my weight without any real GI side effects from it. Maybe that is something you could try. It's not cheap.

I'm not sure that government intervention is going to change medicine. I believe it has to come from the doctor's associations and medical schools to train doctors differently.

Hello there!  I've been reading the posts in this forum, but I'm still quite confused.  If BAM is when bile acids aren't properly absorbed in your intestines, then how does having had your gallbladder removed fit into the equation?  I tend to think that, having had my gallbladder removed, I don't have a sufficient amount of "stored up bile" on-hand to help me properly digest fats, resulting in diarrhea after I eat high amounts of fat.  Could it be that my understanding is incorrect, and that it's not a matter of me having "not enough" bile acid, but that my altered "release" of bile acid is the problem?

It seems counterintuitive that if I have too little bile acid (because of gallbladder removal) that a solution would be to sequester (remove) bile acids. Don't we need bile acids to properly digest (and benefit from) fats?  This is a crucial question for me because I'm trying to follow a ketogenic diet. Thanks very much for any insight you kind folks can provide!

Edited June 17, 20251 yr by Julie C.

@Julie C. My understanding is that the gallbladder stores bile, made by the liver, and it is released during a fatty meal. Since your liver makes the bile, once having your gallbladder removed, you are relying on your liver to make enough bile to digest the fat. Sometimes too much or too little is released. It's unclear exactly what is going on after the gallbladder is removed. My hunch is that more than the usual amount of bile is being made and released and this is acting as a laxative in your large bowel after your gallbladder is removed. Some people have no problems after their gallbladder is removed. Some do and they get labeled as having IBS.

Your questions are completely valid. I have used a bile acid sequester to help with diarrhea and I do not have BAM. The bile acid sequester must be doing more than just binding to what little bile is there. I think we also have to consider that bile is used during digestion in the small intestine. The problem that I use the bile sequester for is excess in the large intestine.

If you would truly like to understand this better, I would email Dr. Michael Camilleri at the Rochester, MN Mayo Clinic. His email is readily available online. He is probably the top US BAM expert in the country.

I had gallbladder out when I was in my thirties. Did fine for awhile and then diagnosed with Crohn’s disease several years after that. Went on steroids and Crohn’s medicine for several years and ended up having my Ilium removed did fairly well as long as I kept with my medicine and then about four years ago, I developed chronic diarrhea and nothing would stop. It went into the hospital and two a bounce back unit and the hospital twice and finally was diagnosed with Bam. I took the powder medicine for sometime, but it would always get me so constipated, even no matter whether I lowered the dose or not now I am taking anti-diarrhea medicine and trying to manage my diarrhea that way any suggestions? I’m now 74 years old and I’m afraid to go out of the house too far because I have no control over my bowel movements.

On 4/12/2026 at 2:56 PM, Clauudia Rose said:

I had gallbladder out when I was in my thirties. Did fine for awhile and then diagnosed with Crohn’s disease several years after that. Went on steroids and Crohn’s medicine for several years and ended up having my Ilium removed did fairly well as long as I kept with my medicine and then about four years ago, I developed chronic diarrhea and nothing would stop. It went into the hospital and two a bounce back unit and the hospital twice and finally was diagnosed with Bam. I took the powder medicine for sometime, but it would always get me so constipated, even no matter whether I lowered the dose or not now I am taking anti-diarrhea medicine and trying to manage my diarrhea that way any suggestions? I’m now 74 years old and I’m afraid to go out of the house too far because I have no control over my bowel movements.

You might see if your doctor would be willing to try you on Viberzi. I have Crohn's disease and IBS-D and take it. You must have a gallbladder to take the medication. I do not take a full dose of 75 mg or 100 mg twice daily. I often using 37.5 mg or 75 mg once daily.

Hi, yes I am new here. My name is MARTHA. I just read what you wrote and I have been on vibrissa for many years and I have no gallbladder but my doctor never said anything about that. They just said everything seems to be OK now you’ve got me wondering fiber is good, but doesn’t always stop the diarrhea. I am home now for the last three days with a bout of this, it is terrible. I know the feeling of being isolated and can’t leave your house and of course your job never understands. I feel so isolated and so mentally depressed. I wanna be out there doing things that I can’t and I don’t know what to do.

Hello everyone!

I am new at this, and I would like to join this online community of people suffering from BAM (Bile Acid Malabsorption). I have tried bile sequestrants, Coveleselam but I really didn't like the side effects of this medication, (abdominal cramps, frequent headaches, not feeling right all the time). My symptoms are more like frequent bowel movements, rather than watery diarrhea, especially in the morning. But the main issue with me is daily lower abdominal pain, especially after eating and even after drinking water, that lingers through the day. I also have gas and gas pain, as if gas was trapped inside and bloating. My pain radiates in the lower abdomen/pelvis/bladder and sometimes vaginal. I realize that a lot of the pain I feel is referred pain of nerves radiating to the adjacent organs in the pelvis area. It's like a burning and a pressure. So, I recently switched to psyllium husks and found that it pretty much does the same as bile sequestrants but it is a little bit more tolerable since it feels a bit more natural to my system. I also take a mild dose of Desipramine that has anticholinergic effects and helps to calm down the strong gastro-colic reflux due to its anticholinergic effects. Sometimes, I wonder if my pain is caused to what I suspect could be disbiosys and or SIBO. I am due to do a second SIBO test soon, the first one I did was about 2 years ago and it was negative. This problems started about 2 years after having my gallbladder removed. It is unfortunate that USA doesn't really perform SeCATH test, because I am still not sure what's going on with me. I would love not to have pain anymore because it's very uncomfortable and has totally changed my way of socializing and eating, since I have a very low fat diet and cannot eat any dairy anymore. I have seen many gastroenterologists, GI, in the past and feel that doctors don't really take these condition seriously. Needless to say, that's very unfortunate for us suffering with this horrific condition. I had to quit my job because the stress of work made things much more unmanageable for me, and lost 15 pounds. Any "tips" shared experiences, and support is appreciated. Thank you! Rita