Style Selector
Layout Style
Boxed Background Patterns
Boxed Background Images
Brain Body Well ~ Natural & Lifestyle Medicine / Digestive Wellness / Mental Health


CholecystectomyGallbladder removal surgery, known as cholecystectomy, is often hailed as a solution to the debilitating pain and discomfort caused by gallstones. However for some, this relief remains elusive and a continued battle with pain and digestive issues ensues. Considering that the majority of those with gallstones are asymptomatic, persistent pain and digestive problems following gallbladder removal raises even more questions about what really causes symptoms. In this blog we will explore the factors contributing to ongoing (and new) discomfort and how to start getting to the bottom of these issues.

Long-term Outcomes of Gallbladder Removal

A number of studies have looked at pain and digestive symptoms before gallbladder removal surgery and up to 7 years afterwards. A systematic review of these studies found that patients were often dissatisfied with the outcomes which included persistent pain, food intolerances, bloating, diarrhea, constipation, fat intolerance and flatulence.

While upper right quadrant abdominal pain, the primary symptom of gallbladder disease, resolved for the majority of patients after surgery, a significant portion—up to one-third—continued to experience this discomfort. Additionally, some individuals reported the onset of upper abdominal pain post-surgery, adding to the complexity of their symptoms. The most common symptoms reported after gallbladder removal however were diarrhea (up to 85%) and constipation (up to 76%).  Of interest is that these symptoms didn't just fail to go away after surgery, people were more likely to experience them after surgery compared to before.  Of studies looking at new symptoms after surgery, increased flatulence was the most common one shared.

Why Do Symptoms Persist?

To understand why digestive symptoms persist and new ones arise after cholecystectomy, it's crucial to grasp the gallbladder's role in digestion and what actually causes gallstones to form in the first place.

The Gallbladder’s Digestive Function

The gallbladder serves as a reservoir for bile, a detergent-like substance vital for the breakdown of fats and oils. Its primary role is to store and concentrate bile, releasing it following the consumption of fatty meals to aid in proper fat digestion and absorption.

Influence on Gut Motility and Microbes

Bile exerts multiple effects, acting as a laxative while also regulating gut motility, pH levels, and microbial balance. By releasing bile at appropriate times, the gallbladder contributes to the coordination of bowel movements and supports gut health.

Gallbladder Dysfunction and Digestive Issues

Poor gallbladder function is a leading cause of gallstone formation. When the gallbladder fails to contract and empty efficiently, bile stagnates, leading to the crystallisation of cholesterol and the formation of gallstones. This stasis also disrupts the proper release of bile for digestion and the maintenance of gut microbiome balance. Consequently, individuals may experience a spectrum of digestive symptoms, including bloating, flatulence, burping, indigestion, nausea, constipation, and diarrhea. Notably, if these symptoms stem from gallbladder dysfunction pre-cholecystectomy, then they are likely to persist even after gallbladder removal.

Allergic Cholecystitis (Gallbladder Inflammation)

While an estimated 1 in 10 people in the U.S. has gallstones, most (around 80%) appear to be asymptomatic. This begs the question, why do the other 20% experience symptoms? Food allergies have emerged as potential contributors to gallbladder symptoms and may shed light on this important and perplexing question. Recent research suggests that food reactions can target specific areas of the digestive tract, including the gallbladder, triggering an allergic response. Symptoms may manifest as swelling, increased mucus secretion, altered motility, and eosinophil infiltration—a type of white blood cell involved in allergic reactions.

By impeding gallbladder emptying, food hypersensitivities may both increase the risk of gallstone formation and trigger the pain and digestive symptoms associated with gallstones. For example, individuals with celiac disease experience delayed gallbladder emptying, which improves upon adopting a gluten-free diet. In another study 69 participants with gallstones or postcholecystectomy syndrome followed an elimination diet removing common allergenic foods. By the end of the study all participants experienced relief from pain and digestive symptoms, with the most common triggers including eggs, pork, and onions.

These findings emphasise the importance of considering food allergies in the management of pain and digestive symptoms both prior to and after cholecystectomy. It also highlights that conventional dietary recommendations for gallstones (i.e. a low fat diet) may not be sufficient because of individual variations in food sensitivity. This means that a personalised nutritional assessment and advice will produce better outcomes both before and after gallbladder surgery. This includes the potential avoidance of unnecessary surgery to relieve symptoms.

What to Do if You Have Persistent Pain and Gut Symptoms

If you're still experiencing pain and gut symptoms after gallbladder removal surgery, the first step is to consult your doctor. This is crucial for ruling out any post-surgery complications, stone reoccurrence, or other serious conditions.

Once these concerns have been addressed, undergoing a physical and digestive health assessment is a sensible initial approach. This assessment helps in understanding the underlying factors driving your symptoms and determining appropriate steps for management. Based on your symptoms and health history, further testing can be recommended to pinpoint the root causes of your symptoms.

Here are some common causes of ongoing pain and gut symptoms that may be investigated:

Bile Acid Malabsorption (BAM)

Bile acids play a vital role in maintaining cholesterol levels in bile. When bile is released into the bowel for digestion, these bile acids are usually reabsorbed and recycled to maintain a healthy bile acid pool. However, improper reabsorption or an excess of bile acids can lead to bile acid diarrhea. Potential causes of BAM include:

  • Certain Medications: Ursodiol, which contains natural bile acids used to reduce cholesterol saturation in bile, can sometimes cause diarrhea as a side effect. Additionally, medications like Metformin are known to increase bile acid production.
  • Damage to the Small Intestine: Surgery, removal, or radiation therapy affecting the small intestine can disrupt the normal reabsorption of bile acids.
  • Conditions Affecting the Small Intestine: Diseases such as Crohn’s disease, Celiac Disease, and Small Intestinal Bacterial Overgrowth (SIBO) can also contribute to bile deconjugation and bile acid malabsorption.

Treatment for BAM typically involves the use of bile acid sequestrant medication. Additionally, a low-fat diet is often recommended. Increasing soluble fibre can help to decrease intestinal pH levels and suppress the enzyme responsible for bile deconjugation. Addressing underlying conditions like Crohn's disease and SIBO can also be beneficial for individuals experiencing BAM.

Irritable Bowel Syndrome (IBS)

IBS is often associated with gut symptoms such as diarrhea, constipation, bloating, pain, and flatulence. While an IBS diagnosis does not always reveal the underlying cause of symptoms, common contributing factors can be explored.

Stress and Psychogenic Pain

Physical and emotional stress have been associated with both gallstone disease and IBS. Acute stress activation can lead to changes in digestive function, as well as gallbladder motility.  When prolonged this stress activation can disrupt signals between the brain and digestive system, leading to chronic digestive dysfunction. Psychogenic pain refers to pain associated with psychological factors, and "pain memories" for example may play a role in ongoing discomfort following surgery.

Colonic Dysbiosis and SIBO

A disruption in the balance of normal flora, and overgrowths of bacteria in the small intestine have been associated with digestive symptoms and pain. Colonic dysbiosis such as methanogen bacteria overgrowth has been linked to chronic constipation, whereas small intestinal bacteria bacteria overgrowth (SIBO) has also been associated with IBS symptoms such as diarrhea, bloating, constipation, and food intolerance. Notably, gallbladder dysfunction and changes in bile flow may contribute to alterations in the balance of intestinal flora. These changes in bacteria may play a role in a range of gastrointestinal symptoms. As such, it's essential to rule out these and other potential causes of functional gut symptoms to effectively manage persistent symptoms post-surgery.

Food Elimination

Addressing food allergies may be crucial in alleviating postcholecystectomy pain and gut symptoms. While food allergies are typically assessed via IgE testing, it's important to consider non-IgE mediated food allergies as well. Keeping a food and symptom diary and undergoing a food elimination protocol can help identify food triggers. Once identified, these triggers can be eliminated and later reintroduced to assess reactivity. Other methods for treating food reactions should also be considered.

While gallstone sufferers undoubtedly hope to return to a symptom-free life after gallbladder removal, many continue to grapple with persistent pain and gut issues. Understanding the root causes of digestive symptoms is crucial for effective management, whether pre- or post-surgery. Once serious complications are ruled out, addressing gut symptoms post-gallbladder removal can be achieved through a comprehensive health assessment, including functional testing and diagnosis of underlying causes.

Further Help for Gut Symptoms

Are you ready to address persistent pain and gut symptoms? Schedule a free, no-obligation health call to learn more about our approach. Don't want to wait? Go ahead and book your initial health assessment to start resolving your symptoms today.


Breneman, J. C. (1968). Allergy elimination diet as the most effective gallbladder diet. Annals of Allergy26(2), 83–87.

Colvin, H. S., Kimura, T., Iso, H., Ikehara, S., Sawada, N., & Tsugane, S. (2022). Risk factors for gallstones and cholecystectomy: A large-scale population-based prospective cohort study in Japan. Digestive Diseases (Basel, Switzerland)40(3), 385–393.

Earley, R. L., Blumer, L. S., & Grober, M. S. (2004). The gall of subordination: changes in gall bladder function associated with social stress. Proceedings. Biological Sciences271(1534), 7–13.

Gaby, A. R. (2009). Nutritional approaches to prevention and treatment of gallstones. Alternative Medicine Review: A Journal of Clinical Therapeutic14(3), 258–267.

Holtmann, G., & Enck, P. (1991). Stress and gastrointestinal motility in humans: A review of the literature. Neurogastroenterology and Motility: The Official Journal of the European Gastrointestinal Motility Society3(4), 245–254.

Jørgensen, T., Teglbjerg, J. S., Wille-Jørgensen, P., Bille, T., & Thorvaldsen, P. (1991). Persisting pain after cholecystectomy: A prospective investigation. Scandinavian Journal of Gastroenterology26(1), 124–128.

Lamberts, M. P., Lugtenberg, M., Rovers, M. M., Roukema, A. J., Drenth, J. P. H., Westert, G. P., & van Laarhoven, C. J. H. M. (2013). Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surgical Endoscopy27(3), 709–718.

Leave a comment

Your email address will not be published. Required fields are marked *