Post-Cholecystectomy Diarrhoea (UK): Is It Bile Acid Diarrhoea and What Should You Do?

Bile Acid Diarrhoea After Gallbladder Removal (UK): Symptoms, SeHCAT Test, and What Helps

Short answer: Some people develop ongoing loose stools after gallbladder removal because bile flows more continuously into the bowel. If excess bile acids reach the colon, they can pull water into the gut and trigger watery diarrhoea and urgency. This is often called bile acid diarrhoea (BAD) or bile acid malabsorption (BAM). It’s uncomfortable — but importantly, it’s treatable.

If you’re thinking “is this normal, or is something wrong?” this guide will help you spot patterns, know what to ask for, and what support options are reasonable while you wait for help.

Start here first: Low-fat diet after gallbladder removal (UK) →

What is bile acid diarrhoea (BAD)?

Bile acid diarrhoea happens when too much bile acid reaches the large intestine (colon). Bile acids are essential for fat digestion, but in the colon they can irritate the lining and cause watery diarrhoea, urgency and cramping.

You might also see it called:

• bile acid malabsorption (BAM)
• bile salt diarrhoea

After gallbladder removal, bile doesn’t “store and squirt” anymore — it tends to flow more continuously. For many people that’s fine. For some, it becomes an ongoing trigger.

Is diarrhoea after gallbladder removal common?

It can be. The reported rate of post-cholecystectomy diarrhoea varies a lot between studies (partly because not everyone is investigated), but research reviews have reported a wide range. One audit paper noted post-cholecystectomy diarrhoea has been reported anywhere from 2.1% to 57.2%, and not all of that is necessarily bile acid diarrhoea.

For readers who want the source (useful for trust and for talking to a clinician):

• Audit: “Rates of bile acid diarrhoea after cholecystectomy” (PubMed)
• Systematic review: post-cholecystectomy diarrhoea rate + predictive factors (BMJ Open)

Symptoms: what BAD feels like (and how it differs from “normal recovery”)

Everyone’s recovery is different. But BAD often has a recognisable pattern:

• Watery diarrhoea (often sudden)
• Urgency (that “I need a toilet now” feeling)
• Cramping that improves after a bowel movement
• Symptoms worse after fatty foods
• Sometimes yellow or pale stool (not always)

Short-term looseness right after surgery can happen for other reasons (medications, diet change, stress, antibiotics). BAD is more likely when symptoms are persistent or follow a “fat-trigger → urgency” pattern.

Table: Is this likely bile acid diarrhoea?

Pattern	More like normal adjustment	More like bile acid diarrhoea
Timing	First few days only	Persists weeks/months
Triggers	Random, inconsistent	Worse after fatty meals
Stool	Soft/loose sometimes	Watery + urgency
Impact	Annoying but manageable	Affects daily life / confidence

How is BAD diagnosed in the UK?

In the UK, a common test is a SeHCAT scan, which assesses bile acid absorption. It involves swallowing a small capsule and attending appointments a week apart for measurements.

Helpful UK patient explanations:

• Guy’s & St Thomas’ NHS: SeHCAT study
• NICE: SeHCAT for diagnosing bile acid diarrhoea (PDF)

Sometimes, clinicians may use a “treatment trial” approach (trying a bile acid binder) if testing is delayed or unavailable — your doctor will guide this based on your situation.

What treatments are commonly used?

The most common medical treatments are bile acid sequestrants (also called bile acid binders). They work by binding bile acids in the gut so they don’t irritate the colon.

Examples often discussed include:

• cholestyramine (sometimes spelled colestyramine)
• colesevelam

Useful references (patient-friendly and UK-based):

• UHCW NHS leaflet: dietary advice for bile acid diarrhoea (PDF)
• University Hospitals Sussex NHS: bile salt diarrhoea (PDF)
• NICE advice: colesevelam and alternatives

Practical “while you wait” steps that often help

These are not cures. They’re practical levers that reduce triggers and give you data to bring to your GP.

• Eat smaller meals (large meals = larger bile demand)
• Reduce fat temporarily, then reintroduce slowly
• Keep a 7-day trigger log (meal → symptoms → timing)
• Hydration + electrolytes if you’re having frequent watery stools
• Consider soluble fibre cautiously (introduce slowly)

If you haven’t already, start with the low-fat diet guide here →

Where Lily & Loaf fits

Important: supplements do not treat bile acid diarrhoea. If you suspect BAD, the right move is medical assessment (and when appropriate, medical treatment). Where supplements can help is supporting hydration, digestion and nutrient intake while you’re stabilising your routine.

These are the most practical “support categories” people explore post-cholecystectomy:

• Electrolytes: helpful if you’re losing fluids (look for simple formulas, not mega-stimulant mixes)
• Digestive enzymes: some people trial enzymes during food reintroduction, especially with mixed meals
• Probiotics: sometimes used while diet patterns shift (results vary person to person)
• Soluble fibre support: some people use fibre strategically to help stool consistency (go slow)

Lily & Loaf links (affiliate):

• Shop Lily & Loaf (all products)
• Browse digestion support options
• Browse electrolytes / hydration support

Safety note: if you’re on prescription medication or have ongoing diarrhoea, check with your clinician before adding supplements (some binders and fibres can affect absorption/timing of meds).

GLP-1 note: why this comes up in the same cluster

GLP-1 medications can change digestion and appetite, and rapid weight loss can increase gallstone risk in some people. That’s why this cluster links together: symptoms → causes → emergency thresholds → recovery.

Read: Did Mounjaro cause my gallstones? (science explainer) →

Read: Right-side chest/back pain on GLP-1: when to worry →

Video diary: my surgery story (authority proof)

If you want the full timeline and how “it started as nothing” becomes a real emergency, this is my diary video.

When to seek urgent help

• Severe abdominal pain that doesn’t settle
• Fever or chills
• Yellowing of eyes/skin (jaundice)
• Persistent vomiting
• Blood in stool, black stools, or signs of dehydration

If you suspect a medical emergency, seek urgent medical care.

FAQs

1) Is diarrhoea normal after gallbladder removal?

Some people have short-term looseness after surgery. Persistent watery diarrhoea and urgency can suggest bile acid diarrhoea and should be assessed.

2) What is bile acid diarrhoea (BAD)?

It’s diarrhoea caused by excess bile acids reaching the colon, where they pull water into the bowel and irritate the lining.

3) How common is post-cholecystectomy diarrhoea?

Studies report a wide range, and not all cases are bile acid related. If symptoms persist, it’s worth investigating.

4) What is the SeHCAT test?

A UK diagnostic scan that measures how well your body retains/absorbs bile acids over a week.

5) What medications treat BAD?

Bile acid sequestrants (bile acid binders) such as cholestyramine or colesevelam are commonly used under medical supervision.

6) Can diet help bile acid diarrhoea?

Lower-fat meals and smaller portions often reduce symptoms, especially in early recovery.

7) Why do fatty foods trigger urgency?

Fat stimulates bile release. Without bile storage, larger fat loads can push more bile acids into the bowel at once.

8) What fibre is best to try?

Soluble fibre is often discussed. Introduce slowly and track your response.

9) Can probiotics help?

Some people find them helpful during diet transitions, but they don’t treat bile acid diarrhoea itself.

10) Are digestive enzymes a treatment for BAD?

No. Some people use enzymes as digestion support during food reintroduction, but they’re not a medical treatment for BAD.

11) How long should I wait before speaking to my GP?

If diarrhoea is persistent, frequent, or affecting daily life beyond the initial recovery period, speak to your GP sooner rather than later.

12) Can dehydration happen from frequent watery stools?

Yes. Monitor hydration and seek help if you feel dizzy, weak, or you’re not keeping fluids in.

13) Does gallbladder removal affect nutrient absorption?

Most people absorb nutrients normally, but persistent diarrhoea can impact hydration and routines. If symptoms persist, get assessed.

14) Does GLP-1 affect diarrhoea after surgery?

GLP-1 can change digestion and appetite. If you are restarting GLP-1 post-op, your clinician should guide timing and dose.

15) When should I go to A&E?

If you have severe pain, fever, jaundice, persistent vomiting, or signs of dehydration or serious illness, seek urgent medical care.

Disclaimer: This article shares lived experience and educational context. It does not replace professional medical advice. If you suspect a medical emergency, seek urgent care immediately.