Help me cope with/solve an unstable digestive system

October 19, 2016 9:32 AM

I am a woman in my late 20s, and I had my gallbladder removed a couple years ago. I feel better now than I did before the surgery, but my gastrointestinal system has become JUST unstable enough to be a source of anxiety in my life.

I have periodic episodes of nausea (never vomiting), and bowel movements that have to happen RIGHT NOW. This doesn't necessarily happen daily, and I don't think it's associated with any particular food. My doctor thinks these are the effects of not having a gallbladder, and I am inclined to agree -- they don't seem severe enough to be IBS, nor consistent enough to point to a food allergy.

The "sometimes but not always" pace of these symptoms has been destabilizing. If they were a constant, I could plan my life around them, or take daily medication, and consider the matter settled. As it is, though, I continue my everyday life and often feel totally fine, but live in fear that the symptoms will crop up in the following settings:

- While I'm leading a meeting
- While I'm giving a presentation
- While I'm on a bus or train with no bathrooms
- While I'm in a carpool
- While I'm in a job interview
- While I'm performing onstage
- While I'm buckled into my airplane seat during taxi and landing

As a result of the fear, I either avoid these things, or have great anxiety while I do them (which leads to more nausea). I've taken Zofran if I'm feeling queasy in one of these settings, but it gives me headaches (and chest pains, but that could just be the anxiety). All the other anti-emetics that my doctor mentioned lengthen the QT interval in the heart, and we have just enough heart concern in my family history to make this risky. It also seems like overkill to address a relatively brief period of nausea with a pill that lasts 8 hours.

I'm not really sure what my question is, but basically, I don't want to be held back in life by this by these weird, seemingly random symptoms. I don't want to stay in my current job forever, avoiding situations where I'm put on the spot, either in an interview or in a position of increased responsibility. I want to take public transit and carpool without it being a hand-wringing ordeal. I want to fly without worrying about the buckled-in parts.

I know my anxiety really stands out here, and I am a more anxious person than most (and in therapy for it). But it's the symptoms that really drive the anxiety in these cases. Thoughts on either (a) coping or (b) getting to the bottom of the cause would be helpful.

posted by anonymous to Health & Fitness (20 answers total)

My husband also had his gallbladder removed, and from what I understand, in some cases you can limit these events by limiting or eliminating certain foods from your diet and planning when you eat - ie, not eating in the morning before your transit to work, etc.
posted by corb at 9:39 AM on October 19, 2016 [3 favorites]

are you taking any anxiety meds? if so, zofran is dangerously incompatible with some benzos and it is very troubling that your pharmacist did not catch this prescription problem.
posted by poffin boffin at 9:41 AM on October 19, 2016 [1 favorite]

I'm not sure if this helps but I had my gallbladder out about 7 years ago and I get the same thing but the frequency of the attacks has reduced greatly for me over the years and I've learned that certain foods are worse than others for this for me.

If I were you i would keep a food/ event journal for a while to see if there is a pattern and then you can see if you can break the pattern.
posted by SpaceWarp13 at 9:58 AM on October 19, 2016 [4 favorites]

Do these bouts of GI unpleasantness follow meals? Digestive enzymes might help a whole lot if so. (Presumably you're not getting any from your non-existent gallbladder anymore, so....) Thorne research makes a good one and has a good rep amidst the otherwise scummy line up of supplement companies. (Jarrow is also a good one.)

ETA: IANAD though, and you should always check, etc etc. at least Google, if your doctor isn't awesome.
posted by schadenfrau at 10:00 AM on October 19, 2016

I'm sorry to hear you're dealing with this. An unpredictable digestive system is a real pain in the neck.

One thing you can do is try and figure out any foods triggers by keeping a food journal. You don't have to worry about calories, so just write down what you eat (all the ingredients and not just "spaghetti" but "wheat pasta, red pepper, tomato, onion, garlic, basil, Italian sausage, etc), and what time you ate. Also write down whenever you have nausea or a bowel attack or any other unusual symptoms and note down the times and duration of those things too.

It's sort of a pain in the neck to do, but if you can keep it up for a while, sometimes patterns emerge. If you can't figure it out yourself, you can take your food journal to your next doctor's appointment, and sometimes--in my experience--they will take you more seriously if you have actual paperwork that backs up what you're saying, even if it's paperwork you made yourself.
posted by colfax at 10:12 AM on October 19, 2016 [1 favorite]

and bowel movements that have to happen RIGHT NOW

So, TMI: Are these movements liquidy and oddly yellow or yellowish orange? If so, welcome to bile acid diarrhea. Something like only 30% of cholecystectomy patients get it, and a small fraction of that percentage deal with it as a chronic issue. How do I know? I'm a chronic sufferer.

Mild sufferers can mitigate the symptoms with diet changes, like corb and spacewarp suggest. For the moderate and severe sufferers, it frequently happens after eating (sometimes within ten minutes, in my case) ANYTHING. Bread. crackers. water. Just a triggering of anything entering my digestive system causes it. For me, at least, it's always worse in the morning/early afternoon. Rarely did dinner ever trigger it.

Let me introduce you to Colestipol. It's a 1gram tablet (so about as big as your average multi vitamin) that you take 2/day. Changed. My. Life. We're talking going from BATHROOM NOW every breakfast and lunch to maybe once a week over a really greasy burger. Your doctor probably has no idea that it can help with this condition. Most nurses look at it and get a "WTF is this?" look on their face. It's officially a cholesterol medication, but it's mechanism of action is that it's a "bile acid-binding resin" - it binds with the extra bile acid that causes the diarrhea.

Unfortunately, nothing I've found helps with the stress induced version of the bile acid diarrhea - short of trying not to be stressed.

I don't know if it can help with the nausea aspect. I've suffered some almost constant levels of nausea my entire life. That hasn't changed after the gallbladder removal or colestipol medication.
posted by INFJ at 10:15 AM on October 19, 2016 [9 favorites]

You should go see a gastroenterologist. They can perform tests to help narrow down the cause. It could be related to your gallbladder, but then again it could be an intolerance to certain foods (lactose, fructose, gluten), small colon bacterial overgrowth, or it could be a sign of an autoimmune disorder. A gastroenterologist can start to investigate and develop a treatment.
posted by chevyvan at 10:22 AM on October 19, 2016 [2 favorites]

Also if you haven't already you might want to keep a journal of what you eat & the attacks listing exact symptoms & times for a month or so to see if there is any connection between what you eat & the attacks. Also include things like if you're feeling stressed etc. Not only will this help you it will help you when you talk to the doctors as you will have an accurate record of the problem.
posted by wwax at 10:26 AM on October 19, 2016

Nthing the suggestions to keep a food (down to ingredients) and symptom journal, and to see a gastroenterologist. It can take multiple trips to the gastro doc to work stuff out--guts are kind of mysterious and there's some understandable but frustrating testing of hypotheses on you, basically. I would recommend keeping track of your menstrual cycle in your food journal too--you might find that certain times in your cycle correlate to more GI issues, which could at least help you with some planning.
posted by purple_bird at 10:40 AM on October 19, 2016

INFJ is spot on about the bile acid diarrhea. Something to be aware of with cholestipol and other bile acid sequestrants: they block absorption of other medications and nutrients. This can be somewhat offset by timing when you take the medications, but I believe it is counterindicated for hormonal birth controls, among other things. I stopped taking them because my doctor couldn't say for sure whether it would affect my Nuvaring. Also, it gave me acid stomach the whole time I took it, along with terrible gas and bloating. So I'm mostly back to the drawing board. I'm currently trying out calcium supplements as a way to deal with the BSD. You can read more about that here. Be sure to get a supplement with low magnesium, because that can make the D worse.
posted by bluloo at 11:47 AM on October 19, 2016

There are certain foods you likely just can't handle anymore. For a lot of folks it's fried, greasy, rich fare, such as fast food, processed meats, fries, pizza, etc. There are others that have trouble with certain veggies, like tomatoes, onions, peppers, etc. It usually gets better over time, but many people need extra digestive enzymes or the Colestipol mentioned before.

Personally, my gallbladder was removed 8 years ago. It took a few years to adjust to it, but now I can handle an occasional heavy, greasy meal (yum). Only one at a time, though. No more leftover pizza for breakfast, or fast food for lunch and dinner. Onions give me indigestion now, for some reason. And holidays and church dinners are hard. It keeps me honest, though. I shouldn't eat that type of stuff anyway, and now I pay the price if I overindulge.

Hope you get relief soon!
posted by jhope71 at 11:50 AM on October 19, 2016

I know someone with issues from having a removed gall bladder and he says he's on Prevalite because Colestipol just went right through him.
posted by aniola at 12:03 PM on October 19, 2016 [1 favorite]

In my experiences, I can handle the situation but not the food. I'm not having a bowel movement because I'm in a meeting, but because my body can no longer process something inside it. You must have been in situations where you had an urgent bodily need even though the situation was low-stress. Prescription drugs could help, but I don't want to comment about that. The type of advice colfax and wwax are giving is not to be ignored. Food is mood. Food is mood. You are what you eat.

I haven't been through this surgery, and I don't know what a gallbladder does, but I do have a food allergy and unfortunately the only way to live is to look at every ingredient list for every type of food in every restaurant and every grocery store. Your filter is yes/no: yes that is okay, NO: PAIN. It seems to take a lot of time to read everything at the start, but you get used to the brands and types of food you can eat. Definitely take notes! Find a food/grocery app to make it easier to record. Find people with similar problems and listen to them!!!!!!!! (You've already started doing this.)

Obviously but still important: ignore anyone who contradicts your literal gut feeling about healthy food. Even if it's a doctor. Keep an open mind for other subjects, if you will. But I have heard so many (unintentionally dumb/innocent) questions about my diet from people who weren't there the years I was vomiting multiple times a week, the days and days and days I couldn't get out of bed, the times I've said no to something I wanted to eat but didn't eat so that I wouldn't feel that anxiety and gut pain later.

Do your own research here, but look into activated charcoal . It helps some people, it's used in hospitals for food poisoning, it's cheap, it's readily available from natural food stores, it might help you but no guarantees.
posted by aralymn at 4:45 PM on October 19, 2016

If you do decide to do food/symptom tracking as suggested above, I really like the mySymptoms app (for iPhone and Android.
posted by radioamy at 5:12 PM on October 19, 2016

I wonder if you'd qualify to join the mindfulness based cognitive therapy programs for chronic pain patients. GI distress, such as nausea, never seems to get a lot of respect in pain circles but a treatment like this one might help you manage symptoms. Otherwise, you could take a similar, more general purpose mindfulness based cognitive therapy program.
posted by crazycanuck at 7:21 AM on October 20, 2016

I had my gallbladder out twenty years ago and had this problem for years. It is miserable not to be able to walk around the block, take a bus, or sit through a meeting without worrying. What helped me was a gradual transition to a low-fat vegan diet. Getting rid of dairy was a definite game-changer. There was definitely some adjustment time, since a vegan diet is naturally much higher in fiber (there is no fiber in animal products), but I have gone from daily misery to having problems in the morning maybe twice a month. I can even go for long walks in the woods now. I still miss ice cream, but I feel like it's just not worth it. YMMV of course.
posted by FencingGal at 7:28 AM on October 20, 2016

Like FencingGal, I've found a low fat vegan diet is basically a solid way of avoiding post surgery problems. I've had mine out for about two years and can't really handle fatty food at all. I wound up going vegan pre surgery as a way of preventing gall bladder attacks and after re-introducing dairy my life kind of got worse.

If that sounds massively unappealing (and I get it, because low fat vegan food is basically the veganism with a lot of the fun stuff taken out) cutting back the fat to begin with should help, and you can use a diary to track what's setting off attacks.
posted by Jilder at 7:33 AM on October 20, 2016

This question comes up every few years on AskMe. You have dumping syndrome. It's a very common side effect of gall bladder removal, approximately 25% of people get it. No amount of diet changes, food diaries, etc, are going to help you. There is a daily, inexpensive med that will completely change your life, and your GP can prescribe it. It's called cholestrimine. Make an appointment today to get a scrip. You will be better within 48 hours. IANAD, but trust me on this one.
posted by raisingsand at 7:42 AM on October 20, 2016 [1 favorite]

I just, feel the need to jump in here and say what you are dealing with is not dumping syndrome. This is an unrelated condition that afflicts weight loss surgery patients and is primarily managed through diet.

The cause of both is that something entering the intestines (bile acid in cholecystectomy patients, undigested food/sugar in WLS patients) draws water and salt into the bowels and causes the runs.

I just don't want you to google dumping syndrome to learn more about it and get the incorrect information. The terminology you want is Bile Acid Malabsorption.
posted by INFJ at 10:07 AM on October 20, 2016

Thanks for the update. When I was diagnosed thirty years ago it was called dumping syndrome, I will update my terminology!
posted by raisingsand at 4:25 PM on October 20, 2016 [1 favorite]