Do gallstones Cause constipation?
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Many people have both constipation and gallstones. However, if you have both conditions, that doesn’t necessarily mean one caused the other.
Gallstones are not known to cause constipation. However, in a very rare condition, a large gallstone reaching the bowel may obstruct the bowel and cause acute constipation and symptoms of bowel obstruction.
Today, we will answer all your questions about gallstones and constipation.
How common are constipation and gallstones?
Constipation and gallstones are two of the most widespread conditions. The prevalence of chronic constipation is about 20% of the general population (reference).
Also, gallstones are more common than many people think. However, it varies widely among different races and geographical areas.
10% to 20% of Americans will develop gallstones at some point in life (reference).
These statistics are important, and we mentioned them for a reason. Two exceptionally common conditions can occur in the same patients without needing other explanations.
You may have constipation and gallstone, each for its unique cause. And this is the most common scenario.
Do gallstones cause constipation?
Constipation is not among the known symptoms of gallstones in adults. However, patients with gallstone-related pain may receive strong pain killers such as opioids which induce constipation.
Here are the most common explanations of constipation in patients with gallstone disease:
A. Random association.
As we explained before, both gallstones and constipation are two common conditions. However, the coexistence of both conditions in the same person doesn’t often mean one condition led to the other.
B. Pain killers used for gallbladder pain.
Patients with severe biliary colics due to gallstones often receive painkillers.
One of the most commonly used pain killers in gallstone disease is opioid analgesics. Common examples include:
- Meperidine (after morphine in acute pancreatitis).
Clinical studies show that 60 to 90% of patients receiving opioid analgesics suffer from constipation.
C. Faulty diet habits.
Patients with symptomatic gallstones often fear eating. In addition, low overall caloric intake in patients with recurrent gallstone disease leads to constipation.
Also, recurrent vomiting and dehydration may end in constipation in people with recurrent biliary colics.
D. Gallstone ileus (rare).
In patients with previous attacks of acute cholecystitis. A fistula (tract) may develop between the gallbladder and the bowel (the small intestine).
The tract is often wides than the physiological opening of the gallbladder. As a result, a larger gallstone may slip through this fistula to the small intestine.
In the small intestine, a large stone may obstruct the narrowest part of the small intestine (the ileus). As a result, a true intestinal obstruction occurs.
This condition often affects older patients who have multiple co-morbid conditions.
Symptoms of gallstone ileus:
- Abdominal pain.
- Sudden severe abdominal distension.
- Persistent vomiting.
- Eventually, the gallstone becomes disimpacted, and the symptoms resolve (including constipation.
- After the disimpaction, the patient may notice the gallstone in the toilet.
- Some cases may need surgery.
Can you develop constipation after gallbladder removal?
Short-term constipation after gallbladder removal is common. The cause of acute constipation in the first few days or weeks after gallstone removal is often multifactorial.
One or more of the following causes may contribute to acute constipation after gallbladder removal:
- Anesthetic medications are used during the cholecystectomy operation.
- Preoperative and postoperative pain killers (opioid analgesics).
- Lack of physical activity after the gallstone removal operation.
- Severe abdominal pain (causes reflex inhibition of the bowel motility).
- Lack of fiber rick diet.
Chronic constipation after gallbladder removal is often due to primary causes, not due to the gallbladder. Common causes include:
- Primary idiopathic constipation.
- Irritable bowel syndrome with constipation.
- Change in dietary habits after gallbladder removal, such as eating fewer amounts or eating less fiber in the diet.
- Alternation of the gut microbiota after antibiotics often giver after the operation.
- Rarely chronic constipation due to intraabdominal adhesions result from a complicated gallstone or multiple previous abdominal operations.
This article discusses the cause of constipation after gallbladder removal in much more detail.
What are the most common symptoms of gallstones?
The symptoms of gallstones can range from completely asymptomatic to life-threatening complications such as gallbladder gangrene, perforation, and sepsis.
The following are the possible scenarios for people with gallstones (reference).
- Asymptomatic gallstones (cholecystolithiasis):
The majority of gallstones don’t cause symptoms. Asymptomatic gallstones are not considered a disease unless they cause symptoms.
- Uncomplicated gallstone disease:
The term refers to gallstones that cause occasional symptoms, mainly biliary colics (described below).
- Complicated gallstone disease:
A minority of patients with gallstones may develop severe complications such as acute cholecystitis (obstruction & inflammation of the gallbladder), gallbladder gangrene, gallbladder perforation, and sepsis. (not our focus today).
Biliary colics often occurs in intermittent attacks of severe upper right abdominal pain. The attack can be very infrequent (even once every year or two), but it also can become very frequent (multiple attacks per day).
The onset of an attack is often related to large fatty meals, but it can occur sporadically.
The table below dives into all the features of typical biliary colic.
|Biliary colic (Uncomplicated gallstone).||Description|
|1. Site||Usually, The right upper quadrant of your abdomen.|
|2. Spread||– The pain may spread to the back of the right shoulder.|
– Also, it spreads to the epigastric area.
|3. Character||Constant builds up then disappears gradually.|
|4. Duration||At least 30 minutes. It may last up to 6 hours.|
|5. Relation to food||– Triggered by foods (especially fatty food and large meals.|
– However, it can start spontaneously.
|6. NOT related to:||Movement, bowel movements, or the passage of flatus.|
|7. Nausea||Often Present, severe.|
|8- Commonly associated symptoms||Vomiting, sweating during the attack.|
|9. Unusual symptoms.||– Heartburn and chest pain.|
– Bloating, fullness.
– Early satiety.
– Isolated epigastric pain.
|10. Symptoms that only present in complicated gallstone disease.||– Fever.|
– Prolonged pain for more than 6 hours.
– Extreme tenderness over the gallbladder (Murphy’s sign).
– Vomiting of blood, blackish stool (PUD).