Problems After Gallbladder Removal (Years Later): Causes & Symptoms.

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What are the Causes of Problems After Gallbladder Removal (Years Later)?

1. Loss of gallbladder function.

Your gallbladder has 2 main functions (reference):

  • First, it concentrates the bile secreted from the liver.
  • On-demand secretion of bile with eating.

The majority of patients don’t experience prolonged symptoms. However, a considerable subset develops a post-cholecystectomy digestive problem.

The removal of your gallbladder leads to the continuous flow of the secreted bile into your intestine regardless of eating. The secreted bile is also not concentrated enough.

Loss of the normal physiology of bile storage and concentration is a major contributor to gallbladder problems which may last for years.

Continous bile flow (loss of gallbladder storage function) may lead to bile acid malabsorption and bile reflux problems.

2. Co-existent diseases.

You may continue to feel symptoms similar to gallbladder pain for years after its removal.

The biliary-like symptoms may be due to another condition that is similar to gallbladder pain.

The conditions that mimic gallbladder pain are:

  • Peptic ulcer disease.
  • Functional dyspepsia.
  • Irritable bowel syndrome.
  • Other functional Gastrointestinal diseases.
  • Gastroesophageal reflux disease or chronic acid reflux.
  • Functional constipation.
  • Anterior cutaneous nerve entrapment syndrome (reference).

From our experience, Co-existing functional gastrointestinal disease is the most common cause of continuous digestive problems after gallbladder removal.


3. Residual or newly formed gallstones.

During gallbladder surgery, the surgery leaves the bile ducts. Bile ducts connect the liver to your duodenum.

Stones left inside the bile ducts (not the gallbladder) may continue to cause problems for years.

Also, New stones may develop inside the common bile duct years after a gallbladder operation (reference).

4. Psychological factors.

Current or previous history of anxiety, depression, unhappiness, or any type of psychological stress reflects on your gut.

The term (brain-gut axis) is well established nowadays. For example, anxiety is way more common in IBS sufferers than in the general population. See IBS & anxiety: in-depth guide.

5. Sphincter of Oddi dysfunction.

The sphincter of Oddi is a ring of muscle at the end of the common bile duct. Abnormal function or contractions of the sphincter of Oddi may cause gallbladder-like pain.

Also, it can lead to pancreatic and liver problems—lean more.

1 .  Post-cholecystetomy syndrome.

Postcholecystectomy syndrome is the most common problem after gallbladder removal. It cal last for years after the surgery.

Post-cholecystectomy syndrome is a group of symptoms that recur or persist after gallbladder removal (reference).

Two types of post-cholecystectomy syndrome:

  • The early type: the symptoms occur shortly after the operation (within days or weeks).
  • The late-type: the onset of Symptoms occurs months or years later.


  • Injury to the bile ducts (early type).
  • The missed stone inside the bile ducts.
  • Recurrence of gallstone inside the bile ducts.
  • Abnormal motility of the bile ducts.
  • Bile duct narrowing (stricture).
  • Associated gut diseases such as IBS, pancreatitis, hepatitis, Peptic ulcer disease, mesenteric ischemia, etc.
  • Intercostal nerve inflammation (interconstal neurititis).
  • Wound neuroma.
  • Psychological factors.


  • Persistent or recurrent gallbadder pain after cholecystectomy (can last for years).
  • The pain is in the upper right abdomen, and it is triggered by food.
  • Dyspepsia (indigestion).
  • Nausea and vomiting.
  • Diarrhea.
  • Gas and bloating.

2 . Bile acid diarrhea.

Bile acid diarrhea (BAD) is a common and underdiagnosed condition. Bile acid diarrhea occurs when your intestine cannot handle bile acid properly.

Gallbladder removal results in an overflow of bile acid into your digestive system. Bile acid malabsorptions can lead to diarrhea for years.

This results in diarrhea with characteristic severe urgency and can present in the form of explosive diarrhea after eating.

Interestingly, several studies stated that about 50% of IBS with diarrhea (IBS-D) patients suffer from BAD. (ref1, ref2).

Also, Secondary bile acid diarrhea can occur after gallbladder removal.

The symptoms of Bile acid diarrhea include:

  • Diarrhea: is often triggered by eating fatty foods.
  • Diarrhea can be chronic or occasional.
  • Extreme and sudden urgency (explosive diarrhea).
  • It may lead to soiling accidents.
  • Related to fatty meals.
  • Associated with bloating and abdominal pain.

The diagnosis of Bile acid diarrhea is usually difficult and overlooked by doctors because:

  • Symptoms are very similar to IBS-D and chronic idiopathic diarrhea.
  • The conventional tests such as stool analysis, colonoscopy, and abdominal CT test negative for BAD.
  • The BAD-specific tests are not widely available.

Cholestyramine (Questran) is a bile acid sequestrant that is used to treat BAD. If you experience diarrhea with urgency after the gallbladder removal, consult your doctor about the possibility of BAD.

3. Bile reflux.

After the gallbladder removal, bile may back up into your intestine and even the esophagus. This leads to a condition called (bile reflux gastritis)  (reference).

Also, bile (together with acid) may reflux up to the esophagus, causing symptoms similar to acid reflux.


  • Upper abdominal pain (in the middle or two the right side). It starts after gallbladder removal and may continue for years.
  • Frequent heartburn.
  • Nausea.
  • Vomiting of greenish or yellowish fluid (bile).
  • Occasionally, cough, hoarseness.
  • Bloating and gas.

Learn More.

More: Can you get gallstones after having your gallbladder removed?. gastroenterologist explains.