SHOULD I HAVE MY
GALLBLADDER REMOVED?
IS GALLBLADDER REMOVAL
REALLY NECESSARY?
Over 1/2 million people in America have their
gallbladders removed every year. Is it necessary? Not that often it isn't.
Sometimes it is absolutely necessary, but not always. How do you know for sure?
That's not easy to determine. Most doctors advise gallbladder removal with any
diagnosis of a gallbladder problem. Large gallstones, small gallstones,
low-functioning gallbladder, few symptoms, no symptoms. If the diagnosis
warrants surgery, you are advised to take it out. But the same diagnosis in
thousands of people does not mean the same condition exists. For example,
gallstones can be silent which means you are unaware of any probelm going on.
There are no symptoms at all and the gallstones are found by routine lab tests
done for a separate issue. You may eventually develop symptoms or you could live
a long life and never experience symptoms of gallstones. Or you may be one of
those people who have frequent attacks and on-going pain who just can't live
with it. The majority of people we hear from here at GallbladderAttack are in
the middle. They had an attack; it's behind them now, but they still have
discomfort that gets worse when they are under stress or when they eat the wrong
foods. If you are in that camp, you have a choice to make. Part of that choice
involves whether or not you are willing to make both lifestyle and dietary
changes.
If you do opt for gallbladder removal, will your digestion be
perfect afterwards? That's what everybody's hoping for, to be pain free, gas
free, bloat-free and to be able to eat whatever they like. You have a 60% chance
of that happening. Out of every 10 cholecystectomies, 4 people will still have
symtpoms. Those symptoms are rarely, if ever, equal to that of the previous
gallbladder attack. They are more often discomfort, or dull pain. But you need
to be aware.
So read the research and find out what your chances are of
that happening before you give your body parts up. And scroll over to the right
of this page to read what my readers are saying about their experiences. And if
you've had a good experience and are symptom-free 2 and 3 years after surgery,
please write and tell us about it. We want to hear from you too. I say 2 or 3
years because it sometimes happens that uncomfortable symptoms resolve after a
year or so.
The most frequently asked question I am asked from people who
have had surgery is this: "Why is that that I still have pain even though my
gallbladder has been removed?"
If you think of your problem as a biliary (bile)
problem as opposed to a "gallbladder" problem you are more on the right track to
understanding how to take care of it. Removing the gallbladder does not always
address the problem in the body that is causing these symptoms. In order to
break down and digest fats, your body must produce bile, which is done in the
liver. Your gallbladder is merely a sac for holding some of the bile that the
liver produces. Whether or not you have had your gallbladder removed, your liver
is still producing bile in order to digest fats. Without the gallbladder,
however, the bile is not as readily secreted in the body, and the liver can
become overwhelmed when faced with large amounts of any fats, especially
saturated fats and hydrogenated fats. And for some people even small amounts of
fats can cause discomfort.
One of the side effects of gallbladder
removal can be the dumping of bile which is now not as easily regulated and can
send someone running to the bathroom immediately after eating. A more common
side effect is a decrease in the secretion of bile. If the bile produced by the
liver becomes thick and sluggish, painful symptoms and bile stones can occur.
Bile stones can form in the liver as well as the gallbladder. One woman had her
gallbladder removed only to end up back in surgery again two or three days later
where they found stones in the bile ducts of the liver causing her alot of
pain.
However, removing the gallbladder may be an absolute medical
necessity. But, unless it is diseased, ruptured or otherwise sick, know that
just having cholelithiasis or gallbladder stones does not mean you have to take
it out. If you have gallbladder attacks, pain or discomfort or digestive
problems but not a diseased gallbladder, this does not mean you necessarily have
to have gallbladder surgery. Get a second opinion. You do have an option of
cleaning up your diet, doing some work on your gallbladder and liver and keeping
your organ of fat digestion. If you happen to think that nature made a mistake
and that you don't need it anyway, you probably wouldn't be reading this page in
the first place.
What's the worst thing that can happen? You try to fix a
huge contributing factor which is based on cleaning up your diet and eating real
food and real fats and not the "pretend food" that can sit on a shelf for 6
months to 2 years. What kind of a food takes two years to go bad? Nothing that
will give health to your body, that's for sure. And if the gallbladder still
needs to come out later, you've only gained by eating better anyway.
The
gallbladder does facilitate and regulate the flow of bile in your body. When
that facilitator is taken away it is quite possible that the flow will be not as
efficient, ie. too much at one time, or more commonly, not
enough.
Whether you choose gallbladder surgery or not, consider taking
products and changing your diet as well as doing a series of gallbladder and
liver flushes to take care of the root of your gallbladder problem.
The
most common problems, apart from actual pain are impaired digestion: bloating,
gas, heartburn, constipation or diarrhea. You are/were already having trouble
digesting fats. So why would removing the organ that regulates the metabolizer
of fats improve your digestion? It may help with the pain, but
know that 34% of people who have their gallbladder removed still experience some
abdominal pain. (4)
The easiest way to avoid this is to take a supplement of
bile salts or choline with meals to help your body with the digestion of
fats. And do a series of gallbladder flushes. Flushes are especially helpful
after gallbladder removal to help flush out the bile ducts. Supplemental bile
salts, (unless you are experriencing bile dumping) available separately or in
the After Gallbladder Removal
Kit, should be taken frequently along with the digestive stimulant
(also in the kit) to help stimulate your own digestive juices. Alternating the
dosage of bile salts will help to mimic the body's way of secreting bile. For
example, take one with breakfast, two at lunch, three at dinner, two with
breakfast the next day, and so on in rotation.
If you have the less
common, but not unusual side effect after gallbladder removal of needing to run
to the bathroom immediately after eating, you are probably getting too much bile
instead of too little. This, unfortunately is much harder to control. Try the
Dumping Syndrome
Kit. Read more about postcholecystectomy diarrhea towards the bottom of
this page.
CAN I FUNCTION WITHOUT A GALLBLADDER
Yes you can. The bile will
still be produced in the liver and find its way to the small intestine. It will
continue to break down your dietary fats and to remove toxins from the liver.
What is different is that the bile will no longer be as concentrated (the
gallbladder removes 90% of the water from the bile) and its function as a
regulator will be gone. Some people have no problem with this at all; others
have problems with getting the right amount of bile at the right time, either
too much or too little.
IS GALLBLADDER SURGERY
EFFECTIVE
What is meant by effective? Will you never have another gallbladder
attack? I mean, how could you if you have no gallbladder, right? Will you never
suffer from indigestion again? Will your gas and bloating disappear? Will the
constipation go away? Will diarrhea resolve?
The answer to all of the
above is "sometimes". Actual attacks are rare, but other forms of pain and
discomfort are possible and new symptoms can also develop. Read
on...
Let's look at gallbladder attacks. Gallstones can also be found in
the liver and the bile ducts leading to the gallbladder. The attack is often
(but not always) caused by a stone blocking a duct. And yes, this can still
happen. As seen by research above, stones are formed partly due to what we eat.
If we take the gallbladder out and continue to eat the same lithogenic forming
diet that we did before, why should stones not form? They will. You may never
know it. You may be asymptomatic for the rest of your life. Or, you may get a
stone stuck in a bile duct. This is one of the reasons for the most frequently
asked question on this site: "I had my gallbladder removed months (or years)
ago. Why do I still have pain?" (See testimonials to the right for examples.)
Removing the gallbladder does not always address the problem in the body that is
causing these or other symptoms listed above. It has probably taken years for
your body to form these stones. Your fat digestion has been impaired for a long
time. In order to break down and digest fats, your body must produce bile, which
is done in the liver. To address the root of the problem you must study and
reflect on the causes of gallbladder disease.
There could be
an underlying thyroid problem which research connects with both gallstones and a
low-functioning gallbladder. Food allergies may also be a big part of it and
stress as well.
Another thing to keep in mind is that you could have
another gallbladder disease that has not yet been diagnosed. For example, if an
ultrasound is done and gallstones found, a cholecystectomy or gallbladder
removal will be recommended without doing any further exploration. This is
because the most obvious and easily diagnosed cause of gallbladder attacks is
gallstones or cholelithiasis. And ultrasound is quick and non-invasive. However,
if your gallbladder is ejecting bile below 33%-40% which is considered normal
range, you would be diagnosed with a low-functioning gallbladder or biliary
dyskinesia. This can only be determined with a HIDA scan which is an invasive procedure using
radioactive dye. Symptoms of biliary dyskinesia are not always resolved with
cholecystectomy either for various known and unknown reasons. One reason is that
the problem could be with the Sphincter of Oddi rather than the gallbladder
itself.
DIET AFTER GALLBLADDER
SURGERY
If you understand that co-existant with your gallbladder disease is
usually a problem of stagnant bile, cholestasis, or some imbalance in the bile
composition itself, you will realize that most people are not out of the woods
after surgery or able to eat anything they like. Treat your lack of a
gallbladder as you would any gallbladder disease and eat the same way. Exactly
what that means depends upon your symptoms. Some people have surgery having had
few symptoms and others were in bad shape. If you are in the latter category,
and are now still having some discomfort, you may be most comfortable giving
your gallbladder a rest by following the strict 30-60 Day Gallbladder Menu Plan.
Most people after surgery will be able to start with the 2nd Menu Plan which is
more relaxed. Others will be comfortable just following the Gallbladder Foods Guidelines in the Helpful and To Be
Avoided lists.
There is a whole page on gallbladder diet with foods
that are good for the gallbladder (think "bile") and liver and foods that are
hard on the biliary system. You still have a biliary system. Treat it gently and
feed it nourishing foods. Of particular importance is the understanding of good
fats and harmful fats. Follow the links on gallbladder diet for more information on
both of these.
When should the gallbladder be
removed?
Many doctors recommend gallbladder removal if you have had
only one attack. Others will do so if you have repeated attacks. Some will do so
if you have stones; others will say unless you are having attacks with the
stones you can leave it. This is a place to get a second opinion and above all,
to educate yourself; read all you can.
If your doctor finds that you have
an infected gallbladder it will almost certainly
have to come out. If it bursts you are in similar danger as with a burst
appendix. Infection is then lose in the peritoneal cavity. This is like an
explosion of infection from a place of contaiment to the body at large and is
difficult to clean up.
If you have a motility
problem or a problem with gallbladder contraction or low-functioning (see
biliary dyskinesia under gallbladder diseases) gallbladder surgery is also
recommended. Yet some doctors do not recommend gallbladder removal for biliary
dyskinesia.
Complications of surgery
Apart from complications
of surgery such as damage to the common bile duct with laparoscopic surgery (due
to lack of visibility) or infection from an incision, one may develop
postcholecystectomy syndrome. (See
below.)
"During laparoscopic cholecystectomy, gallbladder
perforation with leakage of bile and/or gallstones into the abdominal cavity
occurs frequently." or 33% according to this study. However, there were no
complications of infection or blockages in any of the
subjects.(3)
POSSIBLE SIDE EFFECTS FROM
GALLBLADDER REMOVAL
LIFE AFTER GALLBLADDER
SURGERY
Abdominal pain, nausea, gas, bloating, and diarrhea are common
following surgery. Postcholecystectomy syndrome (after gallbladder
removal syndrome) may include all of the above symptoms plus indigestion,
nausea, vomiting and constant pain in the upper right abdomen. Sound familiar?
You're right -- gallbladder attack symptoms. Up to 40% of people who undergo
gallbladder surgery will experience these symptoms for months or years after
surgery. How is this possible? You no longer have a gallbladder and that was the
problem, right? Look to the whole biliary tract. Now that the gallbladder is no
longer present to act as a reservoir for bile, the common bile duct may expand
as the bile backs up in the bile duct between the sphincter or muscular opening
at the small intestine and the liver from which it flows. If it drips constantly
into the small intestine this can cause problems of a different kind. However,
this syndrome with accompanying pain appears to have the flow of bile obstructed
by either a narrowing of the sphincter or a malfunction of the
sphincter.(1)
"Functional biliary pain in the absence of gallstone
disease is a definite entity and a challenge for clinicians." which is to say
that at this point in time, they don't really know what to do with gallbladder
problems that aren't related to gallstones (2) and "Often, following
cholecystectomy, biliary pain does not resolve..." (2) which means after
gallbladder surgery you may just be stuck with the pain.
So in
conclusion, your best bet may be to try and fix what is wrong if that is
possible, before taking it out. Sometimes, that is just not
possible.
Postcholecystectomy Diarrhea or Bile Dumping
Syndrome
The uncomfortable and inconvenient side effect that some
people experience following the removal of their gallbladder is that of running
to the bathroom immediately or soon after eating. For some it is rather
explosive. Whatever its presentation, it is an increased transit time which
means that absorption of nutrients is impaired. Not a good situation for your
overall health. You may find help from the Dumping Syndrome Kit on this site. It
helps to bind the bile salts that accumulate in the intestine along with extra
fluid. However, this quote from a British medical journal suggests that perhaps
IBS is part of the problem and may have been there, if somewhat less
problematic, before the surgery. If that is the case, try our Dumping Syndrome
Kit, by all means. It can be helpful for all sorts of etiologies. But you may
also want to read up on IBS and try some products specifically for an irritable
bowel condition. I like the products at www.diverticulitisinfo.com.
"13-40% of patients have
persisting abdominal pain after cholecystectomy although the vast majority
regard their operation as a success. Up to 12% of post-cholecystectomy patients
when questioned feel that they have diarrhoea as a consequence of their
operation, and at least 4-5% of patients have a definite deterioration in their
perceived diarrhoea or perceive that they have developed diarrhoea for the first
time. Objective assessments postoperatively, however, rarely demonstrate new
onset diarrhoea. Some of these patients may have the irritable bowel
syndrome."6
IS THERE SOMETHING I COULD DO FOLLOWING GALLBLADDER
REMOVAL THAT WOULD BE HELPFUL
Of course! Always keep
following a clean, sensible gallbladder diet that includes good fats, lots of
organic fruits and vegetables and lean meats and fish. And for at least 2 or 3
months immediately afterwards, follow the diet religiously and if you haven't
done a Gallbladder Starter
Kit, do so now to give your digestion and your fat metabolism a kit
start. I also suggest a series of coffee
enemas about a month after surgery (even years after if it's been that
long) to flush all the bile ducts including those of the liver. Your biliary
tree can benefit from this at any time as can your liver. I suggest one per day,
if possible, for 21 days.
Then order the
After Gallbladder Removal Kit
and stay on it from now on. You will need the assistance in
digestion that it offers, especially for digesting fats. That is the ideal. If
it is beyond your means to do this, at least use bile salts with every meal.
(1)Torsoli A, Corazziari E, Habib FI, Cicala M. Scand
J Gastroenterol Suppl. 1990;175:52-7 Pressure relationships within the human
bile tract. Normal and abnormal physiology.
(2) Shaffer E., Dig Liver
Dis. 2003 Jul;35 Suppl 3:S20-5
(3) Surgical Endoscopy Publisher: Springer
New York ISSN: 0930-2794 (Paper) 1432-2218 (Online) DOI:
10.1007/BF00188454Issue: Volume 9, Number 9 Date: September 1995 Pages: 977 -
980
(4)Bates T; Ebbs SR; Harrison M; A'Hern RP.Influence of
cholecystectomy on symptoms.
Br J Surg. 78(8):964-7, 1991
Aug.
(5)E Ros, D Zambon
Postcholecystectomy symptoms.
A prospective study of gall stone patients before and two years after surgery.
1987 BMJ Publishing Group Ltd & British Society of
Gastroenterology
(6)S Hearing, L Thomas, K Heaton, L
Hunt
Post-cholecystectomy diarrhoea: a running commentary Copyright © 1999
BMJ Publishing Group Ltd & British Society of
Gastroenterology.
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