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A recent email from a Constipation Nation reader asked, why does gallbladder surgery cause constipation?
Thank you so much for bringing this to my attention. I briefly addressed gallbladder and post-cholecystectomy syndrome in the book; however, to put it simply, removing the gallbladder changes the way your body manages bile after eating. There is no longer any bile storage. In addition to that, general anesthesia may alter your gut motility temporarily, and, for reasons we still need to elucidate, your gut microbiome is disrupted (either because of the perioperative antibiotics, the bile acids, or the dysmotility, or all of the above). Keep reading to see what to do about it.
The gallbladder stores and concentrates bile, releasing it in a timed burst when you eat fat. After surgery, bile drips continuously from the liver into the intestine instead of being released on cue.
Most people heading into cholecystectomy (gallbladder removal) are warned about diarrhea. But a surprising number of patients—especially those with preexisting gut dysfunction—report something else entirely: constipation, bloating, and unpredictable bowel habits after surgery. This is a real phenomenon tied to what clinicians call post-cholecystectomy syndrome (PCS).
PCS is the umbrella term for persistent or new gastrointestinal symptoms after gallbladder removal, occurring in a significant portion of patients. Symptoms aren’t limited to pain—PCS can include bloating, flatulence, diarrhea, nausea, indigestion, and yes, altered bowel habits including constipation and diarrhea. It affects up to ~47 % of patients in some series and includes both biliary and non-biliary factors in its clinical spectrum.
Uncoordinated bile delivery
Less bile arrives when you need it, so fat digestion is inefficient → slower gut signaling and harder stools.
Microbiome shifts
Bile acids shape gut bacteria. Altered bile flow can change the microbiome in ways that slow colonic transit.
Post-op meds & recovery
Opioids, anesthesia, dehydration, and reduced activity commonly slow the gut in the weeks after surgery.
Diet changes
Fear of fat leads some patients to go ultra-low-fat, which can reduce the natural gastrocolic reflex.
Although diarrhea predominates in published PCS cohorts, constipation and mixed bowel patterns aren’t rare and may be under-reported:
A large symptom outcomes study found minor declines in constipation symptoms (0–47 %) after cholecystectomy, suggesting that some people don’t improve or may even have worsened stool form or transit issues post-surgery.
Mechanistically, altered bile acid kinetics and lack of coordinated post-prandial bile release can blunt the gastrocolic reflex and slow colonic transit in susceptible individuals — especially those with underlying motility disorders.
Functional GI symptom patterns (e.g., IBS-C versus IBS-D) influence post-op outcomes: patients with diarrhea dominate in some cohorts, but those with constipation or mixed IBS profiles before surgery can experience persistent constipation or alternate patterns afterward.
If you’ve had a change in bowel habits since your gallbladder surgery, I would suggest doing a few things. One is getting a test for bile acid to see if you have excess bile acids that might require bile acid medication, such as cholestyramine. This helps a lot with post-cystectomy syndrome. Check with your medical doctor about this. The second thing would be to start on a probiotic such as SEED, one that will help with the frequency of your stools and will start to repair your gut microbiome, and third, start with a good fiber supplement. This will help normalize the consistency of your stools.
1) Re-time bile with food
Don’t avoid fat entirely. Use small, regular amounts (olive oil, avocado) to stimulate bile flow.
2) Fiber—type matters
Start low and go slow. Favor soluble fibers (kiwi, psyllium, partially hydrolyzed guar gum) over bulky insoluble fiber early on.
3) Hydration + electrolytes
Bile acids draw water; dehydration worsens stool hardness.
4) Motility support
Gentle osmotics (PEG) or magnesium can help—tailored to stool form and frequency.
5) Consider bile-targeted therapy
If symptoms swing to diarrhea, bile acid binders may help. If constipation dominates, avoid over-binding bile.
6) Pelvic floor check
If straining persists despite soft stools, evaluate for dyssynergia—especially common after abdominal surgery.
Constipation lasting >6–8 weeks
Alternating diarrhea/constipation with bloating
Weight loss, anemia, or nocturnal symptoms
Cleveland Clinic – Post-cholecystectomy digestive changes
Mayo Clinic – Bile acid malabsorption & bowel symptoms
Gut – Bile acids, microbiome, and colonic motility
Constipation Nation – Whole-gut, real-life approach to constipation
If your gallbladder is gone and your bowels feel broken, you’re not imagining it—and you’re not alone.
Your gut didn’t fail.
It just lost its timing device.
And timing, in digestion, is everything.
Until next, time, that’s just the way the anus wrinkles.
