IBS and gall-bladder removal, and IBS and hormones...

[Trekkiegirl]

Hi, I have IBS-D which was diagnosed around 3 - 4 years ago. I'm asking about two things - if there is a link between IBS and cholecystectomy (I had my gall-bladder removed in 2001 and frankly my tummy has never been the same since!!!) and also, I've noticed in recent months that my IBS flares up consistently around three days before my period arrives. I'm 46 and I'm wondering if this has anything to do with fluctuating hormone levels now I'm getting older? My GP thinks my IBS symptoms (mainly diarrhoea and nausea) are all down to stress (he mainly attributes all my symptoms to me having lost my little boy to cancer 7 years ago) , but having kept a diary of my symptoms I have found no links with what I'm doing in my life/thinking about and the flare-ups, the only link is with my menstrual cycle. Certain foods are off-limits though - I'm intolerant to dairy, caffeine, alcohol, nuts, whole-grains, seeds, veggies with kernels on (like sweetcorn) and most fruits, although I'm re-introducing some fruits very gradually with success! I have had tests for coeliac disease and also both a colonoscopy and an endoscopy, as I had lost lots of weight and the symptoms were waking me up at night (this has all settled down), all tests came back normal. Would you be able to shed any light on any of this?!
Thank you!!

[Dr Nick Read]

Cholecystectomy removes the reservoir for bile. This means that after cholecystectomy there is an unregulated leak of bile into the small intestine all the time. Bile acids tend to combine with fats and stimulate their absorption, but if they leak into the intestine all the time even when there is little of no fat there, they will irritate the intestine and cause IBS symptoms, often .pain and diarrhoea. The reason that flare ups occur just before periods is that progesterone is falling and this will make the bowel more sensitive and reactive. Dairy and some other foods may make things worse because they tend to cause more secretion of bile acids. You may find that taking a bile acid sequestrant such as coleveselam or questran will help but you have to titrate the dose according to your response. . .

[Trekkiegirl]

Thank you very much! That makes sense. Can I get these medications over the counter, or do I have to get them prescribed?

[Dr Nick Read]

They need to be prescribed. Just tell your doctor you've read that cholecystectomy causes leakage of bile acid and makes IBS worse and ask him if you can have a prescription for bile acid sequestrants.