- Is Your Gallbladder to Blame?
- Symptoms of Constipation
- The most common symptoms of constipation are:
- Causes of Constipation
- Treatment For Occasional Constipation
- Travel Constipation
- Enemas – Instant Constipation Relief
- Gallstones And Constipation
- Weight Stigma and the Five F’s of Gallstone Disease
Is Your Gallbladder to Blame?
Q1. Do gallstones cause constipation and bloating? I take a laxative every day for relief, and I’m reluctantly considering gallbladder removal.
— Terrie, Maryland
The most common symptom of gallstones is biliary colic, a crampy abdominal pain that often occurs right after meals, particularly fatty meals. The bloating you mention is very common during these attacks, which usually last anywhere from a few minutes to an hour.
Gallstones can also cause cholecystitis, or inflammation of the gallbladder, when one of the gallstones blocks the flow of bile from the gallbladder. Symptoms can include fever, abdominal pain, and jaundice (yellowing of the eyes and skin). Less commonly, gallstones can cause inflammation of the pancreas or cholangitis, the latter a very serious bacterial infection of the biliary tree. Constipation can occur, though rarely, as a complication of gallstones, most commonly because of pancreatitis or gallstone ileus, a pretty rare event in which a large gallstone passes from the gallbladder into the intestine and blocks the flow of digested food from the small intestine into the colon (large intestine).
Q2. Now that I’ve started menopause, I’m dealing with an increasing number of gallstones that leave me with nausea and indigestion. Will this stop once I’m postmenopausal, or should I have my gallbladder removed?
— Rae, West Virginia
Unfortunately, your gallstones — and the suffering they cause — aren’t likely to go away in the future. In fact, they’ll probably worsen. Developing gallstones (or cholecystitis) is a very common problem for people in their fifties, especially postmenopausal women. Once gallstones begin causing symptoms that disrupt quality of life, such as the nausea and indigestion you describe, it becomes pretty clear that it’s time to have your gallbladder removed.
If you’re looking for nonsurgical options, most will probably fall short. Some people do find that they’re able to lessen their symptoms by making lifestyle changes, such as losing a modest amount of weight and avoiding fried or fatty foods. If you haven’t tried making these changes yet, by all means do so. But know that they’re rarely successful in the long term; at best, they only delay the need for gallbladder surgery. This is because most people aren’t vigilant enough to make these changes stick, and others don’t get adequate relief. In fact, even when diet and lifestyle changes do work, and a patient puts his or her symptoms on pause, most doctors will still recommend having the gallbladder removed.
In my opinion, while all patients are different, there’s little to be gained from waiting to undergo gallbladder surgery. The risks of not having your gallbladder removed can include rupture, gallbladder infection, and sepsis (a general blood infection). While such problems are relatively uncommon and usually not life threatening, they add to the argument that the benefits of having your gallbladder surgically removed outweigh the risks.
Compared with the surgeries of decades past, which required a week in the hospital and a long period of healing, newer, less-invasive laparoscopic procedures require small incisions, have a very low risk of complications, and allow most patients to go home the next day. Some patients are even able to return home in as little as eight hours after surgery. If you’re interested in this option, ask your doctor if you’re a candidate for laparoscopic cholecystectomy, which is the technical name for this surgery.
Q3. I am 52 years old and I have multiple gallbladder stones. I’ve read about a remedy for gallstones where you drink apple juice for five days and then take a lot of lemon juice with olive oil. Do you think this really works?
— Ashok, New Delhi
There is no proof that a regimen of apple juice, lemon juice, and olive oil can dissolve gallstones. Some people who have tried this so-called gallstone cure have reported passing stones in their stool, but what they are actually seeing are the remnants of the oil and juice.
There are basically two types of gallstones, pigmented — which occur mostly in patients with chronic hemolytic anemias, a group of conditions where red blood cells are destroyed prematurely in the bloodstream — and cholesterol stones, which are the most common. Although some cholesterol stones can be dissolved by taking a prescription medication called ursodeoxycholic acid (Actigall), this only works for small stones that have no calcium deposits. Most stones, unfortunately, contain calcium and may not dissolve even with long-term treatment. Bottom line: Surgery is still the best way to get rid of gallstones.
Learn more in the Everyday Health Gallbladder Center.
Understanding what causes constipation is paramount in learning how to change it.
Symptoms of Constipation
Symptoms of constipation may vary from person to person and also from time to time. I have had patients think they are not constipated because they moved their bowels regularly, even though the frequency was every 7 days. A healthy digestive system moves the bowels at least once daily and the longer food stays in the colon, the drier and harder it becomes. There are differing opinions on this but most people find they feel better the more regular they are.
The most common symptoms of constipation are:
- difficulty passing stool
- hard, dry stools
- infrequent stool
- pain with passage of stool
- abdominal bloating and/or pain
- abdominal distention
- feeling of incomplete evacuation after bowel movement
Relying on stool softeners, laxatives, colonics or enemas is not addressing the root of the problem, nor is this dependency good for the colon. Any of them are fine for an occasional short-term aid, but know that constipation is not normal and it is worth it to the health of your whole system to figure out the underlying cause and fix it.
Causes of Constipation
- lack of hydrochloric acid from antacids, PPIs, stress, overeating, etc.
- deficiency of bile
- lack of bile flow
- infections such as H. pylori
- lack of digestive enzymes
- deficiency of good bowel flora
- food allergies
- gluten intolerance
- dairy intolerance
- lack of water
- lack of fiber, soluble and insoluble
- lack of exercise
- side-effects of drugs- pain killers, antidepressants, antihistamines, high blood pressure meds and many more
- some vitamin supplements such as those containing iron
- nerve degeneration
- regularly not taking the time to evacuate
Treatment For Occasional Constipation
- Take ¼ to 1 tsp of olive oil 4x a day for 4 days. Take 3 days off. Repeat.
- Pre- and probiotics
- Soluble and insoluble fiber
- Relaxation and massage
- Castor oil packs over the lower abdomen
- Eliminating food allergens like dairy, wheat and other glutinous grains
- Digestive supplements to improve bile flow, HCl, enzymes and bile salts with taurine, and bitters designed for bile and gallbladder
One of my favorite travel constipation remedies is to take whole flax seeds with me and take 1 tsp, pour it into my mouth and down it with a glass of water, 1 or 2 times a day. Simple and very effective. I don’t grind them; I don’t chew them. I just get them down the hatch.
Enemas – Instant Constipation Relief
Enemas? Wait! Before you discount the idea, know that enemas have been used for centuries for a reason – they work! And they’re not difficult to do. All the suggestions above can help, but every one of them does take some time. Sometimes what we need is fast constipation relief. In other words, NOW. What works instantly and faster than a laxative is an enema.
While we recommend ordering an enema bucket online for regular use with the coffee enema (which flushes the bile as well as the bowel), you can get a fleet enema kit or an enema bag in your local drug store today.
Gallstones And Constipation
According to studies, there is a definite correlation between constipation and gallstones. Constipation or “slow intestinal transit” time is associated with the formation of gallstones. A slow metabolism, such as caused by a hypothyroid, simply slows down all bodily processes from the movement of bile to the movement of bowels. It can even slow down thinking processes. A diet of refined foods (such as flour, bread, pasta and white sugar) has been shown to contribute to both of these conditions as has a sedentary lifestyle.
Constipation is becoming an increasingly chronic issue for Americans. Some children and adults deal with the uncomfortable issue, and higher amounts of seniors deal with this issue. There are many different products on the market to help provide relief and move the bowels. While these are needed to reduce discomfort, what is also needed is for us to look at some of the possible root causes of constipation. If you aren’t addressing the root, you may just be putting a bandaid on the situation.
There are several factors that can contribute to constipation:
- Not drinking enough water
- Not eating enough fiber (mainly this comes from lack of fruits and veggies, though flax seed and chia seeds can be helpful)
- Lack of exercise/excess sitting
- Lack of probiotics
- Gallbladder not functioning optimally
All these factors combined and separately have an impact, but what I wanted to focus on today is how the gallbladder can be one of the culprits in chronic constipation. Most everyone has bouts of occasional constipation, and that is usually created from life circumstances like traveling or being dehydrated. Chronic constipation is an ongoing issue dealt with on a daily and weekly basis.
The Gallbladder’s Job
The gallbladder’s main job is to store, concentrate and release bile. Bile is made by the liver and then transported to the gallbladder to be stored. As it sits there, it is concentrated into a more potent product that is made up of fatty acids and cholesterol and designed to be excreted when fat from food we ingest enters into the duodenum (the start of the small intestines). Bile has two main jobs. It carries toxins out of the liver and it enhances the digestion and utilization of fats that we eat by emulsifying them and breaking them up into smaller fat globules in the small intestines. Once the fats are broken down, they can be absorbed by the body and utilized for fuel.
The other key component of bile is that it helps move things along in the intestines, meaning it moves stools through the intestines and out as waste. If the body is not digesting something well, it tends to stay around for a while, which is what can happen with undigested fat when there is limited bile. This decreases GI motility (or bowel movements).
Without appropriate amounts of bile to break up fat, you will have a harder time digesting the fat soluble vitamins A, D, E, and K. It is important that we eat good fats as they play many important roles in the body. Fats are used in the body as fuel, to satiate us and keep us fuller longer, and they help us to regulate inflammation (omega-3 and omega-6 are important in the right balance for this). Fats also make up part of the structure of our cell walls, and are used to form key hormones.
Signs of a poorly functioning gallbladder
Intense cravings of sugar and fat can be a sign that your gallbladder needs a little more support. If you aren’t digesting fats well, you can tend to crave them, or crave sugar, as fats are like the slow burning fuel and give us longer sustained energy and satiate us. When we don’t eat fats or aren’t digesting them well, we are hungrier more often and can turn to sugar instead to give us quick energy as it digests very quickly and the body uses the glucose for fuel. Of course, dysregulated blood sugar and a constant intake of sugary foods will also contribute to cravings for more sugar, so limit your intake as much as possible. Other signs of gallbladder issues can be pain under the right rib cage where the gallbladder is located, motion sickness/nausea, frequent diarrhea or fatty stools that float due to not digesting fats. If you increase your fiber content and your constipation gets worse or you take liver cleansing herbs and don’t do well, it could be because the bile is not flowing freely like it should and so the fiber isn’t being effectively moved along or the liver cannot get rid of the toxins through the bile appropriately. Fiber helps bind up the bile and toxins and safely escort it out of the body in the form of stools.
Bile and Fats
To have a healthy gallbladder with healthy bile, we need to be eating healthy fats regularly. Healthy fats are fats like coconut oil, olive oil, avocado oil, butter, and ghee. Unhealthy fats are highly processed vegetable oils like canola oil, soybean oil, and any liquid oil that is heated and refined. These oils are not heat stable, are sensitive to light and therefore should be stored in opaque jars, and are often from gmo crops. Unhealthy fats also include consumption of trans fatty acids and fried foods as these fats have been altered and can be rancid and oxidized, contributing to inflammation and poor quality bile. You need healthy fats to make healthy bile!
When you don’t eat fat regularly, meaning you eat low fat or no fat, your gallbladder doesn’t get the signal to release bile regularly, as it is released due to the presence of fat in the duodenum (the beginning of the small intestines). When the bile doesn’t move out regularly, it gets thick and viscous and can lead to gallstone formations. This can lead to inflammation and pain down the road, but also means limited fat digestion takes place. Remember, fats are needed for a healthy inflammation response, cell structure, hormones, and more, so it is important that we digest them to use them.
So how do you take care of your gallbladder?
- Eat healthy fats like olive oil, ghee, tallow, butter, lard, avocado oil, and oils that support healthy inflammation pathways like borage oil, hemp oil, fish oil, flax seed, chia seeds, and black currant seed oil.
- If you no longer have a gallbladder or have trouble digesting fats due to a sluggish gallbladder, coconut oil is a good fat to use for cooking and baking, as it is high in MCTs and gets digested quickly and doesn’t need as much bile to digest it.
- Eat foods that thin the bile and support the liver like beets, lemons, apples, dandelion greens (and other bitter foods or Swedish Bitters), carrots, and flaxseed oil.
Want a tasty recipe that helps support a healthy gallbladder and bile flow? Check out our Gallbladder Salad recipe.
EZ-Go Herbal Stool Softener for ease of bowel movements
For those that do need some extra support, Mt. Capra offers an excellent product that enhances elimination. It is called EZ-Go and is an herbal stool softener that is gentle and non-irritating. It includes mucilaginous herbs like aloe, slippery elm, and marshmallow root that soothe, as well as magnesium, and triphala to add some bulk to the formulation for ease of movement.
Please note: Nothing in this blogpost is making any health claims. This information is for informational purposes only and does not substitute the advice from a qualified medical professional. If you have any concerns about your health, see your primary care provider.
Weight Stigma and the Five F’s of Gallstone Disease
By Louise D. Metz, MD
In medical school, we were taught a multitude of mnemonics to help us memorize lists related to basic science and clinical care. One of those mnemonics was the 5 F’s, a list of risk factors for the development of gallstone disease: “Female, Fertile, Fat, Fair, and Forty”. If a patient came in to the hospital or clinic with upper abdominal pain, we were taught to use this mnemonic to determine if the patient’s symptoms may be caused by gallstones. The gallbladder is a small organ adjacent to the liver that holds bile, a liquid that helps the body digest food. Gallstones are small, hard masses that form in the gallbladder and are made up of cholesterol, calcium salts, and bile pigments. About 10-15 % of the population has gallstones, and this incidence varies among ethnic groups. However, only 15-25% of those with gallstones will have symptoms related to gallstones. In some individuals, gallstones can push against the opening of the gallbladder, leading to increased pressure in the gallbladder and associated abdominal pain, known as biliary colic.
There was an explanation behind the 5 F’s mnemonic of gallstone disease: The incidence of gallstones had been thought to be more common in Females over Forty as they were reaching perimenopause. Women who were Fertile, meaning that they had one or more children, were thought to be at higher risk due to higher estrogen levels and the association of gallstones with pregnancy. Fair was part of the 5 F’s because it was believed that gallstones were more common in Caucasian women, and Fat was included because being “overweight” or “obese” was linked to increased levels of cholesterol that could cause gallstones. Despite this reasoning, this mnemonic was different than the usual mnemonic lists such as MUDPILES for the list of causes of a metabolic acidosis or the 4 T’s for mediastinal masses. This mnemonic was not just an objective list of risk factors for a condition, as it implied a biased image of a certain type of patient who has gallstones. It carried with it a focus of blame on the individual for their lifestyle or behaviors causing their health condition.
Instead of actually helping with diagnostic dilemmas, this mnemonic narrows the critical thinking of the diagnostician and labels a large group of people who fall into these demographics as having this particular health condition. What other conditions might be missed in a woman over 40 in a larger body with abdominal pain if we are only thinking of gallstones? How about heart disease, which can present with abdominal pain or nausea in women rather than the typical chest pain syndrome that was defined in a male population? What about a stomach ulcer, which can lead to serious complications if missed? Given that gallstones are often present but asymptomatic, gallstone disease could often be an erroneous diagnosis once gallstones are identified on an imaging test. And how about individuals who do not fit into this profile, such as women of color? Might the presence of gallbladder disease in this group be missed? And what about the actual validity of this mnemonic? Does it accurately represent the risk factors and physiology of gallstone disease?
The 5 F’s mnemonic has been taught to medical students since well before the 1950s, when a study in the British Medical Journal assessed the validity of the mnemonic. They found that gallstones were more common in women in general, but that men were more likely to have gallstones at older ages. They found that while women under 50 with children were more likely to have gallstones than those without children, the opposite was true after age 50. Similarly, they found that women under 50 with gallstones had higher weights than those without gallstones, but this was not the case after age 50. In addition, we know that Native American women and Mexican American women have a higher prevalence of gallstones (50% and 27% respectively) than Caucasian women (17%), so the “Fair” in the mnemonic also does not hold up. A more recent study in 2013 looking at the validity of this mnemonic found that family history, which is not included in this mnemonic, is actually one of the strongest risk factors for gallstones. Despite the inaccuracies of this mnemonic in these studies done over 60 years ago and in the recent past, medical students have continued to learn this biased list.
What about Fat in the 5 F’s? Though the term fat has been reclaimed as an objective descriptor of body size, the term fat in this gallstone mnemonic was used in a stigmatizing way. It was posited that women who are fat are predisposed to gallstones due to their eating behaviors and cholesterol levels, which could cause gallstones to form. However, this idea is rooted in weight bias, as we know that one’s body size does not provide us with any information about eating behaviors or cholesterol levels. In addition, what we didn’t learn in medical school is that the association between body size and gallstones may be a correlation rather than a causal connection, and there may be other mediating factors that are causal. For instance, weight cycling (yo-yo dieting) increases the risk of gallstones. Studies in both women and men have found that weight cycling (as little as 5-9 lbs) has been found to be independently associated with gallstone disease after controlling for BMI, age, fat intake, and alcohol intake. Rapid weight loss due to very low calorie diets or gastric bypass surgery has also been shown to lead to formation of gallstones. Therefore, it is likely not the body size that is causing the gallstones, but it may instead be the restrictive and repeated dieting that is causing gallstone disease. Prescribing diets is harmful and may be a causal factor in not just gallstone disease, but many other health conditions including heart disease, hypertension, and diabetes, which are also typically blamed on individuals’ body sizes.
Weight bias is pervasive among healthcare providers. Despite our sense of pride in having objectivity in medicine, we as providers carry significant implicit bias and are not neutral in the care that we provide. Weight stigma that is internalized by individuals can lead to avoidance of care, non-adherence to treatment, and an increase in the risk of a multitude of health conditions. The 5 F’s of gallstone disease illustrates the weight bias that is entrenched in our medical culture. It labels individuals as being to blame for a condition when, in fact, the treatments that we are prescribing to those in larger bodies, including diets and weight loss surgery, may actually be causes of these conditions. We must acknowledge the weight bias and stigma that exists in our western medical model, and recognize the harm that is done in the name of health. The health and wellness of each individual is much more complex than a simple and biased mnemonic.
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Regardless of the eventual diagnosis of your gallbladder disease, most of the symptoms will be the same. This is one of the reasons it is hard to know exactly what the actual specifics of your particular issue are without several tests. The most common symptoms are indigestion, gas, bloating, burping and belching; especially (but not necessarily) following a meal. Symptoms most often occur after meals containing fat, as the disease related to the ability of the body to digest fats; but as the disease progresses it can become unrelated not only to fat intake, but even to food intake. The disease may progress to creating a constant tenderness or discomfort under the rib cage on the right side, which is unrelated to food intake. The symptoms are similar to those of a gallbladder attack but with lower severity.
Even if it does not seem to be connected to food now, the indigestion you experienced likely often followed a meal. What caused or is causing the problem with fat digestion could be one of many things: a stone could be blocking the bile flow, or the gallbladder could be distended due to stones or inflammation. The gallbladder could be not emptying fully (biliary dyskinesia), and lack of bile causes improper fat digestion. There could be infection in the gallbladder itself causing tenderness; or tenderness could simply be due to stasis of bile causing distention. Or the problem could start in the liver, with stasis of bile there via the formation of sludge or tiny calculi, which slows bile flow. Constipation and weight gain can also be symptoms of gallbladder problems, though these are not usually as relatable to fat intake.
Specific Gallbladder Diseases
Also called acalculous cholecystopathy, biliary dyskinesia is a disease or condition of the gallbladder that occurs without the presence of gallstones. It could also be termed “functional gallbladder disorder” or “impaired gallbladder emptying”. Some causes may be chronic inflammation or the gallbladder, an issue with the smooth muscles of the gallbladder, or the muscle that contracts the Sphincter of Oddi (and regulates bile flow) being too tight.
Symptoms include right upper quadrant pain, with the absence of gallstones. Any of the listed gallbladder symptoms may accompany this problem, as it results in a lack of concentrated bile from the gallbladder, which is necessary to digest fats.
There is evidence that stress may play a large role in causing this problem. The biliary dyskinesia kit is designed with that in mind.
Cholecystitis is inflammation of the gallbladder. Acute cholecystitis is nearly always due to gallstones, but may also be due to bacterial infection or chemical irritation. Chronic cholecystitis can occur with or without stones (acalculous cholecystitis is without). If there are no stones present, the medical treatment used is often antispasmodics and/or laxatives. The products in the gallbladder attack kit work very well for the pain in this particular case. Choledocholithias Choledocholithias is a condition where gallstones form in the bile ducts. This can be very painful, and symptoms can vary depending upon where the stones are and if it they are actually blocking bile flow. A stone can block the neck of the gallbladder, which causes distention and inflammation (cholecystitis). In the common bile duct, stones can cause a backing up of bile into the liver (resulting in obstructive jaundice), or into the pancreas (causing acute pancreatitis).
Cholelithiasis is the medical term for gallstones. Gallstones are solid, crystalline precipitates in the biliary tract, usually formed in the gallbladder. They consist mainly of calcium, cholesterol, and/or bilirubin. See the page devoted to gallstones for more information.
Cholangitis is inflammation of the bile duct. Acute cholangitis is most often caused by a bacterial infection resulting from stagnation of the bile in the duct. Choledocholithiasis (a gallstone that gets stuck or lodged in the bile duct) can create an obstruction that results in an infection. Infections can also be caused by a stricture or narrowing of the duct itself, such as in Primary Sclerosing Cholangitis (see below), or may accompany a cancer. In this condition, something blocks the free flow of the bile, which causes a stagnant condition that allows the bacteria to take hold.
Symptoms associated with cholangitis are pain, fever, chills, jaundice and abdominal pain.
Primary Sclerosing Cholangitis
PSC is a hardening of the bile ducts of the liver, which obstructs the flow of bile and causes inflammation, leading to the breaking down of and eventual hardening or fibrosis of the bile ducts within the liver and outside the liver both (intrahepatic and extrahepatic bile ducts.)
Cholestasis is the impairment of bile flow due to obstruction in small bile ducts (called intrahepatic cholestasis) or obstruction in large bile ducts (called extrahepatic cholestasis).
Symptoms of cholestasis are caused by the blocking of the secretion of bile, which results in the bile backing up into the bloodstream. This can result in jaundice and excess bilirubin in the blood, which would make the urine dark and the stools pale or chalk colored. The excess of bile salts in the systemic circulation may cause intense itching and skin irritation, and there may be fat in the stools. The clotting time of blood may be impaired due to malabsorption of fats and Vitamin K, which is a fat-soluble vitamin that many clotting factors depend upon.
The American Cancer Society estimates that about 8,750 people will be diagnosed with gallbladder cancer in 2006. Statistics show that gallbladder cancer occurs five times as often in Native American people in New Mexico than in whites, and that women are normally more susceptible than men.
There are rarely any symptoms early on in gallbladder cancer. It is so subtle that it is often only discovered when the gallbladder is removed for other causes, such as gallstones. Otherwise, gallbladder cancer is usually quite advanced by the time it is diagnosed.
If caught early, removing the gallbladder and affected tissues in bile ducts is the standard treatment for gallbladder cancer.
Gallbladder polyps are growths or lesions that grow in and protrude from the lining of the gallbladder. They’re usually benign and rarely cancerous. 95 percent are non-cancerous, and ten percent are the result of inflammation, with most being the result of cholesterol deposits.
Gallbladder polyps usually produce no symptoms, and therefore need no treatment. They may be found accidentally if an ultrasound of the gallbladder done for some other reason. There is rarely any pain involved, and any pain that is there is most likely due to something else (such as gallstones). Occasionally, the polyps may grow large enough to require surgical removal.