Bile Acid Malabsorption and Crohn’s disease

Urgency and visits to the bathroom. Not a topic of conversation anyone prefers to talk about. If anything, it’s taboo and people tend to shy away from the subject, especially those who don’t have inflammatory bowel disease. While IBD is so much more than a “bathroom disease”, those of us with Crohn’s disease and ulcerative colitis tend to spend a lot more time on the porcelain throne than others.

If you’re like me, and have had surgery that involved the removal of your small intestine and part of your colon, it’s commonplace for people to have around three to five loose stools a day. Our bodies just don’t have the proper parts to absorb and digest nutrients like others. I was surprised to find out from my GI that going that many times, is par for the course after bowel resection surgery.

IMG_3329When I visited my GI for a routine appointment last week, she told me those with IBD who have surgery oftentimes have an “issue” called Bile Acid Malabsorption (BAM). BAM causes chronic diarrhea that results from your body producing too much bile acid (or bile salt).

In my case—and for anyone else who has the last part of their small intestine removed…our bodies are unable to absorb bile salt. Bile salts help food get digested as it travels through the small bowel. If you’re like me and don’t have your terminal ileum or ileocecal valve—or if it’s diseased, too much bile salt reaches the colon. Our bodies then send water to the colon, which causes diarrhea.

My doctor recommended I start taking Colestipol as needed. IMG_3434This medication is typically a cholesterol medication, but can be used by Crohn’s patients as a bile acid sequestrant. By taking one pill prior to eating each meal, it helps bind bile acids in the intestines and can prevent the need to go make a mad dash for the bathroom immediately after eating.

I had my small bowel resection in August 2015, this is the first I’ve heard of BAM. I wanted to share this knowledge with you, in case you’ve been overwhelmed with the feeling of being tethered to the bathroom at inopportune times. I’ve only been taking Colestipol before dinner for a few days, but it’s given me peace of mind and comfort already. IMG_3576I wasn’t thrilled to add another pill to my patient repertoire and daily regimen (it’s a horse pill!), but this has the ability to be a game-changer.

Obviously, I’m not a doctor. But, if you have Crohn’s in your small intestine, have had a resection and experience several trips to the bathroom a day, inquire about taking a bile acid pill. See if it can help improve your quality of life, too.