Gastric bypass surgery leads to several positive changes for people who have this procedure. For example, people who have gastric bypass can lose a significant amount of weight, find improvement in their overall health and happiness, and can live a more active lifestyle. Along with these life-changing improvements, there can also be side effects such as diarrhea after gastric bypass surgery. Fortunately, there are strategies that you can take to improve diarrhea after gastric bypass.

What is Gastric Bypass Surgery?

Your digestive system goes through significant changes in gastric bypass surgery. The surgery itself is complex in that it changes your digestive anatomy and even your gut hormones. Gastric bypass surgery is a two-part procedure. In the first phase, the bariatric surgeon cuts the stomach to create a smaller pouch so that you can only eat a small amount of food. In the second phase of surgery, the upper portion of the small intestine is cut and reattached to the lower end of the small intestine. By shortening the small intestine, your body loses some of its ability to digest and absorb calories and nutrients from food.

Gastric bypass surgery leads to significant weight loss by these mechanisms:

• Malabsorption of nutrients
• Calorie restriction (the smaller stomach size makes you feel full quickly)
• Changes to gut hormones that lead to increased satiety and decreased hunger

What is the Relationship Between Diarrhea and Gastric Bypass Surgery?

Diarrhea and obesity often go hand in hand. For example, 8% of obese people struggle with diarrhea before bariatric surgery, which is double the percentage of non-obese people. And up to 75% of people have altered bowel function after gastric bypass. Because your digestive anatomy changes in gastric bypass surgery, your bowel function can be affected. This frustrating symptom is common in patients who have had other bariatric surgeries, including gastric sleeve and biliopancreatic diversion with duodenal switch. These surgeries help people with morbid obesity lose a significant amount of weight by causing malabsorption of nutrients. While malabsorption is a crucial ingredient for substantial weight loss, it can result in diarrhea with foul flatulence and sometimes incontinence.

Diarrhea after gastric bypass can be a short-term problem, or it can become chronic. Acute diarrhea is often the result of poor food choices such as fatty or sugary foods. Short-term diarrhea is prevalent after gastric bypass surgery because your body is adjusting to these anatomical changes. You are also learning how to eat with your modified digestive tract. Sometimes, surgery and antibiotics cause a bacterial infection called Clostridium difficile, which induces diarrhea until you get treatment.

Gastric bypass surgery causes people to have radical shifts in eating behaviors, including portion sizes, food selection, and frequency of meals. For example, people must follow a liquid diet after surgery. Frequently, this liquid diet can be deficient in fiber, which exacerbates diarrhea symptoms. Thus, people can suffer from acute diarrhea during the first six months to one year after surgery as they are learning how to eat for their modified digestive system.

People can experience chronic diarrhea after gastric bypass. Chronic diarrhea is usually the result of malabsorption of food. The foods you eat and the changes in how food empties from your stomach into your small intestine can cause malabsorption.

Dumping syndrome after gastric bypass surgery is common. Indeed, about 85% of gastric bypass patients will experience dumping syndrome at some point after the operation. People with dumping syndrome can experience early dumping in the 30-60 minutes after eating. Early dumping results in extremely unpleasant symptoms, including sweating, flushing, heart palpitations, nausea, and diarrhea. These symptoms occur when food rapidly dumps from the stomach into your small intestine. Rapid emptying changes gut hormones quickly, which creates a cascade of unpleasant symptoms. While dumping syndrome makes you feel terrible and can even be scary, the symptoms act as negative reinforcement to help you identify what foods to avoid after gastric bypass surgery.

What Complications Can Arise from Chronic Diarrhea after Gastric Bypass?

Gastric bypass chronic diarrhea can be debilitating as it impacts your health and alters your lifestyle. People with chronic diarrhea after gastric bypass are at considerable risk for malnourishment. Because your body does not have enough time to digest essential nutrients from food before it expels into your colon, you may experience malnourishment.

To prevent malnutrition, you must ensure that you are avoiding foods that trigger diarrhea. Also, people who have had gastric bypass surgery must supplement with specific vitamins and minerals each day. Indeed, weight loss surgery patients should have a personalized vitamin regimen to meet their unique nutritional needs.

Chronic diarrhea after gastric bypass can also be the result of an imbalance in your gut microbiome. For example, people who have constant diarrhea after gastric bypass frequently flush out their gut bacteria, which can lead to further diarrhea. Dysbiosis, or microbial imbalance, can play a huge role in your overall health. Certain health conditions may be partially caused by dysbiosis, obesity, heart disease, type 2 diabetes, asthma, allergies, and metabolic syndrome.

How to Prevent Gastric Bypass Diarrhea

While diarrhea can negatively impact your quality of life, it should not prevent you from considering gastric bypass surgery if you are struggling with obesity. Gastric bypass surgery is a sustainable solution to treating morbid obesity and the comorbidities associated with obesity. It is essential to keep in mind that diarrhea is common in the initial period after gastric bypass surgery because your digestive system is getting used to functioning differently. Fortunately, there are ways to help manage acute and even chronic diarrhea years after gastric bypass.

Consider making some dietary and lifestyle adjustments if you have abdominal distention and discomfort along with flatulence and diarrhea post gastric bypass. Following your surgeon's dietary recommendations is one of the best ways to relieve diarrhea in the early weeks after surgery. For diarrhea that persists longer than the immediate post-op period, consider these suggestions:

Food Matters - Everyone feels differently on certain foods. When you are reintroducing solid foods after your post-op liquid diet, go slow and be cautious. Start with foods that are high in protein and do not generally cause stomach upset. As you slowly begin to reintroduce foods, you can identify particular foods that may trigger abdominal discomfort and diarrhea. Keeping a food diary can help you track and monitor your symptoms.

Be wary of foods marketed as low-fat and low-carb, as they often have sugar additives that make them taste better. Similarly, some fruit (such as berries) contain sorbitol, which is a form of sugary alcohol that can cause diarrhea. Finally, dairy products contain lactose, which can aggravate your system, so it is best to limit these products, especially in the first few months after surgery.

Portions Matter - Your stomach is decreased to the size of an egg in gastric bypass surgery. Therefore, you physically cannot tolerate very much food. To prevent dumping syndrome and severe discomfort, limit your portions. Many post-bariatric surgery patients benefit from using a bariatric plate to learn how to distribute the main food categories: protein, fruits and vegetables, and carbohydrates.

Meal Frequency Matters - Because your stomach is smaller, you likely will need to eat more frequently than three squares a day. Many people after bariatric surgery eat 4-6 small meals a day.

Probiotics may help - Your gut microbiome can significantly change when you have gastric bypass surgery. And if you have constant diarrhea after gastric bypass, it is even more important to replenish the good bacteria in your gut. Taking a brief course of a probiotic can help you properly digest your food and ward off other health conditions from dysbiosis.

Medication - There are over-the-counter and prescriptive medications that may help relieve diarrhea. If you are unable to see improvement in your bowel function with dietary and lifestyle changes, consult your doctor to learn what anti-diarrheal medications may be best for you.