Bile Acid Diarrhea: Causes, Diagnosis, and Treatment Options

When your body doesn’t reabsorb bile acids properly, they flood into the colon and trigger bile acid diarrhea, a condition where excess bile acids irritate the colon, leading to frequent, watery stools. It’s not just regular digestive upset—it’s a specific disorder often mistaken for IBS, especially when no other cause shows up on tests. Many people live with it for years before getting the right diagnosis because doctors don’t always test for it.

It usually happens after gallbladder removal, bowel surgery, or in people with Crohn’s disease affecting the ileum—the part of the gut that normally reabsorbs bile. Without that reabsorption, bile acids spill into the colon, pulling water in and speeding up movement. This is called bile acid malabsorption, the root cause of bile acid diarrhea, where the intestine fails to recycle bile acids back to the liver. It’s also linked to certain medications and radiation damage to the intestines. The key sign? Chronic diarrhea that doesn’t improve with fiber or standard IBS diets, often worse after meals, especially fatty ones.

Treatment isn’t about fixing the gut—it’s about blocking the bile acids where they cause trouble. cholestyramine, a bile acid sequestrant that binds excess bile in the gut and removes it through stool is the first-line option. It’s a powder you mix with water, and while it tastes chalky, it works for most people. colestipol, another bile acid sequestrant with fewer side effects than cholestyramine is an alternative if the first one doesn’t sit well. Newer drugs like elobixibat are being studied but aren’t widely available yet. The goal isn’t to cure the malabsorption—it’s to manage the symptoms so you can eat without fear of sudden bathroom trips.

What you’ll find in the posts below are real, practical insights from people who’ve been there. You’ll see how bile acid diarrhea connects to other conditions like Crohn’s, how it interacts with common medications, and why some people respond better to one treatment over another. There’s no fluff—just clear, tested info on what works, what doesn’t, and how to talk to your doctor about getting tested. If you’ve been told it’s just IBS and nothing helps, this collection might finally give you answers.