What should you know about bile diarrhoea?

Bile acids are released to help digest fat and are normally reclaimed in the small intestine. If too many pass into the colon, they can draw in water and stimulate bowel movement. Stools may be watery, pale or yellow, and urgency soon after eating is common. It can follow bowel surgery, inflammation or another digestive condition, but diarrhoea can also result from Food Poisoning, Gastroenteritis, Food Intolerance or Irritable Bowel Syndrome.

A clinician will consider duration, stool appearance, triggers, medicines, travel, weight and hydration. Crohn's Disease, Coeliac Disease, Giardiasis and Hyperthyroidism may need consideration when the pattern suggests them.

Drink regularly, replace fluids after loose stools and choose foods you can tolerate while arranging advice. Keep a diary of meals, urgency and stool changes. Avoid an extreme low-fat diet unless a clinician or dietitian recommends it, because overly restrictive eating can reduce nutrition. Treatment may include a prescribed bile-acid binder after the cause has been assessed.

Contact a clinician for diarrhoea that persists, recurs frequently, wakes you, causes weight loss or interferes with work and daily life. Seek urgent help for blood or black stool, severe abdominal pain, high fever, fainting, confusion, very little urine or inability to keep fluids down.

Ask whether bile acid malabsorption fits the pattern, whether stool or blood tests are needed, how to protect hydration and nutrition, whether a medicine could be contributing and how treatment will be monitored.