What is short bowel syndrome?

Short bowel syndrome is a group of problems. They happen to people who have had a large part of their small intestine surgically removed.

The small intestine is a long, curving organ. It connects your stomach to your large intestine (colon). Digestion starts in your stomach. But most digestion takes place in the small intestine. The small intestine also absorbs nutrients. Bowel refers to the small intestine and large intestine together.

You can have problems when too much of your small intestine is taken out. You may not be able to absorb enough water, vitamins, and other nutrients. This can cause major nutritional problems and symptoms. It can also put you at higher risk for short bowel syndrome. The more of the small intestine that has been removed, the greater the chance for severe problems. Some people with short bowel syndrome have also had part of their large intestine taken out. This can lead to more problems.

What causes short bowel syndrome?

This condition can happen after any type of surgery to take out part of your small intestine. The most common reasons for surgically removing part of the small bowel are:

• Crohn’s disease

• When part of the intestine folds over another part (intussusception)

• A blocked blood vessel that causes loss of blood flow and injury to the small intestine (ischemia)

• Small intestine injury from trauma

• Cancer and damage from cancer treatment

• Certain types of weight-loss surgery

• An abnormal passage that forms in the bowel (fistula)

Who is at risk for short bowel syndrome?

Having conditions, such as Crohn's disease, that need to be treated by taking out part of your small intestine raises your risk for short bowel syndrome.

What are the symptoms of short bowel syndrome?

A main symptom of short bowel syndrome is diarrhea. Other symptoms are:

• Bloating and gas

• Cramping

• Heartburn

• Fatigue

• Dehydration

• Weight loss

• Being sensitive to new foods

How is short bowel syndrome diagnosed?

If you have had a large part of your small intestine removed, your healthcare provider will look for short bowel syndrome. If you have a history of surgery and symptoms of short bowel syndrome, you are likely to have the condition.

Your healthcare provider may rule out other causes of your symptoms. They will do an exam and ask about your symptoms. Your healthcare provider may also do other tests. These can include:

• Basic blood tests. These can check for protein levels, anemia, and electrolytes.

• Tests to check for nutritional deficiencies.

• Stool tests. These can tell if you are absorbing enough fat.

• X-ray or CT scan of your abdomen. This is done to look for complications.

• Endoscopy. This test is done to look at your esophagus, stomach, and early duodenum.

• Colonoscopy. This test is done to look at your colon.

How is short bowel syndrome treated?

Treatment depends on how bad the condition is. It also depends on how long it’s been since you had your small intestine removed.

After surgery, your remaining intestine slowly adapts. Over time, it's able to absorb nutrients better. This process can take a year or two. This varies depending on how much and what part of your small intestine was taken out.

You will likely have parenteral feedings after your surgery. This means that you won’t eat anything. Instead, you will get nutrients through a tube placed in your vein.

As you recover, your healthcare provider may slowly start enteral feedings. This gives liquid nutrition directly to your stomach or small intestine through a feeding tube. Over time, your healthcare provider will try to increase your enteral feedings and decrease your parenteral feedings.

Your healthcare provider may eventually move you to oral feedings. Follow your healthcare provider's specific instructions. It's best to eat small meals often. Don't have foods that are high in simple carbohydrates, such as juices.

Some people with severe short bowel syndrome will need long-term parenteral nutrition. This can sometimes cause problems. If this happens, you may need a small intestine transplantation. Or your healthcare provider may suggest a nontransplantation surgery. This can improve how you absorb nutrients.

Other treatments for short bowel syndrome include:

• H2 blockers or proton pump inhibitors. These are medicines to decrease stomach acid.

• Medicines to treat diarrhea

• Extra nutritional supplements

• Electrolyte solutions. You may take these by mouth (orally) or through an IV (intravenous line).

• Medicines to prevent liver damage. These are given to people on parenteral nutrition.

• Medicines to help the small intestine adapt

What are possible complications of short bowel syndrome?

This condition can cause serious issues. Your healthcare provider will watch you for complications. They will also try to treat any problems early on.

If problems aren’t treated well, you can have diarrhea. This can cause dehydration, weight loss, vitamin deficiency, malnutrition, and a decrease in your overall quality of life. It may even lead to death.

Other complications can include:

• Liver disease. This can happen from long-term use of parenteral nutrition. In rare cases, this may lead to a liver transplant.

• Gallbladder disease, including gallstones.

• Bacterial overgrowth of the small intestine. This can make your symptoms of short bowel syndrome worse.

• Nutrient deficiencies. Specific problems depend on which nutrients are low. For instance, some people show early bone loss. This is because of vitamin D deficiency and poor absorption of calcium and other nutrients.

• Kidney stones. This is caused by extra oxalate in your urine.

• Emotional problems, such as anxiety or depression, for both the person with short bowel syndrome and caregivers.

Follow your healthcare provider’s orders about diet and medicines. Keep all scheduled appointments and request more support when needed. For example, you may need dietary support or emotional support. Doing so will reduce your risk for problems.

When should I call my healthcare provider?

Call your healthcare provider if you have any of these:

• Severe diarrhea. You may need to go to the hospital to get IV fluids to rehydrate.

• Any new symptoms, such as confusion or bad stomach pain

Also contact your provider for additional help and resources if you or your caregivers have:

• Increased depression

• Increased social isolation

• Problems managing daily tasks and physical function

Key points about short bowel syndrome

• Short bowel syndrome is a group of problems. They happen to people who have had a large part of their small intestine removed.

• The main symptom of short bowel syndrome is diarrhea.

• After surgery, you will get your nutrients through a vein. This is called parenteral nutrition. Then, you will likely get liquid nutrition directly to your stomach or small intestine through a feeding tube. This is called enteral nutrition. Over time, you may be able to eat normally.

• Some people with severe short bowel syndrome need parenteral nutrition long-term.

• Short bowel syndrome can cause problems. These are more likely in people who need long-term parenteral nutrition. You may need a small intestine transplant.

• You can stay as healthy as possible by following your treatment plan, taking prescribed medicines, getting help with symptoms, and keeping scheduled follow-up appointments.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours or on weekends.