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Bile Acid Malabsorption (BAM) | What is it?

Just to confirm this is written from personal experience and should not be taken as clinical advice. Should you think this may well be a thing then please see your relevant teams to have this investigated*

I have to admit I have an obsession with BAM. This is part of the reason my reversal failed and part of the reason I now have my permanent ileostomy. I have noticed in the groups recently that BAM is being more frequently diagnosed and some are being diagnosed with it after stoma surgery. I find this slightly weird as from my knowledge, BAM is incredibly difficult to diagnose and it involves a fair amount of testing to get that definitive diagnosis. 

So what is BAM?

BAM is short for Bile Acid Malabsorption, for those of us who have had our ileum removed or have damage to the ileum. Our stomach produces bile acids that help to break down what we eat, with an ileum, this is typically absorbed back into the body and sent back to our liver to be produced again for our next meal. 

For those of us who have had a bowel resection, stoma formation or removal of our ileums, our ileums effectively work as the braking system for our intestines. Without this, the bile acids aren’t reabsorbed into our bloodstreams and instead, it comes out via the large bowel and into the toilet. 

For those of you with your bowels still intact, BAM can only be described as being inventive with Sudocrem and needing shares in embalmed toilet roll.

For those of you going what on earth? 

BAM may be typical in people who have ileal Crohn’s disease or have had their ileum removed. The ileum works as the brake system within our bowel, without this our bowels overproduce bile acids, this can no longer be absorbed by the ileum and it has to come out. 

It may also be caused by radiation damage in those who have bowel cancer. My Nan is a prime example of this and lived for a fair few years before talking to me about her symptoms. My Nan has now been living an easier life and suffering less embarrassment now she has medication to manage these symptoms. 

It may cause explosive diarrhoea, excessive wind build up and burns on the way out, without medication this may be quite debilitating. With the correct medication, this can be managed and most can lead a normal life. Sadly for me, 4 years on medication and it started to fail, add another Crohn’s flare, I just wanted my life back. This led me to have my second stoma placed. 

Slight side joke, a year after that stoma placement I went back to see my surgeon to discuss part 2 of my surgery and he said don’t you dare ask for a reversal because it’s not happening… Turns out all the previous surgeries, Crohn’s disease and BAM had caused a fair amount of damage and a reversal just was not a feasible option. 

BAM Symptoms

BAM symptoms are more of a cause for causing anxiety with regards to bathroom habits:

  • Abdominal pain
  • Abdominal cramping
  • Bloating
  • Weight Loss
  • Dehydration
  • Excessive wind
  • Diarrhoea

For most of us, this can cause embarrassment due to the noise and the smells associated with this. 

BAM Diagnosis

For many of us, BAM may take a fair few years to get a clinical diagnosis. The reason for this is due to the nature of Crohn’s disease. The symptoms mirror a flare, if you are flaring then this can be left undiagnosed. A simple test called a SEHCAT scan can help diagnose this fairly swiftly. 

With the right combination of low fat, intermittent low residue diets and medication can make BAM manageable and livable.

Does BAM go away after stoma formation?

For me, most of the debilitating symptoms have gone away, however, due to where my stoma is placed I have high output, I still take loperamide and colostagel to help manage my output. We have tried to take me off of the medication completely but this normally lands me in hospital with severe dehydration, weight loss and acute kidney failure. The BAM has caused issues with my gallbladder and pancreas but at the moment that is being left where it is until the gallstones become too much to handle. 

My output is occasionally greasy and smelly, especially if I miss a day or two of my medication. 

I occasionally get gallbladder grumbles and pains but this is all managed with a healthy diet, healthy fats and a macros calculator, I still take my meds and for the best part the wind and cramps have eased off. 

For those of you who may be experiencing these symptoms please contact your GI or surgeon, If you have been discharged then a referral from your GP will help.

As always 

Many thanks for reading 

Louise X

Louise uses our Platinum Vitamin E range to keep her stoma site healthy. If you’d like to try a sample, click here. 

This blog post is intended to give advice to ostomates. The information given is based on Louise’s personal experience and should not be taken as clinical advice. Each ostomates needs are unique to them and their stoma care routine. Please consult with your Stoma Care Nurse before undertaking any changes to your stoma care routine or if you are experiencing any health issues.

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