What is Short Bowel Syndrome

Short bowel syndrome refers to a condition in which a person loses the ability to absorb enough fluids and nutrients from his or her diet. This condition occurs in people who:

• Have had part of their small bowel, also called the small intestine, removed by surgery.
• Are missing part of their small intestine for other reasons, such as a birth defect (congenital malformation).

When you eat and drink, food and fluids go from your stomach to your small intestine. This is where most of the nutrients in your food and fluids are absorbed. If you have lost more than half of your small intestine, you may not be able to get enough nutrients, vitamins, or fluids to stay healthy.

Living with short bowel syndrome can be challenging. Learn as much as you can about your condition, and work closely with all your health care providers. This may include a dietitian.

What are the causes?

A common cause of this condition is having a part of the small intestine removed during surgery. You may have this type of surgery to treat:

• Crohn’s disease.
• Cancer.
• Obesity.
• Obstructions.
• Loss of blood supply.

Other causes of small bowel loss include:

• Damage from X-ray treatments.
• Scar tissue.
• Trauma.
• Being born with a short small intestine.
• Damage to and loss of the lining of the small intestine wall in infants (necrotizing enterocolitis).

What are the signs or symptoms?

The most common symptom of this condition is long-term (chronic) diarrhea. Other symptoms of the condition include:

• Cramping and bloating.
• Heartburn.
• Greasy, bad-smelling stools (feces).
• Weight loss.
• Tiredness (fatigue).
• Swelling of the feet and ankles.
• Muscle loss or weakness.

How is this diagnosed?

Short bowel syndrome may be diagnosed based on your symptoms and medical history. Your health care provider may also do tests to find out how much this condition is affecting your health and nutrition. These may include:

• Blood tests to check for:
  • Low red blood cell count (anemia).
  • Low levels of vitamins and minerals.
  • Low levels of an important protein called albumin.
  • Liver problems.
• Checking stool samples for fat content.
• X-rays or other imaging studies of the small intestine, such as barium swallow, CT scan, MRI, or ultrasound.

How is this treated?

Treatment for this condition differs from person to person. Your treatment will depend on the cause and how severe the symptoms are. If your short bowel syndrome developed from a previous surgery, your symptoms may improve over a period of about 2 years as the rest of your small intestine adapts. The goals of treatment are to relieve symptoms and improve nutrition. Treatments may include:

• Changes to what you eat. You may need to work with a dietitian to find the best eating plan for you. Your new eating plan may include:
  • More protein and healthy carbohydrates.
  • Less fat and sugar.
• Supplements. These may be necessary for:
  • Getting enough vitamins and minerals.
  • Rehydration.
  • Proper nutrition.
• Medicines. You may need to take medicine to:
  • Control diarrhea.
  • Reduce stomach acid.
  • Slow digestion.
  • Improve growth and muscle strength.
• Parenteral nutrition. You may need to be fed through a tube that is inserted into a large vein in your chest, neck, or arm.
• Surgery.
  • Several types of surgery can help improve intestinal absorption.
  • In some cases, the small bowel may be removed and replaced with one from a donor (intestinal transplant).

Follow these instructions at home:

Eating and drinking

• Follow your eating plan.
• Keep a food diary to see which foods cause diarrhea or other symptoms.
• Eat small meals and snacks six to eight times a day instead of three large meals.
• Drink plenty of fluids between meals, but limit how much you drink during meals.
• Avoid caffeine and alcohol.

General instructions

• Stay active. Ask your health care provider what a safe level of activity is for you.
• Make sure you have a good support network at home.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Drink enough fluid to keep your urine pale yellow.
• When you go out:
  • Always locate the nearest bathroom.
  • Have a change of clothes on hand.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms get worse or you develop new symptoms.
• You lose weight.
• You have trouble coping at home.
• You have blood in your urine.
• You have pain in the side of the abdomen, right below the ribs (flank pain).

Get help right away if:

• You have very bad pain.
• You have bloody or black stools or stools that look like tar.
• You have chest pain or trouble breathing.
• You feel confused.
• Your skin feels cold and clammy.
• You feel extremely weak or you faint.
• You have signs of dehydration, such as:
  • Dark urine, very little urine, or no urine.
  • Cracked lips.
  • Dry mouth.
  • Sunken eyes.
  • Sleepiness.
  • Weakness.

Summary

• Short bowel syndrome refers to a condition in which a person loses the ability to absorb enough fluids and nutrients from his or her diet. It occurs in people who are missing part of their small intestine, such as those who have had part of it surgically removed.
• Treatment for this condition differs from person to person. Your treatment will depend on the cause and how severe your symptoms are.
• The goals of treatment are to relieve symptoms and improve nutrition. Treatment may include making changes to what you eat and taking medicines to reduce stomach acid and control diarrhea. In some cases, surgery may be needed.