What is short bowel syndrome?

Short bowel syndrome (SBS) is a rare, complex and potentially serious malabsorption disorder. It happens when you don’t have enough small bowel (intestine), or your small bowel does not work well. This prevents your body from absorbing enough nutrients, such as water, protein, calories, fat, vitamins and other things your body needs. The specific nutrients your body has difficulty absorbing depends on what part of your small intestine has been removed or is damaged. 

People may have SBS for different reasons, such as: 

  • Surgery to remove a major portion of the small and large intestines. Surgery may be done to treat birth defects, gastrointestinal (GI) diseases, like Crohn’s disease, or injuries.  
  • Being born with part of the small intestine missing, damaged or too short.  
  • Having small intestines that don’t work well for other or even unknown reasons.  

Most children with SBS are diagnosed shortly after birth. They typically have a GI condition that requires surgery. Children diagnosed early may have a very different experience with SBS than those who develop the condition as an adult. 

SBS can range from mild to serious and your condition can change over time based on your symptoms and any surgery you have.

Some people with mild symptoms need less treatment. Others need long-term help to manage their symptoms and make sure they get the nutrients they need. 

  • Mild SBS — You may need to eat several small meals a day, drink extra fluids, and take vitamins and minerals. You also may need medicine to help with diarrhea. 
  • Moderate SBS — You may need the same treatment as those with mild SBS. You also may need to get extra fluids and minerals through a vein in your arm. 
  • Serious SBS — You may have difficulty eating solid food. Instead, you may need to get your meals through a vein in your arm. Or you may need a feeding tube that delivers liquid food directly to your stomach or small intestine.  

 Your body may adjust to having a shorter small intestine over time. If that happens, you may be able to reduce the medications and other treatments you need. How much your condition can improve depends on your age, how healthy you are, how much of your small intestine you still have and whether you have other conditions, such as Crohn’s disease. 

Did you know?

The small intestine, which is the tube-like organ that connects your stomach and your large intestine, has three parts and should be about 20 feet long. It’s an important part of your digestive system. The small intestine’s job is to further digest food coming from your stomach and to absorb the nutrients your body needs to function well.

What are the symptoms of short bowel syndrome?

The most common symptom of SBS is diarrhea, which can affect your health. Diarrhea can lead to malnutrition. That means your body doesn’t get the nutrients it needs. It can also cause dehydration and weight loss.  

Common symptoms:

  • Cramping. 
  • Gas.
  • Bloating.
  • Vomiting.
  • Fatigue.

Always pay attention to your symptoms so you can discuss changes or any concerns with your health care provider. 

Tests for short bowel syndrome

To find out if you have SBS, your health care provider will ask about your personal and family medical histories and perform a physical exam. They also may order some or all of these tests:

Show vitamin and mineral levels and other important measures.

Measure the amount of fat in your stool. This test helps providers assess how well your body breaks down and absorbs fat.  

Show narrowing or blockages.

During this test, you will drink a chalky liquid, called barium. It coats the internal organs and makes it easier for your providers to see the size and shape of organs. 

These tests combine x-rays and computers to create detailed images of the body. These scans can show changes in the intestine and bowel obstructions. 

 

How is short bowel syndrome treated?

Your care for SBS depends on how healthy you are, how much of your small and large intestines you have, and whether you have other health issues, like Crohn’s disease. As your needs and health change, your treatment plan may also evolve. Treatment can:

  • Help ease your symptoms. 
  • Help you get the fluids, vitamins and nutrients you need. 
  • Improve the way your small intestine functions.

Even though SBS can be different from patient to patient, one thing is the same for all patients with SBS. Working closely with your health care team and following your treatment plan is key to your health. These are the best ways for you to manage your health and live an active life.  

Nutritional support

Nutritional support is the core treatment for SBS. This means you need extra help to get the fluids and nutrients you need. Your providers may suggest:  

You may need to drink fluids that contain minerals and salt to help prevent dehydration. Review Short bowel syndrome (SBS): Oral rehydration solutions for more information. 

You may need to have a needle placed in a vein to deliver fluids, electrolytes, vitamins and nutrition. 

You may have a small feeding tube in your nose or mouth that carries liquid food to your stomach. 

You may need supplements to replace nutrients you don’t get naturally through food.

Diet

There is no one diet for people with SBS. Your health care providers or dietitian will create a diet for you based on the part of your small intestine that is affected and how well your remaining intestine works. They may tell you to eat food if and when you can to help your intestines function better. They may also suggest that you: 

  • Eat small amounts of food frequently. 
  • Avoid eating foods that may trigger diarrhea, such as foods high in sugar, fiber and protein.  
  • Stay away from foods that are high in fat. 

Read more about diet and nutrition for SBS created by AGA and Dietitians in Gluten and Gastrointestinal Disorders (DIGID).

Medication

There are a variety of drugs that may help you in different ways. For example, there are medications to help your intestine absorb more nutrients, prevent or minimize diarrhea, and reduce stomach acid.  

Surgery

You may need surgery to help your small intestine absorb more nutrients. Surgery can help prevent blockages, preserve the length of the small intestine, or lengthen the intestine. Patients who have surgery to remove a large portion of the small intestine may go through whats called intestinal adaptation. This means their intestine’s ability to absorb nutrients may improve over a period of several years. 

Intestinal transplant

Some patients may benefit from an intestinal transplant that involves replacing a diseased or injured intestine with a healthy intestine from a donor. This is major surgery and providers usually only recommend it when other treatments haven’t worked. 

Complications of short bowel syndrome

Having a plan for managing your SBS can help you avoid these possible complications.   

This happens when your body doesn’t get enough nutrients. 

Unbalanced levels of electrolytes can cause an irregular heartbeat, nausea and headaches. 

Too much gastric acid in your stomach can cause sores in the lining of the stomach or the first part of the intestine. Learn more. 

Reduced absorption of bile salts, fats and calcium can cause solid masses to form in the kidney. Kidney stones can be painful. They may affect your kidney function and urine flow. 

Excess bacteria in the small intestine can affect digestion and absorption in the small intestine. Symptoms may include diarrhea, bloating, vomiting and nausea.