Short bowel syndrome (SBS) is a set of symptoms that occur due to a shortened small intestine. Symptoms can be mild or severe and include diarrhea, bloating, and fatigue. Surgeons may remove part of the intestine to help treat conditions such as Crohn’s disease. This can lead to a shorter small intestine and the onset of SBS. Some people have the condition from birth.

SBS, also known as short gut syndrome, is a rare condition affecting approximately 3 in 1 million people. The Crohn’s and Colitis Foundation estimates that SBS affects 10,000–20,000 people in the United States.

SBS can develop after an illness or damage to the intestines, such as after surgery for Crohn’s disease. However, infants can also have a genetic abnormality at birth that can lead to SBS.

Keep reading to learn more about SBS, including its causes, symptoms, and treatment options.

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The most common cause of SBS is the surgical removal of the small intestine. It can also develop due to any condition that prevents the upper bowel from working as it should.

Less commonly, SBS is present from birth.

Inflammatory bowel disease

Most people who have SBS have had surgery for inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. These are serious inflammatory conditions affecting the intestines that can cause severe symptoms.

Learn the five types of Crohn’s disease and their symptoms here.

People with Crohn’s disease may opt for surgery if their condition is not responding to treatment. Surgery may involve complete removal of the small intestine, which would lead to a shorter bowel.

Learn more about surgery for Crohn’s disease here.

In children

SBS can be also present in newborns due to genetic or birth conditions. Some of the causes in newborns include having intestines that form outside of the body or become twisted.

SBS in infants is rare. Also, survival outcomes are improving as researchers learn more information through studies and as surgery techniques improve.

Other causes

Other causes of SBS include:

  • cancer of the intestine, as well as treatment such as radiation therapy or surgery
  • trauma or accident
  • volvulus, where the small intestine is twisted or tangled, restricting blood supply and damaging tissue of the intestine
  • folding of part of the intestines into another part, called intussusception
  • damaged or diseased internal blood vessels, including hernia

Symptoms of SBS can differ depending on how much and where portions of the small intestine remain.

The main symptom of SBS is diarrhea, which can lead to serious complications, such as malnutrition and dehydration.

Malnutrition manifests in a number of ways, such as:

Some of the symptoms of severe dehydration are:

Other symptoms include:

People with SBS are also more likely to develop food allergies or sensitivities, including lactose intolerance.

There is currently no cure for SBS, and a person may need to manage the condition for the rest of their life.

However, treatment options are available that can alleviate the symptoms of SBS and help a person live a full and active life.

The main aim for people living with SBS is to balance their body’s nutrient intake as carefully as possible.

Factors that influence the length of treatment include:

  • age and overall health
  • the amount of remaining small intestine
  • whether an inflammatory disease is present in the small intestine
  • whether the large intestine is present or removed
  • whether the ileocecal valve, which links the two intestines, is present and working

A person with SBS may be at higher risk of the following complications:

  • infection, particularly if they receive food through a tube
  • sores in the small intestine or in the stomach from excess stomach acid
  • kidney stones, which are solid matter that forms in the kidneys, causing pain and blood in the urine
  • excess growth of small intestinal bacteria
  • malnutrition

There are a number of tools that can help diagnose SBS, such as:

  • Medical history: This can include any relevant family history.
  • Physical examination: Doctors may check for signs of muscle wasting, weight loss, or deficiencies due to a lack of vitamins and minerals.
  • Blood tests: Doctors may recommend a complete blood count. Other tests could include albumin levels, liver enzymes, electrolytes, vitamin and mineral deficiencies, and kidney function.
  • Fecal fat tests: These tests, which use stool samples, can examine how well the body is able to break down fat and absorb it.
  • Ultrasound for liver health: Doctors may use these scans to look for biliary sludge or gallstones.
  • Upper gastrointestinal series: A person will drink a barium liquid, which enables the upper digestive tract to show more clearly on an X-ray. The procedure may cause bloating, nausea, and pale-colored stools for a short time afterward.
  • Abdominal X-ray: This scan can show blockages or the narrowing of intestines.

There are numerous treatment options for SBS. They include:

  • Total parenteral nutrition (TPN): This involves feeding easy-to-digest solutions with a complete nutritional requirement through a tube directly into the stomach, through an intravenous (IV) line, or both.
  • Intestinal adaptation: Doctors gradually reduce and possibly remove a person’s reliance on TPN.
  • Nutritional help: Adults and children with SBS may need additional supplements to avoid vitamin and mineral deficiencies.
  • Medication: The body may not fully absorb oral medication, so doctors may prescribe doses that are higher than normal. Medications can include:
    • antimotility drugs to slow the action of the intestine down
    • drugs to help bind unabsorbed bile salts
    • drugs to reduce gastric acid or the overgrowth of bacteria
  • Surgery: Surgery can help lengthen the small intestine and prevent its blockage.
  • Intestinal transplant: Doctors may only recommend this procedure when nothing else has been effective and the person has serious complications and cannot continue taking in nutrients via TPN.

After bowel resection surgery, most people will rely on TPN through a tube to receive nutrients. This tube uses an IV line to deliver nutrients directly into a person’s bloodstream.

A person with some remaining colon may need a diet that is low in fat and high in carbohydrates.

A person who has had a jejunostomy or an ileostomy may need a diet that is high in fat, low in carbohydrates, and higher in salt.

There is no one diet that can treat SBS symptoms in everyone with the condition, but the following tips may help:

DoDo not
Keep a food diary to track symptoms.Drink more than half a glass of fluid with each meal.
Chew food well.Eat concentrated sweets.
Eat smaller meals more frequently.Consume alcohol or caffeine.
Consume more calories than someone with an average-sized bowel should.Consume osmotic carbohydrates, such as fruit juice, colas, and simple sugars, including cakes, cookies, pies, and donuts.
Stay hydrated using oral rehydration solutions.Consume whole nuts or seeds, coconut, fruit skins or peels, or dried fruits.

Learn what to eat after an ileostomy surgery here.

People with SBS will need to increase their energy intake by 50% to enable their bodies to compensate for poor retention of nutrients, and to help them maintain a moderate body weight.

A person may find that eating 5–6 smaller meals throughout the day can help improve their food intake.

A person with SBS should consult a registered dietitian, who may suggest trying a low FODMAP diet to slowly introduce foods and understand which ones the body is not tolerating.

Learn more tips for gaining weight safely here.

SBS occurs when a person experiences symptoms such as diarrhea, bloating, and fatigue as a result of a shorter bowel.

The condition may be present at birth, but it may also develop due to damage to the small intestine. This damage may result from a surgery to address conditions such as Crohn’s disease.

Currently, there is no cure for SBS, but it is possible to manage the condition with medications and dietary adjustments.

A person can work closely with a registered dietitian to find the most suitable nutritional treatment for them.