Gallstones: symptoms, tests and treatment options

Gallstones are one of the most common digestive problems, yet many people who have them never know. Others first find out when a sudden, intense pain in the upper abdomen sends them to a doctor. Whether your gallstones were discovered on a routine scan or after a painful episode, it helps to understand what they are, which symptoms matter and what the treatment choices look like.

What gallstones are

The gallbladder is a small organ in the upper part of the abdomen that helps with digestion. It stores bile, a digestive fluid made by the liver, before it passes into the small intestine. Bile travels through a network of narrow tubes called bile ducts.

Gallstones are small, hard deposits that form in the gallbladder. They can also be found in the bile ducts. They may develop when bile contains too much cholesterol or bilirubin, or too few bile salts, or when the gallbladder does not empty completely or often enough. Researchers do not yet fully understand why these changes happen in some people and not others.

Who is more likely to develop gallstones

Anyone can develop gallstones, but the chance is higher if you:

• are over 40
• are a woman
• are living with obesity
• eat a diet high in fat and low in fibre
• have lost weight quickly, for example after weight-loss surgery or with certain dieting patterns
• have a condition such as diabetes or Crohn's disease

Symptoms: what a gallbladder attack feels like

Most gallstones cause no symptoms. Problems usually begin when a stone blocks one of the bile ducts. The resulting pain is often called biliary colic or a gallbladder attack. It typically:

• is felt in the middle of the upper abdomen or just under the ribs on the right side
• is constant and can be severe
• lasts from around 30 minutes to several hours
• may come with nausea or vomiting
• often follows a heavy meal and tends to happen in the evening or at night

The pain usually eases when the stone moves out of the way. However, once someone has had one attack, further attacks are more likely, so it is worth getting checked even if the pain has settled.

Warning signs that need urgent care

If a bile duct stays blocked, complications can develop. These include inflammation of the gallbladder, inflammation of the pancreas (pancreatitis) and jaundice. Although complications are not common, they need prompt treatment.

Contact a doctor or an urgent advice service if abdominal pain lasts longer than about 30 minutes. Seek emergency care straight away if you have:

• sudden, severe abdominal pain, or pain that lasts several hours
• pain that spreads to your back together with vomiting
• a high temperature, or you feel hot, cold or shivery
• yellowing of the skin or the whites of the eyes (jaundice)
• dark, tea-coloured urine together with pale stools

Do not drive yourself if you are in severe pain. Take your medicines, or a list of them, with you. Similar symptoms can be caused by other conditions, such as appendicitis, ulcers, pancreatitis or acid reflux, which is another reason to be assessed rather than waiting it out.

How gallstones are diagnosed

Gallstones are sometimes found by chance during a scan or X-ray for something else. If you have symptoms, your doctor will usually start with a blood test and an ultrasound scan.

What to tell your doctor

A clear description of your symptoms helps your doctor decide which tests are needed. Try to note when the pain started, where you felt it and how long it lasted, whether it followed a meal, and whether you had nausea, vomiting, a temperature, yellowing of the skin or eyes, dark urine or pale stools. Mention any previous attacks, recent rapid weight loss or weight-loss surgery, conditions such as diabetes or Crohn's disease, and all the medicines you take.

Blood tests

Blood tests can show signs of infection or inflammation in the bile ducts, gallbladder, pancreas or liver.

Ultrasound

Ultrasound uses sound waves to create images and is the main imaging test for finding gallstones.

Other scans

Depending on your situation, other tests may be suggested:

• CT scan: can show complications such as infection or blockage, although it may miss some gallstones.
• MRI: can show stones in the bile ducts without using X-rays.
• HIDA scan: a small amount of a radioactive tracer is injected and followed with a special camera to see how the gallbladder contracts and whether bile ducts are blocked.

ERCP

ERCP combines an endoscopy with X-rays to examine the bile and pancreatic ducts. Because it is more invasive than scans, it is used selectively, usually when treatment is needed at the same time, such as removing a stone stuck in the common bile duct.

Treatment options

Watchful waiting for silent stones

If your gallstones are not causing symptoms, treatment is usually not needed. Your doctor may suggest follow-up and will explain which symptoms to look out for.

Removing the gallbladder (cholecystectomy)

When gallstones cause symptoms or complications, the main treatment is surgery to remove the gallbladder. It is one of the most common operations performed on adults.

• Keyhole (laparoscopic) surgery is the usual approach. Many people are able to go home on the same day. Your surgical team will advise you on when to return to your normal activities.
• Open surgery uses a larger cut. It may be needed when the gallbladder is badly inflamed, infected or scarred, or if problems arise during keyhole surgery. The hospital stay and recovery are usually longer.

ERCP for stones in the bile duct

If a stone is stuck in the common bile duct, it can often be removed with ERCP. An endoscope is passed through the mouth and stomach to the opening of the bile duct, which can be widened so the stone can be cleared.

Non-surgical options

For people with small cholesterol stones who cannot have surgery, medicines that gradually dissolve the stones may be considered. Treatment can take months or years, and stones may return once it stops. A technique that breaks stones up with shock waves exists but is rarely used.

While you wait for treatment

Your doctor may suggest pain relief, avoiding foods that seem to bring on attacks and following a lower-fat diet. Keep the urgent warning signs in mind and seek help if they appear.

Life without a gallbladder

The gallbladder is not essential, and people live normally without it. After it is removed, bile flows directly from the liver into the small intestine instead of being stored first. Some people notice softer or more frequent bowel movements afterwards; this is usually temporary, but mention it to your doctor if it continues. Serious complications of the operation are rare, and your surgical team will talk you through the risks that apply to you.

Questions to ask your specialist

• Are my gallstones causing my symptoms, or could something else be responsible?
• Are there any stones in my bile ducts?
• Do I need treatment now, or is follow-up enough?
• Is keyhole surgery suitable for me, and might I need ERCP as well?
• What should I eat, and which symptoms should prompt me to call you, while I wait?

Next steps

If you have had pain that could be from gallstones, or a scan has shown stones and you are unsure what to do, a specialist can explain your results and the options that suit you.

• Learn more about our gastroenterology services, including endoscopic procedures such as ERCP.
• Be matched with a suitable specialist in a few steps: Find my physician.