What You Need To Know About Gallstones

What are gallstones?

The gallbladder is a pear-shaped organ located below your liver. Its job is to collect bile, a fluid that helps your body digest fats. Bile flows from the liver to the gallbladder and then into the intestines.

Gallstones occur when bits of bilirubin or cholesterol in the bile join together and develop into hardened bits inside your gallbladder. When your gallbladder squeezes against these gallstones, or they block the bile from flowing freely, it can be very painful.

Gallstones can vary in size and shape. While some can be as small as a grain of sand, others can be the size of a golf ball. Some people may develop many gallstones at once, while others may have only one. A gallstone will likely grow over time as bile continues to flow over it, and it incorporates more particles.

Different types of gallstones

Two different types of gallstones can develop in your gallbladder. These include:

  • Pigment gallstones form due to too much bilirubin in your bile. They are typically black or dark brown.

  • Cholesterol gallstones form out of undissolved cholesterol found in the bile your liver produces. They are the most common gallstones and are usually yellow.

Statistics

Gallstones are incredibly common, affecting 10-15%¹ of the US population. Approximately 25% of the almost one million people diagnosed with gallstones every year will need to be treated, typically with surgery. Most gallstones are “silent,” and they don’t produce any symptoms or generally require surgery.

  1. Definition & facts for gallstones | NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Symptoms

If you have one or more gallstones, you may or may not experience any symptoms. Typically, when a gallstone blocks a duct in your gallbladder, any of these symptoms may occur:

  • Nausea and/or vomiting¹

  • Pain below your breastbone that gradually intensifies

  • Pain in the upper right portion of your abdomen¹ under your ribs that gradually intensifies

  • Pain in your right shoulder area or between your shoulder blades

  • Digestive upset after consuming high-fat meals

  • Unexplained belching and gas

Symptoms from a gallstone can last a few minutes or several hours. If you've experienced a gallstone attack, it is more likely to happen again or more frequently. These painful episodes usually occur after eating a heavy meal, particularly when it contains a lot of fat, and they are more common in the evening or at night.

Gallstone attacks usually end when the gallstone moves and the bile duct is no longer blocked. It's important to seek medical attention immediately if you experience:

  • High fever

  • Jaundice (yellowing of your skin and the whites of your eyes)

  • Severe abdominal pain

Causes

Gallstones are very common: 1 in 5 women and 1 in 10 men¹ will have at least one gallstone by 60. No one knows what causes gallstones, but it's thought they can form because:

  • There’s too much bilirubin in your bile which your body produces when it breaks down red blood cells. An overproduction of bilirubin can result from certain conditions, including biliary tract disorders and some blood diseases that cause increased red blood cell destruction.

  • There’s too much cholesterol in your bile, which is the most common cause of gallstones, comprises 75-80% of cases². If your liver produces more cholesterol than your bile can dissolve, gallstones can develop and grow larger over time.

  • Your gallbladder is slow to empty or doesn't empty completely. Bile can become more concentrated than usual, leading to gallstone formation.

Risk factors for developing gallstones

Certain risk factors³ could make you more likely to form a gallstone. These include:

  • Being a woman

  • Being over the age of 40, although younger people⁴ can also get them

  • Being overweight or obese

  • Being Hispanic or Native American

  • Being pregnant or having been pregnant multiple times

  • Not exercising enough

  • Having diabetes, Crohn’s disease, or liver disease

  • Eating a diet⁵ low in fiber and high in fat and cholesterol

  • Having elevated cholesterol levels

  • Losing weight quickly

  • Taking certain medications, such as birth control, estrogen replacement, or cholesterol-lowering pills

  • Having a family history or personal history³ of gallstones

Complications of gallstones

While gallstones aren't dangerous for most people, they can cause serious complications⁶, including:

Inflammation of the gallbladder

A gallstone that blocks the gallbladder duct can result in inflammation, also known as cholecystitis, causing pain and fever.

Gallbladder cancer

People with gallstones and a positive family history are more likely⁷ to be diagnosed with gallbladder cancer, although this is very rare.

Blockage of the common bile duct

Gallstones can block the ducts that allow bile to flow from your gallbladder to your small intestine, resulting in jaundice, inflammation, and significant pain. This is known as choledocholithiasis.

Blockage of the pancreatic duct

The pancreatic duct is a tube that connects the pancreas to the common bile duct. Pancreatic juices travel through it to help your body digest food. If a gallstone gets stuck in the pancreatic duct, it can cause inflammation of the pancreas, called pancreatitis, which can lead to severe abdominal pain and hospitalization.

How are gallstones diagnosed?

If you aren't experiencing symptoms, you may never know you have a gallstone. If you have symptoms, your healthcare professional will likely perform a variety of tests to determine if a gallstone is to blame, such as:

Blood tests

Blood tests can show liver issues, infection, or other complications that could be side effects of a gallstone. Doctors may also use them to help determine the cause of your symptoms.

Ultrasound

Doctors diagnose most gallstones by ultrasound⁸, and it’s the method of choice for evaluation. A small transducer on your abdomen sends images to a computer, which will give your physician a clear view of any gallstones and obstruction of the bile duct.

Endoscopic ultrasound (EUS)

If you have a small gallstone that’s undetectable on a traditional ultrasound machine, endoscopic ultrasound may be beneficial. During this procedure, your doctor will place a thin tube through your mouth into your digestive tract. A tiny transducer inside the tube will allow your doctor to get a closer picture of nearby structures, including your gallbladder.

Other tests

It's possible to identify gallstones with other imaging tests as well, including computerized tomography (CT) scans, endoscopic retrograde cholangiopancreatography (ERCP), and a hepatobiliary iminodiacetic acid (HIDA) scan, among others.

Most gallstones are not visible on a traditional x-ray.

Treatments

If your gallstones aren't causing any symptoms, your doctor will likely tell you that treatment isn't necessary. But if you are experiencing gallstone attacks, it’s wise to schedule an appointment with your healthcare clinician.

Even if your symptoms are mild or sporadic, getting a diagnosis and starting treatment can prevent your symptoms from worsening, becoming more difficult to manage, or developing into a more complicated situation. If your medical professional confirms that you have gallstones, they will refer you to a specialist for further treatment, such as a gastroenterologist or surgeon.

Gallstone surgery: What to expect

Surgery is the most common treatment for gallstones. Also known as cholecystectomy¹, gallbladder removal is one of the most common adult surgeries in the United States. The gallbladder is not an essential organ, so you can live a perfectly normal life without one.

Gallbladder surgery usually happens under general anesthesia, so you’ll be asleep throughout the procedure and under the care of your surgeon and anesthesiologist. Often, gallbladder surgery can be performed laparoscopically as an outpatient procedure, so you can go home the same day to recover once you've woken up.

You'll likely feel sore but can walk and resume light activities within 24-48 hours after laparoscopic surgery. Doctors recommend not lifting anything heavy or participating in vigorous activities for two weeks after surgery while your body heals.

If your gallbladder is inflamed or there are other complications, your doctor may recommend an open cholecystectomy. In these cases, recovering in the hospital for a few days is more likely.

After your gallbladder removal, the bile that would once flow into it moves from your liver through the hepatic duct and common bile duct straight into your small intestine.

Medications

While it's possible to dissolve a gallstone with oral medications, this can take months or even years to be effective and likely won't cure your symptoms. The gallstones could return if you don't take the medication every day. For these reasons, doctors rarely use drugs to treat gallstones unless there’s a reason a patient cannot undergo surgery.

After your gallbladder removal: What to expect

Patients rarely experience any complications after their gallbladder removal. Some may see changes to their stools (poop), such as softer stools or more frequent trips to the bathroom, but these symptoms are usually temporary.

Prevention

Recent studies have demonstrated the role of lifestyle factors in preventing the development of cholesterol gallstones, the most common type. In some conditions like sickle cell disease, gallstones are formed from the build-up of bilirubin and can't be prevented in the same way.

If you want to lower your chances of developing a gallstone, keep these tips in mind:

  • Lose weight gradually. Losing a large amount of weight in a short period can increase your risk of developing gallstones. Try to lose no more than two pounds per week if possible.

  • Avoid skipping meals. Maintaining a routine meal schedule can help your gallbladder work properly and lower your risk of a gallstone forming.

  • Incorporate more fiber¹ into your diet, such as whole grains, fruits, and vegetables², and reduce fat and cholesterol. Consider moving toward a vegetarian or plant-based diet³.

  • Maintain a healthy weight and lifestyle. Being overweight can make you more likely to develop a gallstone, so exercise regularly and eat a balanced diet to stay at a healthy weight.

Doctors & specialists

Working closely with your healthcare professional is the best way to accurately diagnose your symptoms and treat the cause. It can often take weeks to be seen by a specialist, such as a gastroenterologist, so preparing for your appointment in advance is important. For this reason, it's a good idea to have answers ready for these questions that your doctor will likely ask you:

  • When did your symptoms begin, and how frequently do they occur?

  • Do your symptoms occur sporadically or after a specific activity, such as eating?

  • Are your symptoms mild or severe?

  • Where is your pain located?

  • How long does your pain or other symptoms last?

  • Does anything improve your symptoms?

  • Does anything make your symptoms worse?

  • When your symptoms occur, do they include a fever?

  • Do gallstones or other gastrointestinal diseases run in your family?

Providing detailed information will give your medical professional a clear picture of your experience and symptoms. This will help them create the best treatment plan for your needs.

Questions to ask during your appointment

Just as your healthcare clinician will have many questions for you, it's a good idea to prepare questions for them. This way, you’ll know what to expect, and it’ll ensure your treatment plan goes as smoothly as possible. Here are some helpful questions to ask at your appointment:

  • Do you think gallstones are the source of my symptoms? If not, what could be?

  • What kind of tests do you recommend?

  • If I am diagnosed with gallstones, can they go away on their own?

  • Is gallbladder surgery necessary?

  • What are the risks of gallbladder surgery?

  • What are my other treatment options?

  • How long will it take me to recover from gallbladder surgery?

  • Is there anything I can do to prevent gallstones in the future?

  • Is there anything I can read to learn more about gallstones and gallbladder surgery?


Medications for gallstones