Gallstones symptoms usually come as attacks of sudden pain in the upper right abdomen that last from one to a few hours, but most people with gallstones have no symptoms at all. When stones do cause trouble, they tend to keep doing so, and complications such as infection or jaundice need prompt care. This article is part of our guide to laparoscopic surgery and covers seven signs to know, how gallstones are confirmed and when surgery becomes the right step.
Gallstones are small, hard deposits that form in the gallbladder, a pouch under the liver that stores bile. They are common, especially in women, people over 40, people living with obesity and anyone who has lost weight quickly.
Why many gallstones cause no symptoms
Most gallstones sit quietly in the gallbladder and are found by chance on an ultrasound done for another reason. These are called silent gallstones, and they usually do not need treatment.
Symptoms start when a stone temporarily blocks the outlet of the gallbladder or slips into the bile duct. The gallbladder squeezes against the blockage, and that is what produces the typical pain attack.
7 gallstones symptoms you should know
The first three signs describe a typical uncomplicated attack. The last four suggest a complication and need a doctor the same day.
1. Sudden pain in the upper right or centre of the abdomen
The classic symptom is biliary colic: a steady, intense pain just under the ribs on the right, or in the centre of the upper abdomen. It often comes on quickly, sometimes after a large meal or at night.
2. Pain spreading to the right shoulder or back
The pain can travel to the right shoulder blade or between the shoulder blades. Shifting position rarely brings relief, unlike many other types of tummy pain.
3. Nausea and vomiting during attacks
Many people feel sick or vomit while the pain is at its worst. An uncomplicated attack usually eases within a few hours, leaving a dull soreness that fades over a day.
Vague bloating, wind or indigestion on their own are less specific. They are common in people with and without gallstones, so they are a weaker reason for surgery than true pain attacks.
4. Pain that does not settle, with fever
Pain that lasts longer than several hours, especially with a high temperature, can mean the gallbladder is inflamed or infected. This is acute cholecystitis, and it needs urgent assessment.
5. Yellow skin or eyes
Yellowing of the skin or the whites of the eyes is called jaundice. With gallstones it can mean a stone is blocking the main bile duct.
6. Dark urine, pale stools or itching
These often appear alongside jaundice. Fever and shivering with jaundice can point to infection in the bile duct, which is a medical emergency.
7. Severe central pain going through to the back
Very severe pain in the upper abdomen that spreads to the back, with repeated vomiting, can be gallstone pancreatitis, an inflammation of the pancreas triggered by a passing stone. It needs hospital care.
When gallstones symptoms need urgent care
Seek same-day medical help if pain lasts more than a few hours, if you have a high temperature with abdominal pain, or if you notice yellow skin or eyes. Go to an emergency department for severe pain with repeated vomiting, confusion or shivering.
Do not wait to see whether the next attack is milder. Complications are easier and safer to treat when they are caught early, and an early assessment often allows surgery to be planned rather than done as an emergency.
How gallstones are diagnosed
An abdominal ultrasound is the usual first test. It is painless, quick and very good at showing stones in the gallbladder and signs of inflammation.
Blood tests check liver function and inflammation, and whether the pancreas is involved. If a stone in the bile duct is suspected, an MRI scan of the bile ducts (MRCP) or an endoscopic ultrasound may be added.
When you need gallbladder surgery
The main treatment for symptomatic gallstones is removing the gallbladder by keyhole surgery, called laparoscopic cholecystectomy. NICE guidance recommends offering it to people with symptomatic gallbladder stones.
Surgery is usually advised if you have had:
- Repeated attacks of biliary colic
- An episode of acute cholecystitis
- Jaundice or a stone in the bile duct
- Gallstone pancreatitis
For acute cholecystitis, NICE advises offering keyhole removal within a week of diagnosis rather than waiting months. Waiting after a first attack carries a real chance of further attacks or complications in the meantime.
Removing only the stones is not done, because new stones form in the same gallbladder. You can read how the operation works, what recovery involves and how long you stay on our laparoscopic cholecystectomy procedure page.
When surgery is not needed
If your gallstones were found by chance and have never caused symptoms, watchful waiting is usually the advice. You will be told which symptoms should bring you back.
Surgery may also be delayed if another condition makes an operation riskier, or during pregnancy, depending on symptoms. Dr. Elbasatiny reviews your scan, blood tests and history to decide whether surgery is right for you now, later or not at all.
Gallstones symptoms and diet
Changing your diet will not dissolve gallstones, but some people find that large, fatty meals seem to trigger attacks. Smaller, balanced meals can make the wait for surgery more comfortable.
Avoid crash diets or very rapid weight loss while you have gallstones, because fast weight loss itself can make new stones form and attacks more likely.
Living without a gallbladder
The gallbladder stores bile but is not essential. After removal, bile flows directly from the liver into the intestine, and most people return to a normal diet within a few weeks.
A minority notice looser stools or sensitivity to very rich meals for a while. These effects usually settle, and serious long-term digestive problems after the operation are uncommon.