Patient information from BMJ

Gallstones

Last published:Dec 20, 2023

Gallstones are small stones that form in your gallbladder. Most people won’t know they have them but these stones can cause severe pain in some cases. If you have gallstones that are causing problems, you will need treatment for them.

What is the gallbladder and what are gallstones?

Your gallbladder is a little pouch that sits under your liver. It stores the digestive juices (bile) that your liver makes. Bile helps your body break down fats in your gut.

But sometimes bile gets too thick and forms gallstones. Gallstones can be as small as a grain of sand or as big as a golf ball. You may have just one gallstone or hundreds.

Lots of people have gallstones and don’t know it. In most people, they don't cause any problems. But sometimes they block the tubes in your gut that carry bile which can cause severe pain in your abdomen. 

You are more likely to get gallstones as you get older. Women get them more often than men. Other things that increase your chances of getting gallstones are:

• Being obese or overweight

• Being pregnant

• Having a close family member who has had gallstones.

What are the symptoms?

Most people don't get symptoms from gallstones. Sometimes people only find out they have them when they have a scan.

But if the stones the opening of your gallbladder (the cystic duct) they can cause severe cramping pain in your upper abdomen. Doctors call this biliary colic. Sometimes, this can lead to inflammation of your gallbladder too (known as cholecystitis).

Gallstones can also block other parts of your gut. For example, they may block the tube which carries bile from your gallbladder and liver (bile duct). This can lead to inflammation of the bile duct (known as cholangitis).

Your first attack of gallstone pain can be frightening. You may feel sick and vomit.

Often, the pain comes on in the evening or at night. It typically comes on fast too, sometimes after you eat and usually lasts several hours.

You may also notice other symptoms such as a fever or yellowing of your skin (jaundice). This depends on where the gallstones have lodged and if there is inflammation.

If you have pain that could be caused by gallstones, your doctor will do an ultrasound scan. You will also have blood tests to check how your liver is working and to look for signs of infection. 

What treatments work?

If you have gallstones picked up on a scan but don’t have any symptoms, you won’t need treatment. But your doctor should follow up with you yearly to monitor your condition.

If your gallstones are causing pain, the standard treatment is with pain relief and an operation to remove your gallbladder (known as a cholecystectomy). Simple painkillers such as paracetamol and ibuprofen can usually help with mild or moderate pain, but some people may need stronger medicines for severe pain. Taking quick, shallow breaths during an attack, instead of deep ones, might also help with the pain because it reduces the pressure on your gallbladder.

Gallstones can cause other complications such as cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). If this is the case, you may need treatment with antibiotics first before you have any procedures.

Surgery (cholecystectomy) 

If you have painful gallstones without any other complications, your doctor may recommend that you have your gallbladder removed. You may have keyhole surgery (also called laparoscopic surgery) where the surgeon makes several small cuts and uses a tiny camera and tools to take out your gallbladder. Or you may need open surgery, where the surgeon makes a larger cut to see directly into your abdomen. Occasionally surgeons need to switch to open surgery after attempting a keyhole operation.

Keyhole surgery is better for most people because you are likely to recover faster. You may also be able to go home the next day after your operation. If you have open surgery, you may need several days in hospital. Your doctor will likely recommend that you have keyhole surgery unless there is a specific reason why you shouldn’t.

Lots of people have surgery to remove their gallbladder, and most of these operations are successful.

But all operations have some risks. You might have an allergic reaction to the anaesthetic, or get an infection in your wound. Some people have problems with bleeding during or after surgery. Your doctor will monitor and treat you for any complications if they occur.

What will happen to me?

Surgery to remove your gallbladder will prevent future attacks as well as more serious complications like an infected gallbladder. But, until your operation, you should try avoiding food and drink that triggers your symptoms. You can go back to your normal diet once you’ve had your operation.

You can live a healthy life without your gallbladder. After it is removed, your body still makes bile. But it goes straight into the gut instead of being stored in the gallbladder first.

You may experience diarrhoea after your surgery but this is usually short-lived and can be treated with anti-diarrhoea medicines. If you’re concerned about surgery for gallbladder removal, speak to your doctor.