Most people with gallstones don’t have any symptoms. So you might not know that you have them unless you have a scan to investigate something else and they show up in that.
You usually only know about gallstones if they move and get stuck in a duct (opening) inside your gallbladder. This can cause the following symptoms.
- Severe pain on the upper right side of your tummy, just under your ribs, often after you eat. This may last for several hours and spread to the centre of your back and tip of your right shoulder blade.
- Feeling sick or vomiting.
- A high temperature, shivering and sweating.
- Yellow skin and a yellowing of the whites of your eyes.
If you have these symptoms, see your GP.
Your GP will ask about your symptoms and feel your tummy to see if it’s tender or swollen. You may have further tests, some of which we’ve explained here.
- Blood and urine tests to check for inflammation and to see if you have any complications.
- An ultrasound scan – this uses sound waves to produce an image of the inside of your body. Gallstones usually show up well on this test.
Your GP may refer you to your local hospital for more tests, some of which we’ve described below. If your GP thinks you have complications that need immediate treatment, you may have to go hospital straight away.
- A type of MRI scan, called a magnetic resonance cholangiopancreatography (MRCP), can produce images of the inside of your body, including your bile duct.
- A CT scan can also produce detailed images of your bile ducts and pancreas.
- Endoscopic retrograde cholangio-pancreatography (ERCP) is a detailed X-ray of your pancreas and bile ducts. Your doctor will use a special dye and a narrow, flexible, tube-like telescopic camera called an endoscope to do this test.
- A hydroxyiminodiacetic acid (HIDA) cholescintigraphy test can check if your gallbladder is working as it should. In this test, your doctor will inject a radioactive chemical into a vein in your arm. It then travels in your blood to your liver and acts like bile would. The chemical shows up on a scanner so your doctor can see how well your gallbladder is working.
If gallstones aren’t causing any symptoms and were found in a scan that was done for something else, your GP may suggest leaving them alone. They usually don’t cause any problems. Your GP will keep an eye on you and whether you get any symptoms later on. If your gallstones start to cause problems, you may need treatment.
A gallstone may stay in your gallbladder but sometimes they can pass out naturally, go down your bile duct and into your bowel. You may then pass them out when you go to the toilet. However, if the gallstone gets stuck along the way, it can cause complications (see Complications).
You may be able to manage your symptoms by taking over-the-counter painkillers. You might also find it helps to note down any foods or drinks that make your symptoms worse. If possible, you could cut out these from your diet, or at least eat less. For example, it may help to eat a low-fat diet. Ask your GP for more information about foods that can affect gallstones.
Your doctor may advise you to have your gallbladder removed in an operation called a cholecystectomy. There are two main ways this can be done.
- Laparoscopic cholecystectomy. Your surgeon will remove your gallbladder through small cuts in your tummy (abdomen). This is called keyhole surgery and is the most common type of operation. However, it’s possible that during the surgery, your surgeon may need to convert to an open operation. This is more likely if your gallbladder is very inflamed or you’re very overweight.
- Open cholecystectomy. Your surgeon will make one large cut to remove your gallbladder. This technique is used less often but you may have it if keyhole surgery isn’t suitable for you.
If you have gallstones in your bile duct, it may be possible to remove them during an endoscopic retrograde cholangio-pancreatography (ERCP). This test is used to diagnose gallstones but if your doctor finds any, they might be able to remove them at the same time. Bear in mind though that most people still need to have an operation to remove their gallbladder because there may be more gallstones in it. Even if there aren’t, it’s likely that more would form if you don’t have your gallbladder removed. So you would still be at risk of having symptoms and possible complications.
It might be possible to break up gallstones using shock waves although this treatment isn’t used very often. The treatment is called extracorporeal shock wave lithotripsy (ESWL) and uses high-energy shock waves to break up the stones.
You can develop gallstones at any age but your chance of getting them increases as you get older. Women are up to three times more likely to get gallstones than men. If you’re overweight, this can be another big risk factor so trying to lose any excess may help prevent gallstones developing in the first place.
You’re also more likely to get gallstones if you:
- have someone in your family who has had them
- have lost weight quickly – if you’ve had weight loss surgery, for example
- are pregnant
- take the pill (oral contraceptive)
- have Crohn’s disease
- have diabetes
- have a health condition that affects your blood, such as sickle cell anaemia
If you have symptoms caused by gallstones but don’t have treatment to remove them, they can cause complications including those listed here.
- If gallstones pass out of your gallbladder and block your bile duct, the flow of bile may stop. This will make your skin and eyes look yellow, which is called jaundice.
- Gallstones may travel down your bile duct and block the opening of the pancreatic duct. This causes inflammation in your pancreas, known as pancreatitis.
- If a gallstone obstructs your bile duct and becomes infected, you may get a high temperature, shivering and sweating. This is known as cholangitis.
- If large gallstones pass out of your gallbladder, there is a chance that they may get stuck and block your bowel.
- Gallstones can lead to gallbladder cancer and possibly liver cancer.
- Gallstones can stop your gallbladder working properly.
How much time will I have to take off work after having my gallbladder removed?
If you have your gallbladder removed in keyhole surgery, you can probably go back to work within a couple of weeks. If you have open surgery, it usually takes longer to recover.
Most people can go home on the same day or the day after keyhole surgery. You can usually get back to your daily activities, including going back to work, within two weeks. But this will be different for everyone and depends on lots of things, such as the type of job you have. So get advice from your surgeon.
If you’ve had open surgery to remove your gallbladder, your surgeon will make a larger cut in your tummy (abdomen). This means it will take longer to recover so it may be four to six weeks before you’re up to going back to work.
It’s important to remember that everyone is different – some people may need to rest for longer while others are ready return to work after a few days. If you have a manual job, where you’re doing heavy lifting, you may need to take more time off.
What will happen if I don't have my gallstones removed?
If gallstones aren’t causing you any problems, they can be left alone. But if you have symptoms, you may need to have the gallstones removed in case they lead to complications.
Gallstones often don’t cause symptoms and you may only find out you have them by chance if you have a scan for something else. If your gallstones aren’t causing any problems, it may be best not to have any treatment. It’s common to have them for years without knowing it.
You’re likely to get symptoms if a gallstone blocks the flow of bile out of your gallbladder or through your bile duct. These symptoms may include pain in your tummy (abdomen), yellow skin and whites of your eyes, and feeling sick or vomiting.
If you have an inflamed or infected gallbladder, you’re more at risk of getting gallbladder cancer. But it’s important to keep in mind that gallbladder cancer is very rare and most people with gallstones don’t get it.
Will having my gallbladder removed affect how I can digest food?
Most people can digest food and drink normally without a gallbladder. Around one in 10 people get diarrhoea after having their gallbladder removed. You can help manage this by making some changes to your diet.
Bile is stored in your gallbladder to help you digest fats but your body can still work properly without it. Once your gallbladder is removed, instead of bile being stored and released when you eat, it continuously drips into your bowel. This means you can break down food as you usually would.
Some people get diarrhoea, feel bloated and pass wind after they have their gallbladder removed. This is because the constant drip of bile into your bowel can irritate your digestive system.
Although you probably won’t need to stop eating any particular foods, having more fibre may help with diarrhoea. This is because it bulks up your faeces and makes it firmer. So try to eat plenty of fruit and vegetables, beans, pulses, lentils and wholegrain bread or cereals. And bear in mind that caffeine, spicy or fatty foods and dairy products may make diarrhoea worse. It’s important to drink enough fluid (like water and squash) if you get diarrhoea too.
- Gallstone disease. National Institute for Health and Care Excellence (NICE), October 2014. www.nice.org.uk
- Cholelithiasis. BMJ Best Practice. www.bestpractice.bmj.com, published 5 December 2014
- Single-incision laparoscopic cholecystectomy, December 2014. National Institute for Health and Care Excellence (NICE). www.nice.org.uk
- Gallstones and cholecystitis. PatientPlus. www.patient.co.uk/patientplus, reviewed 15 October 2013
- Map of Medicine. Gallstones (and associated conditions). International View. London: Map of Medicine; 2015 (Issue 1)
- Gallbladder anatomy. Medscape. www.emedicine.medscape.com, published 16 August 2013
- Gallstones (cholelithiasis). Medscape. www.emedicine.medscape.com, published 20 January 2015
- Gallstones. British Society of Gastroenterology. www.bsg.org.uk, published 8 February 2015
- Sickle cell disease and sickle cell anaemia. PatientPlus. www.patient.co.uk/patientplus, reviewed 20 January 2015
- Endoscopic retrograde cholangiopancreatography. PatientPlus. www.patient.co.uk/patientplus, reviewed 2 July 2013
- Nuclear medicine – hepatobiliary. Radiological Society of North America. www.radiologyinfo.org, published 12 February 2014
- Laparoscopic gallbladder removal (cholecystectomy) patient information from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). www.sages.org, published 9 February 2015
- Cholangitis. PatientPlus. www.patient.co.uk/doctor/patientplus, reviewed 2 August 2013
- Liu Y, He Y, Li T, et al. Risk of primary liver cancer associated with gallstones and cholecystectomy: a meta-analysis. PLos ONE 2014; 9(10):e109733. doi:10.1371/journal.pone.0109733
- Get well soon – helping you to make a speedy recovery after gallbladder removal. Royal College of Surgeons of England. www.rcseng.ac.uk, accessed 9 February 2015
- Gallbladder cancer. Medscape. www.emedicine.medscape.com, published 14 April 2014
- Gallstones. British Liver Trust. www.britishlivertrust.org.uk, published 2011
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