Gallstones
Your health expert: Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon
Content editor review by Rachael Mayfield-Blake, May 2022
Next review due May 2025
Gallstones are stones that develop in your gallbladder. Most people don’t get any symptoms from gallstones and so don’t need treatment. But if you have problems, such as abdominal (tummy) pain and inflammation of your gallbladder, you may need surgery.
About gallstones
Your gallbladder is a small, pear-shaped pouch in the upper right part of your tummy (abdomen). Between meals, your gallbladder stores bile, a fluid that’s produced by your liver. When you eat, your gallbladder releases bile into your bowel through a channel called the bile duct. Bile helps your body break down food, especially fats, and helps your body absorb some vitamins.
Gallstones develop if the chemicals that make up your bile become imbalanced and form lumps which then harden. You might form one stone, several or many. Gallstones can vary in size from being as small as grains of sand, to as big as pebbles.
If you have gallstones, they may stay in your gallbladder without causing any problems. Sometimes, small gallstones may pass out of your body without you realising. But if gallstones begin to block the flow of bile, they can cause pain and inflammation. See our section on symptoms below for more information.
Types of gallstone
There are three main types of gallstone.
- Cholesterol gallstones form if you have too much cholesterol in your bile. These are the most common type.
- Pigmented gallstones form from calcium salts and bilirubin in your bile. Bilirubin is a waste product that’s produced when your body breaks down red blood cells. These stones mostly happen in people who have inherited red blood cell disorders like sickle cell anaemia.
- Mixed gallstones are a combination of cholesterol and pigmented stones.
Causes of gallstones
Your chance of getting gallstones increases as you get older, especially once you’re over 40.
You’re also more likely to get gallstones if you:
- are female – women are more than twice as likely to get gallstones as men
- are obese
- have high cholesterol
- have someone in your family who has had them
- have lost weight quickly –for example. through weight loss surgery,
- have a health condition that affects your blood, such as sickle cell anaemia
- have diabetes
- have Crohn’s disease
- take hormone replacement therapy (HRT)
- take certain medicines
- are pregnant
- have non-alcoholic fatty liver disease (NAFLD)
Symptoms of gallstones
Most people with gallstones don’t have any symptoms. Sometimes, gallstones are found if you have a scan to investigate something else.
Abdominal pain (biliary colic)
The most common gallstones symptom is pain in the middle or right side of the upper part of your tummy (abdomen), just under your ribs. This is known as biliary colic. It can happen when a gallstone blocks the flow of bile out of your gallbladder.
The pain may be severe, and there all the time – it doesn’t come and go. It may spread to the centre of your back and the tip of your right shoulder blade. You may develop this pain after a heavy meal, and notice it in the evening, although you can get it at any time. The pain usually lasts for at least 30 minutes and may go on for up to eight hours. You may also feel sick and be sick.
Sometimes when the pain starts to feel better, biliary colic can leave you with a dull ache or discomfort for a few days afterwards.
Other less common gallstones symptoms
Gallstones may block the flow of bile for a long time, or leave your gallbladder and cause problems in your bile duct and pancreas. See our section on complications below for more information about what can happen. If this happens, gallstone symptoms may then include the following.
- A high temperature, perhaps with shivering and ‘chills’ or shaking (rigors).
- Pain that doesn’t go away.
- Yellow skin and a yellowing of the whites of your eyes (jaundice).
- Dark urine (pee) and very pale poo.
- Itchy skin.
Diagnosis of gallstones
You may only discover you have gallstones when you have a test, such as an ultrasound of your abdomen (tummy) for some other reason.
If you do have symptoms, your GP will ask about these and about your medical history. This will help to identify possible causes and any other conditions. They’ll feel your tummy area to see if it’s tender or swollen.
You may need blood tests to check for any inflammation or infection, a problem with your liver or a blocked bile duct.
Your GP may refer you to your local hospital for more tests, some of which are described below. If your GP thinks you have complications that need immediate treatment, you may have to go to hospital straightaway.
- An ultrasound scan– this uses sound waves to produce an image of the inside of your body. Gallstones usually show up well on this type of scan, but very small stones may be missed. For more information, see our FAQ below: Do negative tests mean I don't have gallstones?
- A type of MRI scan, called a magnetic resonance cholangiopancreatography (MRCP) – this can produce images of the inside of your body, including your pancreatic and bile ducts.
- An endoscopic ultrasound scan – this may be recommended if you can’t have an MRCP for some reason. A narrow, flexible, tube-like telescopic camera called an endoscope goes into and through your stomach via your mouth. It can spot small gallstones which lie in the bile duct.
- A CT scan – this can produce detailed images of your bile ducts, liver and pancreas. Gallstones can be missed on CT scan, unless they contain a lot of calcium.
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Treatment of gallstones
If you don’t have any gallstone symptoms, your GP may suggest that you don’t have any treatment. But let them know if you develop any gallstone symptoms in the future. If tests show that you have gallstones in your bile duct, even if you don’t have symptoms, you may still need treatment. If your gallstones start to cause problems, your GP may refer you for further investigations and treatment.
Non-surgical treatments
Medicines
You may be able to manage your gallstones symptoms by taking over-the-counter painkillers like paracetamol. Your GP may prescribe stronger painkillers if you need them.
If your gallstones have caused an infection, you may need antibiotics. You’ll have these given intravenously (into a vein) in hospital.
Always read the patient leaflet that comes with your medicine and if you have any questions, ask your pharmacist.
Diet
There’s no special gallstones diet, but your GP may advise you to avoid any food or drinks that you notice make your pain worse. They may recommend that you eat a low-fat diet to help prevent pain from gallstones too.
Gallbladder removal surgery
If your gallstones are causing you problems that need treatment, the main treatment for gallstones is an operation to remove your gallbladder. Your gallbladder isn’t essential, and most people don’t have problems without it.
The decision to remove your gallbladder may depend on how often you get symptoms, how severe they are and what problems your gallstones are causing. Your decision should also take into account your age and general health. Your doctor or surgeon can explain your options and answer any questions you may have.
An operation to remove the gallbladder is called a cholecystectomy (pronounced co-le-sis-tec-tomy). There are two main ways this can be done.
- Laparoscopic cholecystectomy (keyhole surgery). Your surgeon will remove your gallbladder through small cuts in your tummy (abdomen). This is the most common way to have your gallbladder removed.
- 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.
Other treatments
If your doctor thinks you might have gallstones in your bile duct, they may suggest having an endoscopic retrograde cholangiopancreatography (ERCP). This uses a combination of endoscopy and X-rays to find and treat your gallstones. Your doctor will pass an endoscope through your mouth down to where the bile duct opens into your bowel (intestine). They’ll then widen the end of the bile duct and take out the gallstones or the gallstone will pass out naturally (in your poo).
If an ERCP isn’t possible, your doctor may recommend a procedure called a percutaneous transhepatic cholangiogram (PTC). In a PTC, your doctor will pass a tube through the skin below your ribs, and into your liver to remove the gallstones in the bile duct. There are some options other than PTC too. Your surgeon or specialist doctor will discuss these with you.
It’s possible that you may still need to have an operation afterwards to remove your gallbladder because there may be more gallstones in it.
Complications of gallstones
Most gallstones stay in your gallbladder; occasionally they can pass out of your body (in poo) without any problems. But sometimes they can move and cause complications. They may block ducts to your internal organs, such as your gallbladder, liver, pancreas and small intestine and cause inflammation, swelling or infection.
Some of the most common complications are as follows.
- Biliary colic. This is the most common complication. If gallstones move, your gallbladder or duct (connecting tube) could tighten around them, causing pain. See our section on symptoms above for more information about biliary colic.
- Cholecystitis. This is an inflamed gallbladder and is the second most common problem. It can lead to a severe infection, and damage to your gallbladder. If you have an infection, you’ll need antibiotics, usually given intravenously (into a vein) in hospital.
Other complications, including those listed here, are much less common but can be more harmful.
- Jaundice. 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.
- Pancreatitis. Gallstones may travel down your bile duct and block the opening of the pancreatic duct. This causes inflammation in your pancreas, which is a serious medical condition.
- Cholangitis. If a gallstone completely obstructs your bile duct, the duct may become infected. This needs urgent treatment.
- Gallstone ileus. If large gallstones (over 2.5cm) pass out of your gallbladder, there is a chance that they may get stuck and block your bowel.
- Gallbladder cancer. Rarely, gallstones are associated with gallbladder cancer, although a direct cause hasn’t been found.
If you have a complication of gallstones, your doctor will explain any tests and treatments you might need.
If you have gallstones, you don’t need to follow a special diet. But if you notice any foods that trigger symptoms, it’s best to avoid or cut back on those. Your doctor may recommend that you eat a low-fat diet to help prevent pain from gallstones. If you’re overweight, it can increase the risk of developing more gallstones. Eat a healthy balanced diet and do more physical activity to help stay a healthy weight.
See our section: Treatment of gallstones above for more information.
Not necessarily. It depends on the type and size of the stones, and where they’re causing problems. An ultrasound scan may not spot very small gallstones, or those that are in the bile duct. You may need another sort of scan that will show if small stones are inside your bile duct.
See our section: Diagnosis of gallstones above for more information.
The most common warning sign of gallstones is pain in the middle or right side of the upper part of your tummy (abdomen), just under your ribs. This pain may be severe, and there all the time – it doesn’t come and go. The pain may spread to the centre of your back and the tip of your right shoulder blade.
See our section: Symptoms of gallstones above for more information.
Not usually but sometimes the complications of gallstones can be dangerous. For example, a complication called cholangitis. This is when a gallstone completely obstructs the bile duct, and the duct can get infected. This is very serious and needs urgent treatment.
See our section: Complications of gallstones above for more information.
Small gallstones may occasionally just be passed out of your body (in poo), without you having had any problems. Larger gallstones often stay in your gallbladder so you might not need surgery. But sometimes gallstones can move and cause complications. And the main treatment is an operation to remove your gallbladder.
See our section: Treatment of gallstones above for more information.
Gallbladder removal
You may need to have your gallbladder removed if you have gallstones or if your gallbladder becomes diseased or damaged.
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