Gallstones
- Professor Adam Frampton, Consultant General and Hepato-Pancreato-Biliary Surgeon
Gallstones are stones that develop in your gallbladder. They are very common, but most people who have gallstones don’t get symptoms. Around 8 in 10 people with gallstones have no problems, so don’t need treatment. But if you do have issues with gallstones, such as abdominal (tummy) pain, 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 to break down food, especially fats, and helps your body to absorb some vitamins.
Most gallstones develop when the chemicals that make up your bile become imbalanced, alongside less gallbladder motility (movement). As the bile sits, tiny crystals collect into lumps that harden, forming stones.
You might get one stone or several, and a small number of people even form dozens of stones. Gallstones also vary in size. Large stones are bigger than 1cm, but gallstones can be as small as grains of sand, or even like ‘muddy’ sludge.
If you have gallstones, they may not cause any problems. Sometimes, small gallstones may pass out of your body without you realising. In fact, most people with gallstones – around 8 in every 10 – have no symptoms. But if your gallstones begin to block the flow of bile, they can cause pain, inflammation, and infection. See our section on Gallstones Symptoms below for more information.
Types of gallstones
There are three main types of gallstones.
- Cholesterol gallstones are the most common type. These stones form if your bile has high cholesterol in it compared with other bile contents, and if this bile stagnates. Around 9 in every 10 people with gallstones have the cholesterol type.
- Pigmented gallstones are much less common – up to 15 in every 100 people with gallstones have this type. Pigmented stones form from calcium salts and bilirubin in your bile. Bilirubin is a waste product of your body breaking down red blood cells.
- Mixed gallstones are made up of both cholesterol and pigment.
Causes of gallstones
You’re more likely to get gallstones as your age increases, especially after 40. Women are more than twice as likely to get gallstones as men. If you have someone in your family with gallstones, this also makes stones more likely for you. Some genes have been linked to gallstones too.
Your chances of gallstones are also higher if you:
- have obesity, diabetes, or metabolic syndrome
- have high cholesterol
- are pregnant
- take hormone replacement therapy (HRT)
- have non-alcoholic fatty liver disease (NAFLD)
- have fasted for a long time, or lost weight quickly – for example, through weight loss surgery
- take certain medicines
- have Crohn’s disease
- have a hereditary blood disorder (one passed down through parents) like sickle cell anaemia
Diet and physical activity
A diet high in protein and fibre, calcium, and vitamin C might help, along with physical activity, to prevent gallstones forming.
The evidence about diet directly causing gallstones, though, is weak. Eating foods high in fat and sugars, and other refined carbohydrates, along with foods that are low in fibre has, however, been linked to getting gallstones.
Conversely, eating a high-fibre diet with plenty of fruits and vegetables has been connected to a lower chance of gallstones. Also, obesity, diabetes, and metabolic syndrome are known risk factors behind gallstones. A healthy diet and physical activity can help against these conditions.
If you already have gallstones, you may notice that some foods trigger symptoms, so it’s best to avoid or cut back on these. Your doctor may recommend you eat a low-fat diet to help to prevent the pain from gallstones, although the scientific evidence for this is not strong.
Symptoms of gallstones
Most people with gallstones – around 8 in every 10 people – don’t have any symptoms. Sometimes, gallstones are found if you have a scan for something else.
Abdominal pain (biliary colic)
The most common gallstones symptom is pain in part of your abdomen (tummy). This is usually in the upper part of your tummy, just under your ribs, and in the middle or to the right side.
This pain is known as biliary colic, and it usually feels severe. The pain may spread to the right side of your back or your right shoulder.
This pain of biliary colic is caused by the squeezing action of the gallbladder around gallstones. This can happen when they block the flow of bile out of your gallbladder.
You may develop this pain about an hour after a heavy meal, and you may notice this gallstones symptom in the evening.
The pain comes on suddenly, then it’s steady and usually lasts for at least 30 minutes. It may go on for up to eight hours, but usually starts to go away before this. You can still have a dull ache after the pain has gone. You may also feel sick and be sick (vomit).
Other less common gallstones symptoms
Gallstones may block the flow of bile for a long time, and may leave your gallbladder and cause problems in your bile duct or pancreas. See our section on Complications below for more information about what can happen.
If you get a complication of gallstones, the symptoms may then include the following.
- A high temperature, perhaps with shivering and ‘chills’ or shaking (rigours).
- Pain that doesn’t go away.
- Tenderness when pressing on your tummy.
- Yellow skin and a yellowing of the whites of your eyes (jaundice).
- Dark pee and pale poo.
- Itchy skin.
Diagnosis of gallstones
It might be that you don’t have gallstones symptoms and discover you have gallstones only after a test for some other reason. This could be when you go for an ultrasound of your abdomen (tummy).
If you do have gallstones symptoms, your GP will ask about these and 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 these are described below. You may have to go to hospital straightaway if your GP thinks you have complications needing immediate treatment.
- 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. Very small stones may be missed, though.
- 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 an option if you can’t have an MRCP for some reason. A narrow, flexible, tube-like telescopic camera called an endoscope goes down through your mouth and stomach. It can spot small gallstones lying in your bile duct.
- A CT scan – this can produce detailed images of your bile ducts, liver, and pancreas.
If you have an ultrasound and MRCP, you will need to eat no food for six hours before the scan. This allows the gallbladder to fill up with bile and give better images.
GP Subscriptions – Access a GP whenever you need one for less than £20 per month
You can’t predict when you might want to see a GP, but you can be ready for when you do. Our GP subscriptions are available to anyone over 18 and give you peace of mind, with 15-minute appointments when it suits you at no extra cost.
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, you may need treatment even if you don’t have symptoms. If your gallstones start to cause problems, your GP may refer you for more investigations and treatment.
Gallbladder removal surgery
If your gallstones need treatment, the main option is an operation to remove your gallbladder. Your gallbladder isn’t essential, and most people who’ve had it removed don’t have problems.
The decision to gallbladder removal surgery may depend on how often you get symptoms, how severe they are, and what problems your gallstones are causing. Your doctor or surgeon can explain your gallstones treatment options and answer any questions you may have. They will consider your general health and your age when guiding your decision.
An operation to remove the gallbladder is called a cholecystectomy (pronounced co-le-sis-tec-tomy).
You’ll usually have keyhole surgery for your cholecystectomy. This is called laparoscopic cholecystectomy, and most people have their gallbladder removed this way.
Occasionally during a cholecystectomy, the surgeon may need to switch from a keyhole operation to open gallbladder surgery. For this they’ll make a large cut across the right side of your tummy.
For some people, keyhole surgery isn’t suitable as the first approach to gallstones treatment – for example, if you’ve had lots of surgery on your tummy before. In these cases, the operation is done as open surgery.
Some surgeons are trained to do robotic cholecystectomy in selected hospitals. This is a keyhole approach that can be used in complex cases, and potentially avoid a large open cut.
Non-surgical treatments
Medicines
Over-the-counter painkillers like paracetamol may help with your gallstones symptoms. 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. In mild cases, your GP may give you antibiotics to take by mouth (tablets).
Always read the patient leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor.
Diet
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 to prevent pain from gallstones too. There is poor evidence, however, of the benefit of such a diet as gallstones treatment.
Diet is a possible factor behind gallstones forming in the first place. See our section above on Causes of gallstones for more information about how healthy eating might help to prevent gallstones.
Other treatments
If your doctor thinks you might have gallstones in your bile duct, they may suggest you have an endoscopic retrograde cholangiopancreatography (ERCP). This uses a combination of endoscopy and X-rays to find and treat your bile duct stones. If an ERCP isn’t possible, there are other options that your surgeon or specialist doctor may discuss with you.
You may still need to have an operation to remove your gallbladder, because there may still be gallstones in it after bile duct treatments.
Complications of gallstones
Most gallstones do not cause any symptoms or problems. But sometimes they can cause complications. They may block ducts to your internal organs like your gallbladder, liver, pancreas, and small intestine. This may cause inflammation, swelling, or infection.
The following two are among the most common complications of having gallstones.
- Biliary colic. This is a type of pain, and it’s the most common problem for people who get symptoms with gallstones. Your gallstones can be painful when your gallbladder or duct (connecting tube) tightens around them. See our section on Gallstones symptoms above for more information about biliary colic.
- Cholecystitis. This is an inflamed gallbladder and the second most common complication. It can lead to a severe infection, and damage to your gallbladder. If you have an infection, you’ll need antibiotics. You’ll usually have these intravenously (into a vein) in hospital.
Other complications are much less common but can be more harmful. These include the following.
- 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 duct from your pancreas. This causes inflammation in your pancreas, which is a serious medical condition.
- Cholangitis. Your bile duct may get infected if a gallstone completely blocks it. This needs urgent treatment.
- Gallstone ileus. This is an obstruction in your bowel that can happen with gallstones, but only rarely. If large gallstones pass out of your gallbladder, they might block your bowel.
- Gallbladder cancer. Rarely, people with gallstones develop gallbladder cancer. But there is no evidence that gallstones themselves cause cancer.
Your doctor will explain any tests and treatments you might need if you have a complication of gallstones.
Gallbladder removal
You may need to have your gallbladder removed if you have gallstones or if your gallbladder becomes diseased or damaged.
Tips for a healthy and well-balanced diet
A healthy, well-balanced diet involves eating foods from a variety of food groups to get the nutrients that your body needs to function.
Obesity in adults
Obesity is a condition in which excess body fat accumulates and may lead to health problems
How to start exercising
We should all be getting active – and it may be easier than you think. Here we give you tips and advice for getting started
Tools and calculators
BMI calculator
BMI, or body mass index, is one way of measuring whether you’re a healthy weight for your height.
Simply enter your details into our calculator and the result will give you an indication of whether you're a healthy weight.
Calories calculator
If you want to lose weight, you need to increase your physical activity and watch your calorie intake. Bupa's calorie calculator will help you to work out how many calories you're burning in a day.
Did our Gallstones information help you?
We’d love to hear what you think.∧ Our short survey takes just a few minutes to complete and helps us to keep improving our health information.
∧ The health information on this page is intended for informational purposes only. We do not endorse any commercial products, or include Bupa's fees for treatments and/or services. For more information about prices visit: www.bupa.co.uk/health/payg
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.
The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.
- Cholelithiasis (gallstones). BMJ Best Practice. bestpractice.bmj.com, last reviewed 20 March 2022
- Liver, pancreatic, and biliary surgery. Oxford handbook of clinical surgery. Oxford Medicine Online. oxfordmedicine.com, published online November 2021
- Gallstones and cholecystitis. Patient. patient.info/doctor, last edited 14 May 2021
- Gallstones. Guts UK. gutscharity.org.uk, accessed 20 April 2022
- Gallstones. British Liver Trust. britishlivertrust.org.uk, accessed 20 April 2022
- Cholelithiasis. MSD Manual Professional Version. www.msdmanuals.com, last full review/revision September 2021
- Personal communication, Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon, 11 May 2022
- Gallstones. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
- Bilirubin. Encyclopaedia Britannica. www.britannica.com, accessed 20 April 2022
- Gallstones (cholelithiasis). Medscape. emedicine.medscape.com, updated 1 April 2019
- Gastroenterology. Oxford handbook of clinical medicine. Oxford Medicine Online. oxfordmedicine.com, published online September 2017
- Gastroenterology. British Medical Ultrasound Society. www.bmus.org, accessed 20 April 2022
- Gallstone disease: diagnosis and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 29 October 2014
- Young M, Mehta D. Percutaneous transhepatic cholangiogram. Statpearls Publishing. www.ncbi.nlm.nih.gov/books, last updated 13 August 2021
- Percutaneous transhepatic cholangiography. Medscape. emedicine.medscape.com, updated 11 August 2020
- Markus MacGill, Content editor
