Gallstones

Gallstones are hardened bits of bile that grow in your gallbladder. They happen when an imbalance in your biliary system allows tiny grains to collect and crystallize.

“Gall” means bile. But healthcare providers also use the term cholelithiasis. “Chole” is another word for bile, and “lithiasis” means that stones are forming.

Most gallstones don’t cause issues, and you might never know you have them. But some can get stuck in your biliary tract and clog it up. This is painful and might cause complications. Surgery to remove your gallbladder can treat these stones. Medications can help in some cases.

Types of gallstones

There are two main types of gallstones. They are:

• Cholesterol gallstones: These are the most common kind of gallstone (up to 9 out of 10 cases). They happen when your bile has more cholesterol in it than your bile salts (bile acids) can break down. You can also get these stones if your gallbladder doesn’t move things along as it’s supposed to.
• Pigment gallstones: These gallstones form when your liver makes too much bilirubin as it dissolves hemoglobin from your bloodstream. Certain conditions involving your liver — like cirrhosis or a bile duct infection — can cause this. Pigment gallstones can be black or brown.

Symptoms of gallstones

Most people (up to 8 in 10) don’t have any symptoms from gallstones. But if you do, you might experience symptoms of biliary colic, like:

• Sudden pain in the upper right side of your abdomen
• Nausea and vomiting

If gallstones cause more severe problems, symptoms can include:

• Abdominal tenderness and swelling
• Fast heart rate
• Fever and chills
• Low blood pressure
• Yellowish tint to your skin and eyes

Seek medical attention as soon as you experience any of these symptoms. A healthcare provider can help you find relief.

What does gallstone pain feel like?

Gallstones that get stuck in your biliary tract can lead to gallbladder pain or pain in your biliary system. You can usually feel it under your right ribcage. But sometimes, it can spread to other areas — like the middle of your chest, your right arm or shoulder, or between your shoulder blades. The pain can feel:

• Intense and sharp
• Stabbing
• Cramping
• Squeezing

You may also get sick to your stomach. When this happens, it’s called a gallbladder attack.

You might feel it the most after eating. This is because your gallbladder contracts, creating more pressure in your biliary system. It can even wake you from sleep or make it impossible to sit still.

These episodes can last minutes to hours. They end either when the pressure decreases or when the stone moves out of the way. And if a gallbladder attack isn’t in a typical location, you may mistake it for heartburn, indigestion or even a heart attack.

Gallstone causes

Causes of gallstones generally involve an imbalance in the way your liver, gallbladder and bile ducts process bile. They include:

• Too much cholesterol: If there’s extra cholesterol in your bloodstream, your liver won’t get rid of it. Instead, it’ll turn into little grains that can go on to make gallstones.
• Too much bilirubin: Bilirubin comes from old red blood cells. If something is causing a buildup of bilirubin or your liver can’t process it, you may have more than usual.
• Not enough bile acids (bile salts): Your liver needs bile salts to make healthy bile. So, if a disease makes you lose them and there aren’t enough left to break down cholesterol, you’ll have more cholesterol in your bile than you should.

Risk factors

Many conditions can increase your chances of getting gallstones, like:

• Cirrhosis
• Crohn’s disease
• Cystic fibrosis
• Heart disease from atherosclerosis
• Insulin resistance
• Problems with your ileum (the last part of your small intestine)
• Sickle cell anemia

But you don’t need to have any of these conditions. Other, more typical factors that raise your risk of having gallstones include:

• Age: If you’re male, you’re more likely to get gallstones after age 60. If you’re female, you’re more likely to get them during fertile years, roughly between the ages of 20 and 50.
• Hormones: If you’re female, you’re three times more likely to get gallstones. Estrogen increases cholesterol levels, while progesterone slows your gallbladder from emptying.
• Extra weight: Body fat releases estrogen. So, having more of it raises your estrogen and cholesterol levels.
• Rapid weight loss: Losing weight quickly (such as after weight-loss surgery) can cause gallstones. This is because losing body fat in a short amount of time releases large loads of cholesterol into your bile.
• Ethnicity: If you’re of Native American or Mexican descent, you may be more prone to higher cholesterol levels in your bile. This can lead to gallstones.
• Genetics: If you have a biological family history of gallstones, you may be more likely to develop them regardless of heritage.

Gallstone complications

Gallstones that block bile flow can affect any of the organs that rely on your biliary system to work properly. Possible complications include:

• An abnormal tunnel between your gallbladder and GI tract (cholecystoenteric fistula)
• Cancer from chronic gallbladder inflammation
• Inflammation in your bile duct (cholangitis)
• Inflammation in your gallbladder (cholecystitis)
• Stones in your bile ducts (choledocholithiasis)
• Inflammation in your pancreas from a gallstone blocking its ducts (gallstone pancreatitis)

How doctors diagnose gallstones

If you’re having gallstone symptoms, a healthcare provider will use imaging and lab tests to see what’s going on.

Imaging tests let your provider take a closer look at your specific situation. First, you’ll have an abdominal ultrasound. This is a quick and easy test that doesn’t need any prep. It can find most gallstones in and around your gallbladder. But if a gallstone is stuck somewhere else in your biliary tract, you may need another test to find it.

Other imaging tests could include:

• CT scan, in some cases
• ERCP or MRCP
• HIDA scan
• MRI

Lab tests look for inflammation and infection. They can help pinpoint the organs affected. These may include:

• Blood tests, like amylase and complete blood count (CBC)
• Urinalysis

How are gallstones treated?

If you have gallstones and they never cause issues, you won’t need treatment. But if they block your biliary tract, your healthcare provider will review treatment options with you.

Surgery

Your provider will likely recommend gallbladder removal (cholecystectomy). This is one of the most common surgeries in the world. Surgeons usually perform it using only a few cuts in your skin (laparoscopically).

If your provider decides that surgery to remove your gallbladder may not be right for you, they might suggest a cholecystostomy instead. This is a minor procedure that places a catheter in your gallbladder to drain it. It removes the gallstones currently inside it.

These procedures may sound overwhelming. But they’re the most effective way to keep your biliary system healthy.

Medications

If you aren’t a candidate for surgery, your provider might prescribe ursodeoxycholic acid (ursodiol). This medication may dissolve small stones that haven’t caused complications. But it can take months or years, if it works at all, and only around half of the people who take this medication see any success. The stones can also return.

It’s not a practical way to treat gallstones for most people. But in some cases, medication may be helpful for temporary or preventive use.

When should I seek care?

If you experience symptoms of a gallbladder attack, don’t wait for it to go away. Seek medical help as soon as possible.

If you think you’ve had biliary colic before, see a provider. They can confirm the cause and treat the condition before it causes more problems. Untreated gallstones will continue to form and grow.

What can I expect if I have gallstones?

If a provider diagnoses you with gallstones after you have symptoms, you can expect to go over treatment options with them. It’s best to seek care because gallstones don’t go away on their own. And they can cause complications down the line.

Can I pass a gallstone?

Sometimes, gallstones pass in your poop. But there will always be stones left behind. And it won’t stop more from forming.

Gallstones that are small enough to pass may be hard to see. If you spot them in the toilet, they might look like tiny, sharp pebbles. They can be yellow or brown.

Can gallstones be prevented?

There’s no surefire way to prevent gallstones from forming. But you can take some steps to lower your risk, like reducing cholesterol in your diet and maintaining a healthy weight for you.

Rapid weight loss can raise your risk, though. So, if you plan to undergo any weight-loss procedures or treatments, your provider may prescribe gallstone medication preventively.