Gallbladder diseases are most often caused by gallstones, which can block the flow of bile through the bile ducts, causing inflammation and pain. Most gallbladder diseases are treated with gallbladder removal surgery.
Gallbladder disease refers to any condition that affects the health of your gallbladder. Your gallbladder is a small organ in your digestive system. It stores some of the bile your liver makes and sends it to your small intestine to help break down food there. It does this through a series of pipes called bile ducts.
Gallbladder disease can begin in your gallbladder itself or in the bile ducts connected to it. Any infection or blockage in these ducts can back up into your gallbladder. Because the bile ducts connect your gallbladder with other organs in your digestive system, gallbladder disease can affect these other organs too.
Gallbladder diseases include:
Gallstones affect as much as 15% of the population, but only 20% of those with gallstones will have complications or symptoms. Gallbladder disease not associated with gallstones is much less common.
You are most likely to have gallbladder disease if you have gallstones. Risk factors include:
The five Fs were a mnemonic device that healthcare providers used in the past to memorize common risk factors for gallbladder disease. The five Fs were: fair, female, fat, fertile and 40. They were based on statistics, but they are controversial today because they add up to a kind of stereotype. If healthcare providers are looking for a specific profile when diagnosing gallbladder disease, they might be misled to jump to conclusions, overlooking patients who don’t fit the profile or overlooking other possible diagnoses in patients who do. However, the five Fs do reflect common risk factors.
“Fair” is based on the fact that white populations are more often affected by gallbladder disease. This might be partially genetic, or it might have more to do with the modern Western diet. “Female” is based on the fact that women are more than twice as likely to be affected. “Fat” is a generalization of people who may have a high-cholesterol diet or people who may have diabetes. “Fertile” is based on the fact that women who are or have been pregnant are more likely to have been affected by high estrogen. And “forty” is based on the fact that risk increases with age, so people who are at least forty are more likely to have it.
When the gallbladder can’t do its job, bile can’t flow to your small intestine to help with digestion, and instead builds up in your blood. Since bile in your small intestine is important for breaking down fats, you may have some digestive difficulties, especially digesting fatty foods. Since bile is also a carrier for toxins that the liver has filtered from your body, bile that builds up in your blood will make you sick. A sick gallbladder can also be intensely painful.
Most gallbladder diseases can be treated in surgery, either by removing gallstones or removing the whole gallbladder. Surgeons redirect the bile ducts to flow directly from your liver to your small intestine without stopping in the gallbladder first. In this way, digestive processes can continue normally and you can live well without your gallbladder. But complications of gallbladder disease to other parts of your body can be more lasting if they aren’t addressed early enough.
Gallbladder disease can affect your bile ducts, liver or pancreas.
Gallbladder disease can cause inflammation, infection and/or blockage of the bile ducts, especially if a gallstone passes from the gallbladder into the bile ducts. Any one of these things also tends to cause the others to follow. Over time, this can cause scarring and narrowing of the bile ducts, which will cause long-term bile flow problems.
When bile backs up into your liver, as a result of gallbladder problems or bile duct problems or both, it causes inflammation and eventually scarring of the liver (cirrhosis). This will do long-term damage to your liver’s functioning. Cirrhosis also causes complications to other organs.
A gallstone that travels from the gallbladder into the bile ducts and pancreas duct opening can cause a blockage that backs up into the pancreatic duct and the pancreas. This is a common cause of pancreatitis, inflammation of the pancreas. Severe or long-lasting pancreatitis can do long-term damage to your pancreas.
Symptoms of gallbladder disease fall into a few different categories.
Biliary colic is a type of visceral pain associated with gallbladder disease. It’s usually the first symptom of something going on in your gallbladder. The name “biliary colic” implies that the bile ducts are involved, and they usually are, if not directly then by proxy. A blockage in either the gallbladder or bile ducts will cause pressure to build up in both. Most commonly, a gallstone causes a blockage. But swelling due to infection, biliary stricture or a problem with the emptying function of your gallbladder may also cause pressure to build up. The pain is proportional to the pressure.
It may begin as a dull ache that comes and goes, often in conjunction with gallbladder contractions after a meal. You’ll feel it in the upper right side of your abdomen under the right rib cage, where your gallbladder is located. You may also feel it in the middle of your abdomen, or it may radiate to the right shoulder blade. It’s typical to experience nausea and vomiting with biliary pain. An episode usually lasts a few hours and occurs intermittently but not every day. This indicates a partial or occasional blockage that may occur when your gallbladder contracts and eases when it relaxes.
A persistent blockage, infection or tumor in your gallbladder can cause acute inflammation, which feels like a more intense version of biliary colic. Nausea and vomiting may be accompanied by fever and chills. The pain is steadier and may be extreme enough to bring you to the emergency room. You may have an accelerated heart rate or abrupt drop in blood pressure during gallbladder contractions, such as after a meal. As blocked bile begins to accumulate in your blood, you may begin to show visible symptoms, such as jaundice, dark-colored pee and pale-colored poop.
Chronic symptoms are often milder than acute symptoms and may go unnoticed for some time. You may only notice digestive difficulties, such as abdominal bloating and distension, chronic gas, nausea or diarrhea after eating. These symptoms have many possible causes that don’t necessarily point to the gallbladder. In the case of gallbladder cancer, you might have chronic inflammation with mild jaundice, but no pain. The vague nature of these symptoms, without alarming pain levels, can cause chronic cholecystitis to go undiagnosed, causing long-term damage.
Gallstones are the most common cause of gallbladder problems, but they don’t always cause problems. When they do, it’s usually because they block the flow of bile in your gallbladder, bile ducts or both. Less commonly, bile may back up because the emptying function of your gallbladder is sluggish, or because some other condition has made your bile ducts too narrow. Backed-up bile is the most common cause of gallbladder inflammation (cholecystitis), but sometimes a separate infection causes it. Inflammation makes your gallbladder swell and builds up pressure inside it. This can also cause bile to back up as a secondary effect.
As always, your healthcare provider will begin with your medical history and review of your symptoms. They'll take your vital signs, observing any change in heart rate, blood pressure or body temperature, such as fever. Then they’ll examine you physically, looking for signs of jaundice and swelling in your abdomen. They might feel the abdominal area where your gallbladder is located. If they can feel your gallbladder, that’s a sign of inflammation. Whether it is painful to the touch or not may help distinguish between gallstone-related acute inflammation and cancer-related chronic inflammation. They will follow up with blood tests and imaging tests.
Not all risk factors can be managed or modified, but you can optimize your gallbladder health by maintaining a healthy diet and lifestyle. The modern Western diet is high in fats and cholesterol and low in fiber, which helps clear excess fats from the body. Make an effort to reduce fatty processed foods and eat more fiber-rich plants. Regular exercise can also help reduce your risk by encouraging your motility — the regular contractions of your digestive organs.
Most gallbladder disease ends in surgery (gallbladder removal), but you’ll be in good company if it comes to that. Most people recover quickly and don’t have long-term side effects from the surgery. You may have some temporary digestive difficulties while recovering. You might have to avoid fatty foods at first while your body is adjusting to the lack of a gallbladder. Most people are able to resume a normal but healthy diet after a few months.
A note from Cleveland Clinic
Gallbladder disease can sneak up on you. By the time you have symptoms, it may already be serious. Fortunately, most gallbladder diseases are easily treated with minimally-invasive surgery. The important thing is to take symptoms seriously, even if they aren’t severe. You may have mild passing biliary pain that seems to resolve itself, but this can become a persistent and growing problem. Don’t wait for the intense alarm symptoms of acute cholecystitis, or for the long-term damage caused by chronic cholecystitis. Your healthcare provider can locate and often remove problematic gallstones through common outpatient testing procedures.
Last reviewed by a Cleveland Clinic medical professional on 05/03/2022.
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