Gallstones

What are gallstones?

Gallstones are hardened, concentrated pieces of bile that form in your gallbladder or bile ducts. “Gall” means bile, so gallstones are bile stones. Your gallbladder is your bile bladder. It holds and stores bile for later use. Your liver makes bile, and your bile ducts carry it to the different organs in your biliary tract.

Healthcare providers sometimes use the term “cholelithiasis” to describe the condition of having gallstones. “Chole” also means bile, and “lithiasis” means stones forming. Gallstones form when bile sediment collects and crystallizes. Often, the sediment is an excess of one of the main ingredients in bile.

How serious are gallstones?

Gallstones (cholelithiasis) won’t necessarily cause any problems for you. A lot of people have them and never know it. But gallstones can become dangerous if they start to travel through your biliary tract and get stuck somewhere. They can clog up your biliary tract, causing pain and serious complications.

The problem with gallstones is that they grow — slowly, but surely — as bile continues to wash over them and leave another layer of sediment. What begins as a grain of sand can grow big enough to stop the flow of bile, especially if it gets into a narrow space, like a bile duct or the neck of your gallbladder.

How common are gallstones (cholelithiasis)?

At least 10% of U.S. adults have gallstones, and up to 75% of them are women and people assigned female at birth (AFAB). But only 20% of those diagnosed will ever have symptoms or need treatment for gallstones.

What are gallstones symptoms?

Gallstones generally don’t cause symptoms unless they get stuck and create a blockage. This blockage causes symptoms, most commonly upper abdominal pain and nausea. These may come and go, or they may come and stay. You might develop other symptoms if the blockage is severe or lasts a long time, like:

• Sweating.
• Fever.
• Fast heart rate.
• Abdominal swelling and tenderness.
• Yellow tint to your skin and eyes.
• Dark-colored pee and light-colored poop.

What is gallstone pain like?

Typical gallstone pain is sudden and severe and may make you sick to your stomach. This is called a gallstone attack or gallbladder attack. You might feel it most severely after eating, when your gallbladder contracts, creating more pressure in your biliary system. It might wake you from sleep.

Gallstone pain that builds to a peak and then slowly fades is called biliary colic. It comes in episodes that may last minutes to hours. The episode ends when and if the stone moves or the pressure eases. People describe the pain as intense, sharp, stabbing, cramping or squeezing. You might be unable to sit still.

Where is gallstone pain located?

Your biliary system is located in the upper right quadrant of your abdomen, which is under your right ribcage. Most people feel gallstone pain in this region. But sometimes, it can radiate to other areas. Some people feel it in their right arm or shoulder or in their back between their shoulder blades.

Some people feel gallstone pain in the middle of their abdomen or chest. This can be confusing because the feeling might resemble other conditions. Some people mistake gallstone pain for heartburn or indigestion. Others might feel like they’re having a heart attack, which is a different emergency.

Are gallstones symptoms different in a female?

Gallstone symptoms aren’t different in women or people assigned female at birth (AFAB). But people AFAB may be more likely to experience referred pain — pain that you feel in a different place from where it started. So, they may be more likely to experience gallstone pain in their arm, shoulder, chest or back.

People AFAB are also more prone to chronic pain, and they may be more likely to dismiss pain that comes and goes, like biliary colic does. It’s important to see a healthcare provider about any severe or recurring pain, even if it goes away. Once you’ve had a gallstone attack, you’re likely to have another.

What triggers gallstone pain?

Gallstone pain means that a gallstone has gotten stuck in your biliary tract and caused a blockage. If it’s a major blockage, you might feel it right away. If it’s only a partial blockage, you might not notice until your gallbladder contracts, creating more pressure in your system. Eating triggers this contraction.

A rich, heavy or fatty meal will trigger a bigger gallbladder contraction. That’s because your small intestine detects the fat content in your meal and tells your gallbladder how much bile it will need to help break it down. Your gallbladder responds by squeezing the needed bile out into your bile ducts.

What are the important warning signs of gallstones?

Biliary colic is the only warning sign of gallstones that you’ll get. It happens when a gallstone causes a temporary blockage, then manages to move out of the way and let bile flow through again. Even though the pain eventually goes away, it’s important to recognize these episodes as the warning that they are.

Once a gallstone has caused a blockage in your biliary tract, it’s likely to keep happening. The same one may be hanging around the same tight spot and continuing to grow. Or you may have more gallstones waiting in the wings. One day, a gallstone might get stuck and stay stuck. This would be an emergency.

What are the possible complications of having gallstones?

If a gallstone blocks the flow of bile through your biliary system, it can affect any or all of the organs in that system. Bile that can’t flow backs up into your bile ducts and organs, causing acute inflammation and encouraging bacterial infections. When severe, these conditions can become life-threatening.

Complications include:

• Cholecystitis (gallbladder inflammation).
• Pancreatitis (pancreas inflammation).
• Cholangitis (bile duct inflammation).
• Hepatitis (liver inflammation).
• Jaundice (bile in your bloodstream).
• Septicemia (an infection in your bloodstream).

Can gallstones make you tired and dizzy?

Dizziness and fatigue are symptoms of low blood pressure. These aren’t typical symptoms of gallstones. However, low blood pressure is a possible side effect of gallstone complications. Severe inflammation or infection in your biliary system could trigger a faster heart rate along with a drop in blood pressure.

What causes gallstones?

Gallstones form when there’s an excess of one of the main ingredients in bile. The excess ingredient turns to sediment at the bottom of your gallbladder or bile ducts, and the sediment gradually hardens into stones. Cholesterol stones are the most common type. Pigment (bilirubin) stones are the other.

A variety of factors may be involved in this process, including:

• Excess cholesterol. Your liver extracts cholesterol from your blood to make bile. If there’s too much cholesterol in your blood, the proportions in your bile will be off. Bile needs a balance of lipids and acids to hold all the ingredients together. Any excess will fall by the wayside.
• Excess bilirubin. Bilirubin is a byproduct of broken-down old red blood cells. You might have an excess of bilirubin if you have a blood disorder that destroys too many red blood cells, or if your liver is impaired in some way and struggling to process its normal load of bilirubin into bile.
• Not enough bile acids (bile salts). Certain diseases can cause bile acid malabsorption, which means that you lose bile acids in your poop. If you lose too many, your liver won’t have enough left to make bile with. The lack of bile acids creates an excess of lipids (cholesterol) in your bile.
• Cholestasis or gallbladder stasis. “Stasis” means inactivity. If your bile ducts or gallbladder aren’t moving bile effectively through your biliary tract, the bile is more likely to form sediment. This might be an issue with the muscles or with the chemical signaling that tells them to move.

What risk factors contribute to gallstones (cholelithiasis)?

A variety of diseases and conditions can affect your bile flow or your cholesterol, bilirubin or bile acid levels. But not everyone with gallstones has an underlying condition. Some of the most common risk factors are normal factors, like your age, genetic profile, hormone levels and weight fluctuations.

Risk factors include:

• Age. Gallstones take time to develop and grow large enough to cause an obstruction. Men and people assigned male at birth (AMAB) are more likely to get them after age 60. Women and people AFAB are more likely to get them during their fertile years, roughly between the ages of 20 and 50.
• Hormones. Women and people AFAB are three times more likely to get gallstones than men and people AMAB. Their risk peaks and declines with their estrogen and progesterone levels. Estrogen increases cholesterol levels, while progesterone slows your gallbladder from emptying.
• Weight. Body fat releases estrogen, so having more of it raises your estrogen levels and your cholesterol levels. On the other hand, rapid weight loss, like after weight loss surgery, can also cause gallstones. Losing body fat quickly releases large loads of cholesterol into your bile.
• Genetics. If you’re of Native American or Mexican descent, your genetic profile makes you more prone to higher cholesterol levels in your bile, leading to gallstones. If you have a family history of gallstones, you may be more likely to develop them, regardless of your racial heritage.

How are gallstones diagnosed?

If you’re experiencing gallstone symptoms, your healthcare provider will investigate with blood tests and imaging tests. Blood tests can detect inflammation, infection or jaundice and offer clues to which organs are affected. Imaging tests will help locate the source of the blockage in your biliary tract.

What tests can detect gallstones?

Your provider will begin with an abdominal ultrasound, which is a quick and easy test that doesn’t require any preparation. An ultrasound 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 kind of test to find it.

Other possible tests include:

• MRCP (magnetic resonance cholangiopancreatography).
• HIDA scan.
• Endoscopic ultrasound.
• ERCP (endoscopic retrograde cholangiopancreatography).

What is the treatment for gallstones?

If your gallstones never cause problems, you won’t need treatment for them. But if gallstones cause a blockage in your biliary tract, your healthcare provider will want to remove them — not just the blockage, but all of them. Once gallstones have caused a blockage, they’re highly likely to do so again.

Most people who need treatment for gallstones will have surgery to remove them. Surgery is the only way to ensure gallstones won’t cause issues for you again. But if you can’t or don’t want to have surgery, there are some alternative treatments to try, including medications and other procedures.

Gallstone surgery

Gallbladder removal (cholecystectomy) is the only reliable long-term solution for gallstones. It’s one of the most common procedures performed worldwide, usually as a laparoscopic surgery. You can live well without a gallbladder. From now on, bile will simply flow directly from your liver to your small intestine.

Occasionally, some people who need treatment for gallstones aren’t in a safe condition to have gallbladder removal surgery. In these cases, cholecystostomy is one alternative. This minor procedure places a catheter in your gallbladder to drain it. It can remove the gallstones currently inside.

Medical treatments for gallstones

Healthcare providers don’t prescribe medications for gallstones very often because they aren’t very effective. Medications like ursidol and chenodiol only work on smaller cholesterol stones that haven’t caused any complications yet. It can take months to years to dissolve them, and they often return.

This isn’t a practical way to treat gallstones for most people. But there may be limited circumstances where medications are helpful as a temporary or preventive measure. If you’re not a good candidate for gallstone surgery, your healthcare provider will discuss their recommendations with you.

How can I prevent gallstones from forming?

There’s no sure way to prevent gallstones from forming, but you can take certain steps to reduce your overall risk. For example, you can reduce your risk of cholesterol stones, which are by far the most common type, by reducing cholesterol in your diet. However, this won’t prevent pigment stones.

If you have overweight or have obesity, losing some weight can reduce your risk of cholesterol stones. But losing weight fast can raise your risk. If you’re expecting rapid weight loss from a procedure or other treatment, your healthcare provider might recommend taking gallstone medications preventatively.

What is my prognosis after treatment for gallstones (cholelithiasis)?

After surgery, most people will never need treatment for gallstones again. Complications are uncommon, but some people develop chronic diarrhea. This is because bile now flows continuously to your intestines, instead of on demand. You can treat it with medications called bile acid binders.

Do gallstones ever go away on their own?

Gallstones won’t go away without treatment. Gallstones can sometimes come out in your poop, but it won’t be all of them. Even if your provider removes a gallstone from your bile duct, there will be others left behind, and you can get new ones. Gallbladder removal is the only way to make them stop for good.

How do you pass gallstones in your poop?

A gallstone that makes its way into your common bile duct may pass all the way through to your intestines if it doesn’t get stuck along the way. From your intestines, it can pass out in your poop. That’s a lucky scenario, but you can’t expect that outcome from every gallstone, and you can’t make it happen.

There’s no way to make your gallstones enter your common bile duct, and there’s no way to ensure they’ll pass safely through to your intestine. They might just hang around in the duct and continue to grow. In general, you don’t want to risk having gallstones in your common bile duct in the first place.

How does it feel to pass a gallstone?

You probably won’t feel a gallstone passing out of you. For a gallstone to pass successfully through your common bile duct into your intestines, it needs to be less than 5 millimeters. This is too small for you to feel in your intestines, although you might feel pain briefly while it passes through your common bile duct.

What do gallstones look like in the toilet?

A gallstone that’s small enough to pass through your common bile duct might be too small to notice in your poop, even if you’re looking for it. But if you saw a gallstone in the toilet, it would look like a tiny pebble. The shape might look angular rather than smooth. Most are yellow, but some are brown.

Can you pass gallstones in your pee?

You can’t pass gallstones in your pee, because there’s no way for gallstones to get into your urinary tract. Stones in your urinary tract are kidney stones. Gallstones and kidney stones are similar, but they travel through different pipelines. Painful urination is a symptom of kidney stones, not gallstones.

When should I see my healthcare provider about gallstones?

If you develop sudden stabbing pain in your upper right abdomen or shoulder, especially after eating, you might be having a gallbladder attack. Seek medical attention right away. Don’t wait for it to go away because it might not. A healthcare provider can relieve your pain while confirming the cause.

If you think you’ve experienced biliary colic in the past, even if it’s over, see your provider. They’ll take images of your biliary system to look for gallstones. If they find them, they’ll recommend treating them before they can cause further problems. Without treatment, gallstones will continue to form and grow.