Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. The gallbladder is a small pear-shaped organ attached to the underside of your liver in the upper part of your abdomen. The gallbladder stores bile, a fluid produced by the liver. Bile aids digestion by breaking down fats in the food you eat.

When you eat, the gallbladder squeezes bile through the bile duct into the small intestine. Usually, bile moves smoothly from the gallbladder into the small intestine. However, if gallstones form, the flow of bile may be blocked. This can cause pain and, sometimes, may lead to serious complications. People who experience symptoms usually require gallbladder removal surgery. Gallstones that don’t cause symptoms usually don’t need treatment.

If your pain is likely to be due to gallstones and your gallbladder is not working properly, removal of the gallbladder is then usually recommended. Symptoms may worsen and complications may develop if you do not have treatment. Our experienced surgeons at the Gallstone Clinic will be happy to advise you.

Recognising The Symptoms Of Gallbladder Pain 

The pain and symptoms of gallstones and related gallbladder issues can be sudden and debilitating and last anywhere from 20 minutes to several hours. The severity of these symptoms and their location can mean huge uncertainty around what is causing such pain and why? Read on to learn more about gallbladder pain , symptoms, risk factors, possible complications, and diagnosis and treatment options.

What Is The Gallbladder And What Does It Do?

Located just under the liver, the gallbladder is a small, pear-shaped pouch—it stores and releases bile which is made in the liver. The gallbladder doesn’t make any bile itself, its like a small reservoir.  Bile is used by the body to break down fat and aid in digestion. While eating, the stomach releases a hormone causing the muscles around the gallbladder to contract – thereby releasing bile. The bile travels through a series of pipe-like bile ducts called the biliary tract and on into the small intestine.

Bile is a fluid made up of cholesterol, bile salts and water. Sometimes bile can form small hardened deposits called gallstones, these ‘stones’ range in size from something similar to a grain of salt up to golf-ball-sized lumps. Gallstones are a fairly common occurrence, and some never become problematic, however, when they do, it can be a distressing and painful experience.

What Causes Gallbladder Pain?

What triggers gallbladder pain? One of the most common causes is the formation of gallstones in the gallbladder. Gallstones are the result of too much cholesterol or bilirubin in the bile within the gallbladder. This excess causes crystals to form, which then clump together to form ‘stones’. These gallstones aren’t usually a problem unless they block the bile ducts stopping bile from leaving the gallbladder. 

When gallstones get stuck and block the outflow of bile, this causes the gallbladder to go into spasm resulting in sharp pain on the upper right-hand side of the abdomen just under the rib cage, or sometimes in the centre of the abdomen. The pain may radiate to the back .

Types Of Gallstones

There are two main types of gallstones that can form in the gallbladder, these are:

• Cholesterol Gallstones. As the name suggests, these gallstones are mostly made up of cholesterol deposits. They generally appear yellow in colour and are the most common form of gallstones. It doesn’t mean you have high cholesterol levels.
• Pigment Gallstones. These are dark brown or black stones formed when bile contains too much bilirubin (a pigment made during the break down of red blood cells). High levels of bilirubin are often caused by conditions such as Gilbert’s syndrome, Haemolytic anaemia, hepatitis A, alcoholism, liver disease or dysfunction and immune system disorders.

Other Causes of Gallbladder Pain

It is important to note that not all gallbladder pain is as a result of gallstones, there are other underlying conditions that may cause different kinds of gallbladder pain, some of these are: 

• Cholecystitis – Infection in the gallbladder 
• Abscesses or tumours of the gallbladder
• Infection of the bile ducts from  the gallbladder (Cholangitis) 
• Gallbladder rupture
• Gallbladder polyps
• Chronic gallbladder disease keeps the gallbladder from working the way it should, e.g. acalculous gallbladder disease (no stones but inflamed), gallbladder dyskinesia (non-functioning)

Risk Factors for Gallbladder Issues

Anyone can develop gallbladder problems, but there are some factors that can increase the likelihood of this occurring, 9 things that may play a part in increasing the risk of developing gallstones include:

1. Weight. Both obesity and a rapid loss of weight can increase susceptibility to gallstones.
2. Diet. A high-fat diet high in refined carbohydrates with little fibre.
3. Age. The older you get, the more likely you are to develop gallstones.
4. Pregnancy. This is likely linked to the extra oestrogen in your body. 
5. Sedentary Lifestyles. Living an extremely sedentary lifestyle also raises the risk.
6. Genes. If someone in your family had gallstones, you are more likely to get them.
7. Existing Diseases. Such as Cirrhosis (when the liver stops working because of disease or injury), Crohn’s Disease (Inability to absorb certain nutrients), and diabetes.
8. Blood Disorders. For example, Sickle Cell Anaemia (lack of healthy red blood cells) and leukaemia (bone marrow cancer).
9. Gender. Women aged between 20 to 60 years of age are known to have a greater chance of developing gallstones than men of the same age. After 60 years of age, men and women are thought to be at equal risk. (Hormone replacement therapy and birth control pills are believed to be a possible factor in this variance).

Gallbladder Pain and Symptoms

Gallbladder pain resulting from gallstones can have mild symptoms, or it can be a very painful condition that comes and goes over time. Common symptoms of problems with your gallbladder are:

• Sudden rapidly intensifying pain in the upper-right side of the abdomen
• Back pain between your shoulder blades or right shoulder
• Upper abdominal pain soon after eating
• Unexplained nausea or vomiting
• Rapid onset fever or chills
• Light-coloured stools
• Brownish-coloured (like tea) urine
• Yellowing of skin or whites of eyes (when backed-up bile enters the bloodstream and causes the whites of the eyes and skin to turn a yellow colour). Referred to as jaundice.

Frequently Asked Questions About Gallbladder Symptoms

The sudden onset of gallbladder pain can be distressing, sometimes, it helps to know the answers to some basic questions.

How Do You Know If It’s Gallbladder Pain Or Something Else? Gallbladder pain caused by gallstones blocking the ducts in the gallbladder is pretty intense with rapid onset (sometimes immediately after eating) and may be accompanied by nausea or vomiting. Other causes  of pain such as a heart attack or a peptic ulcer can be similar.

Where Is Gallbladder Pain Felt? Gallbladder pain is usually felt in the upper right-hand side of the stomach (up under the ribs) and/or in your back between the shoulder blades or more to the right-hand side. 

How Long Does The Pain Last? Gallbladder attacks commonly last anywhere between 20 minutes and 1.5 hours, but can last as long as 5 to 6 hours. It often occurs at night, but can occur anytime of the day.

Does Gallbladder Pain Come And Go? For most people, gallbladder pain is strong and consistent within the first few minutes, but it can also come and go over time. Pain may resolve after an hour or so and return at a later date.

How Long Is Too Long For Gallbladder Pain? Gallbladder pain and symptoms that lasts for longer than six hours likely indicates the possibility of a gallbladder infection or other form of complication. It is essential to seek medical assistance immediately if the pain continues for more than a few hours.

Gallbladder Complications

While most gallstones will not cause serious complications, there are some serious complications associated with the formation and movement of gallstones in the gallbladder; these are:

• Inflammation. A gallstone that ends up stuck in the narrower top part of the gallbladder can cause the entire gallbladder to become swollen and inflamed, possibly an abscess, causing severe pain and fever.
• Infection. Gallstones that block the bile ducts result in bile duct infection accompanied by severe pain and the development of jaundice.
• Pancreatitis. Gallstones can cause a blockage in the pancreatic duct, resulting in inflammation of the pancreas (pancreatitis). Pancreatitis causes extreme and constant abdominal pain and almost always requires hospitalisation.
• Gallbladder Cancer. Although there is a minimal chance of developing gallbladder cancer, those with an ongoing history of gallstone issues do have an increased risk of this developing disease. Large polyps can become malignant.
• Gallstone ileus. Rarely, larger stones can erode into the bowel and cause a bowel obstruction, with pain and vomiting.

How Are Gallstones Diagnosed?

Most people with gallstones may not even realise they have them, presenting with few, if any, symptoms at all and may never need treatment. However, a GP will determine if treatment is necessary for those with obvious symptoms based on diagnostic testing results, including the following tests.

• Blood Tests. Blood tests may reveal the existence of gallbladder inflammation, infection, jaundice, and pancreatitis.
• Ultrasound.   This is the most common test . It can easily detect most gallstones, and can also assess the liver, kidneys, pancreas , spleen etc. 
• Computed Tomography (CT) Scan.  This may show up  some gallstones as well as revealing any complications including blockages in the gallbladder or bile ducts, and pancreatitis.
• Magnetic Resonance Imaging (MRI). Magnetic scanning procedure that provides detailed images of the gallbladder and surrounding organs. This is the best test to see if any stones have moved into the bile ducts.
• Endoscopic Retrograde Cholangiopancreatography (ERCP). Surgical procedure using a special gastroscope with sedation to diagnose and remove gallstones that have moved to the lower bile duct and are causing pancreatitis or bile duct obstruction and jaundice. 

How Are Gallstones Treated?

In most cases, gallstones only require treatment if you have ongoing symptoms. In fact, according to Health Navigator NZ, about 3 in 10 people who get a gallstone pain attack will not get another one. This is largely because the stone has dislodged on its own. Therefore treatment for milder cases usually only involves medicine for pain, nausea, and vomiting. 

If gallstone signs and symptoms occur often, surgical intervention is a the only form of treatment. Depending on the level of pain and/or the possibility of complications, you may be admitted to hospital for more effective treatment, such as:

Intravenous antibiotics. The introduction of fluids, pain medicine and/or antibiotics directly into the bloodstream.

Medications. Sometimes oral medication can be used to attempt to dissolve the gallstones. It only works for certain types of gallstones. However, this form of treatment may take many months (or years) to work and the likelihood of gallstones forming again is high. It is rarely used.

Some people have tried olive oil and lemon juice, but it doesn’t work.

Endoscopic Retrograde Cholangiopancreatography (ERCP). A minimally invasive surgical procedure often used to remove stones in the distal bile ducts.

Laparoscopic Cholecystectomy.  Keyhole surgery to remove the gallbladder. The gallbladder is not considered essential, and it is possible to remove it. This results in bile flowing directly into the small intestine from the liver instead of being stored. This type of surgery is the treatment of choice and usually considered if recurrent gallstone pain occurs or in an emergency situation involving severe complications. The surgery usually takes about an hour to perform. It is “keyhole surgery” 99 % of the time. There is one small incision in the umbilicus (tummy button), and three in the upper abdomen. 

Occasionally a small drain is needed for 12-24 hrs and is easily and painlessly removed.  Most people can go home the following morning, needing 1-2 weeks off work for full recovery.

Rare risks and  possible  complications will be discussed prior to any surgery.

Open Cholecystectomy.   Open surgery with a larger incision is only rarely needed if there is severe infection, or scarring, or a tumour. Recovery may be longer.

10 Things You Can Do To Avoid Gallstones

While it is impossible to completely eliminate the risk of developing gallstones, it is possible to live a healthy lifestyle and reduce the risk of them developing. Here are 10 things you can do today!

1. Eat healthy foods with plenty of fruit and vegetables
2. Don’t skip meals
3. Lose weight slowly (no more than approximately 0.5 to 1 kg per week)
4. Include more fibre-rich foods in your diet
5. Maintain a healthy weight
6. Increase physical activity
7. Keep hydrated
8. Limit consumption of caffeine and alcohol 
9. Avoid fatty foods and excess oils when cooking 
10. Check your medication (some medicines, postmenopausal hormone replacement therapy, for example, can increase the risk of gallbladder disease)

NB: If you have severe gallbladder pain or symptoms accompanied with a fever, constant nausea or vomiting, or jaundice (yellow eyes or skin), it is important to seek urgent medical attention at your nearest hospital. 

For more general information on gallstone symptoms and treatment options, get in touch with the team at the Gallstone Clinic at Christchurch Surgical Associates.