If you have severe pain in the center or the upper right portion of your abdomen, you may have gallstones. Gallstone pain can occur at any time, but it's most common after eating fatty or greasy foods. Most gallstones are minor and do not call for medical attention. However, gallstones occasionally require treatment, so it's important to consult your doctor about your abdominal pain. Treatment for gallstones is often very effective and can help control or resolve your symptoms.

What Are Gallstones?

Gallstones develop in your gallbladder when substances in your bile harden into stone-like objects. Gallstones can vary in size, but most are small and don't cause any symptoms.

Here are some terms that are often used when discussing gallstones:

  • Gallbladder: The gallbladder is an organ that lies under your liver on the right-hand side of your upper abdomen. It stores bile and releases it into your small intestine via tiny tubes called bile ducts when you eat.
  • Bile: Bile is a fluid that's made in your liver and stored in the gallbladder. It contains various substances, including a fat called cholesterol, and helps break down the food you eat.
  • Bile duct: Bile ducts are small tubes that allow bile to flow from your liver and gallbladder through your pancreas to your small intestine.

Stages and Types of Gallstones

There are two main types of gallstones:

  • Cholesterol gallstones: These gallstones develop when there's too much cholesterol in your bile. Cholesterol is a waxy substance made naturally by the liver which is also in certain foods. Your body needs some cholesterol to make bile, but too much cholesterol can cause gallstones. Cholesterol gallstones are the most common type of gallstones.
  • Pigment gallstones (or bilirubin gallstones): These gallstones develop when there's too much bilirubin in your bile. Bilirubin is a chemical that's made when your body breaks down red blood cells.

There are three stages of gallstones.

  1. Formation of gallstones: At this stage, the gallstones do not typically cause pain or other symptoms.
  2. Occasional gallbladder pain: At this stage, patients feel infrequent pain and discomfort in the form of symptoms described below.
  3. Gallbladder attack: This is a severe condition that occurs when a gallstone blocks the bile duct. It causes acute pain, and often fever and will require emergency medical attention. See more details of the symptoms in the next section.

Symptoms and Causes

Most gallstones only cause symptoms when they lodge in a bile duct and create a blockage. When symptoms do occur, they can include the following:

  • Sudden and severe abdominal pain, nausea, and diarrhea.
  • Pain under the ribs on your right-hand side.
  • Pain between your shoulder blades.
  • Pain in your right shoulder.
  • Indigestion and belching.

Gallstone pain is constant and may last several minutes to a few hours. It may occur at any time of the day or night, but it is most common after eating fatty or greasy foods. 

Severe symptoms of a “gallbladder attack” that require immediate medical attention include the following:

  • Sudden and severe abdominal pain that lasts longer than eight hours.
  • Yellowing of your skin and the whites of your eyes.
  • Rapid heartbeat.
  • Fever with chills.

These symptoms can indicate a severe gallstone complication, which can be life-threatening if left untreated.

Gallstones develop as a result of an imbalance of chemicals in the gallbladder bile, namely cholesterol and the waste product bilirubin. Research is yet to reveal the cause of this imbalance.

Prevention and Risks

Several factors can increase your risk of developing gallstones, including the following:

  • Being female.
  • Being overweight or obese.
  • Being age 60 or older.
  • Losing weight very quickly.
  • Eating an unhealthy diet.
  • Having a history of previous gallstones.
  • Having a medical condition that's known to increase your risk of gallstones, such as high cholesterol or cirrhosis.
  • Taking medication that contains estrogen, such as hormone replacement therapy (HRT).

There is no way to prevent gallstones for sure, but if you're at risk of developing gallstones, take these steps to help lower your risk:

  • Eat healthy, balanced meals at regular intervals.
  • Avoid foods with a high content of saturated fat.
  • Maintain a healthy weight.
  • Lose weight slowly if you're overweight or obese. Be sure to avoid “crash diets” with low caloric intake.

Diagnosis and Tests

Your doctor may suspect gallstones after asking you about your symptoms and medical history and performing a physical exam. He may then recommend tests or procedures to confirm or rule out gallstones.

Below are some tests and procedures for diagnosing gallstones.

  • Blood tests: Blood tests can help diagnose a gallbladder infection. They can also help your doctor determine whether your liver is working properly. An abnormal liver function test result may suggest you have gallstones in your bile duct. If blood tests indicate you may have gallstones, your doctor may refer you for one or more imaging tests or procedures.
  • Computerized tomography (CT) scan: A CT scan uses a series of X-rays taken from many different angles to produce images of your gallbladder.
  • Abdominal ultrasound: An abdominal ultrasound uses sound waves to create pictures of your gallbladder.
  • Magnetic resonance imaging (MRI) scan: An MRI scan uses magnetic fields and radio waves to produce images of your gallbladder.
  • Endoscopic retrograde cholangiopancreatography (ERCP): An ERCP uses an instrument called an endoscope — a small camera at the end of a long, flexible tube — which is inserted down the throat and through the stomach to the bile duct. If your doctor finds gallstones during the procedure, she may remove them at the same time.

Treatment, Procedures, and Medication

If you suspect you have gallstones, consult your family doctor. Your doctor may perform a physical exam and order tests and procedures to find out whether you have gallstones.

If you do have gallstones, your doctor may provide you with diet and lifestyle advice and possibly prescribe medications to help your gallstones, or they may refer you to a gastroenterologist for further examination.

A gastroenterologist is a doctor who specializes in the digestive system. They can carry out a range of tests and procedures to investigate your gallstones. A gastroenterologist can also prescribe medications that might help your gallstones or, if necessary, refer you to an abdominal surgeon.

Treatment for gallstones depends on the type and size of your gallstones and your symptoms, including:

  • Pain relievers: Your doctor may recommend painkillers, such as acetaminophen, to help relieve your gallstone pain.
  • Diet changes: Your doctor may suggest you keep a food diary to help identify any foods or drinks that make your symptoms worse. If you have any trigger foods or drinks, you may be advised to eliminate them from your diet.
  • Medications: Your doctor may prescribe a drug, such as ursodeoxycholic acid tablets, to dissolve your gallstones.
  • Gallstone removal: Your doctor may diagnose and remove your gallstones during an endoscopic procedure (ERCP).
  • Gallbladder removal: Depending on the severity of your gallstone issues, your doctor may suggest you have your gallbladder surgically removed in a procedure called cholecystectomy. Most of the time this can be a minimally invasive keyhole surgery, although it could require open surgery in some cases. The gallbladder is a non-vital organ, like the appendix, so its removal won't affect your ability to digest food or live a full and healthy life.

Healthy Lifestyle Tips

Maintaining a healthy weight can help relieve your gallstone symptoms and may reduce your chances of developing new gallstones. Getting regular exercise is a good way to help you do this. Try aiming for two and a half hours of exercise per week, or 30 minutes for five days a week.

Eating a healthy, balanced diet can also help you prevent or manage gallstones. Research suggests the tips below can contribute to reducing your risk of developing gallstones or suffering gallbladder attacks.

  • Eat small, frequent meals throughout the day.
  • Try not to eat too much fat in one sitting.
  • Choose low-fat dairy foods and lean meats.
  • Eat at least five portions of fruit and vegetables every day.
  • Eat nuts and whole grains.
  • Avoid low-calorie, fast weight-loss “crash” diets.

Conclusion

Gallstones can be very painful, but treatment can help you feel better. If you suspect you may have gallstones, you should consult your family doctor. Your doctor can investigate your symptoms and help you find relief from your pain.