What Are Gallstones?
Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have gallstones, you might hear your doctor say you have cholelithiasis.
Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries cholesterol and wastes such as bilirubin (which your body makes when it breaks down red blood cells) out of the liver. These things can form gallstones when they’re out of balance.
Gallstones can range in size from a grain of sand to a golf ball. You can have one large stone or hundreds of little ones. Some people get a mix of big and small stones. You might not know that you have them until one or more block a bile duct, causing pain.
Are gallstones dangerous?
Most gallstones don’t hurt or cause health problems. These “silent gallstones” typically don’t need treatment. But you should get medical help right away if you have sudden and severe pain that lasts for hours. This can be a sign that gallstones are stuck in your bile duct, which can be life-threatening.
Gallstone Types
The two main kinds of gallstones are:
- Cholesterol stones. These are usually yellow-green because they’re mostly made of undissolved cholesterol. But they can have other stuff in them, such as bilirubin or bile salts. They're the most common, making up about 80% of gallstones.
- Pigment stones. These are brown or black stones made mostly of bilirubin. People who get them usually have liver disease or a blood disorder such as sickle cell anemia or leukemia.
Some people have a mix of cholesterol and pigment stones.
Gallstone Symptoms
You can have gallstones and not know it. Symptoms typically happen only when one or more gallstones get stuck and block the flow of bile from your gallbladder to your small intestine (where your food goes right after it leaves your stomach). This is called a gallbladder attack or biliary colic.
Some symptoms of gallstones include:
- Pain in the upper right side of your belly just under your ribs
- Pain in your lower chest, right shoulder, or back
- An upset stomach
- Nausea or vomiting
- Other digestive problems, including indigestion, heartburn, and gas
Gallstones may pass on their own. But in some cases, you might need immediate medical care.
See your doctor or go to the hospital if:
- Your belly pain lasts more than 2 hours or is severe.
- You have a fever along with chills.
- Your skin or eyes look yellow.
Not getting treatment quickly could lead to complications such as infection and inflammation. It’s important to talk to your doctor because a gallbladder attack can be similar to other health conditions that also need treatment, such as appendicitis, ulcers, pancreatitis, or more serious medical issues.
Gallstone pain
Your gallbladder can spasm when gallstones clog your bile ducts. You may feel a sharp cutting or stabbing pain when this happens. Your belly may hurt so bad that you have trouble catching your breath. Some people think they’re having a heart attack.
Gallstone pain may also:
- Start shortly after you eat
- Wake you from sleep
- Last 15 minutes to several hours
- Come and go over weeks, months, or even years
Once a gallbladder attack starts, there’s nothing you can do to stop it. But gallstone pain usually goes away if the gallstone moves through the bile duct on its own.
Can gallstones make you tired and dizzy?
If gallstones get stuck in your bile duct and cause gallbladder spasms, your heart rate may speed up and your blood pressure may drop quickly, causing dizziness. You may feel tired if they get stuck for hours (or longer), causing inflammation or an infection that makes you sick.
What Causes Gallstones?
Doctors aren’t sure exactly what causes gallstones, but they might happen when:
- There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might build up and form stones.
- There’s too much bilirubin in your bile. Conditions such as liver disease, infections, and blood disorders can cause your liver to make too much bilirubin.
- Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.
Gallstones without gallbladder
You’re less likely to get gallstones if you have your gallbladder removed. But even after you have surgery to remove your gallbladder, gallstones can form in your pancreatic ducts or directly in the common bile duct (the tube that goes from your liver to your small intestine).
Gallstone Risk Factors
You're more likely to get gallstones if you:
- Have a family history of them
- Are a woman or assigned female at birth
- Are over age 40
- Are of Native American or Mexican descent
- Have obesity
- Have a diet high in fat and cholesterol but low in fiber
- Don’t get much exercise
- Use estrogen-based birth control or hormone replacement therapy
- Add estrogen to your body with feminizing hormone therapy
- Have diabetes
- Have an intestinal disease such as Crohn’s
- Have hemolytic anemia or cirrhosis of the liver
- Take medicine to lower your cholesterol
- Lose a lot of weight in a short time (like from weight loss surgery)
- Fast on a regular basis
Gallstones in pregnancy
During pregnancy, your body makes extra hormones called estrogen and progesterone. Extra estrogen can raise your cholesterol levels, and progesterone can slow gallbladder emptying. It’s not very common to have symptoms of gallstones during pregnancy, and it rarely causes serious problems.
Gallstone Diagnosis
Your doctor will do a physical exam and might order tests including:
- Blood tests. These check for signs of infection or blockage and rule out other conditions.
- Abdominal ultrasound. This makes images of the inside of your body. The pictures can show gallstones outside of the bile duct or signs of gallbladder inflammation.
- CT scan. Specialized X-rays let your doctor see inside your body, including your gallbladder.
- Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio waves to make pictures of the inside of your body, including your liver and gallbladder.
- Cholescintigraphy (HIDA scan). This test can check if your gallbladder is working well. Your doctor injects a harmless radioactive material that makes its way to the gallbladder. A technician can then watch its movement. This test can help distinguish between cholecystitis (inflammation of the gallbladder) and gallstones.
- Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope.
- Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones that may be in places that are hard to see with other imaging tests, such as in the common bile duct as it passes through your pancreas.
What do gallstones look like in the toilet?
They usually look like yellowish or brownish crystals in your poop. They can be of different shapes or sizes. If they’re small enough to pass through your gallbladder and gut, you may not be able to see them in your stool.
Can You Pass Gallstones?
Small gallstones usually pass into your small intestines and out with your stool on their own. You may not ever need to do anything about these stones if they don’t cause any symptoms, even if they keep coming back. But you’ll need medical treatment if your gallstones cause pain and block your bile ducts.
If you have sickle cell or another blood disorder, your doctor may consider removing your gallbladder as a precaution, even if you don't have symptoms.
Gallstone Treatment
You usually don’t need treatment if you don’t have symptoms, as some small gallstones can pass through your body on their own. But there are ways to reduce the chances of gallbladder complications or to treat a gallbladder attack.
Gallstone removal
Most people who get gallstones that block their bile ducts and cause symptoms have their gallbladders taken out. Your body can function fine without a gallbladder as your liver can make bile.
Your doctor will use one of two procedures to remove your gallbladder:
- Laparoscopic cholecystectomy. This is the most common surgery for gallstones. The surgeon works through tiny cuts (incisions). They pass a narrow tube called a laparoscope into your belly through a small cut. The tube contains a tiny light and a camera. The doctor will take out your gallbladder through another small cut using special devices. You’ll usually go home the same day.
- Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward. You’ll need open surgery if you have a bleeding disorder. You may also need it if you have severe gallbladder disease, have a bigger body size, or are in your last trimester of pregnancy.
For both types of surgery, you’ll get general anesthesia. This means you won’t be awake during the procedure.
If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.
Gallstone treatment without surgery
You may not be able to have your gallbladder removed if you have any medical condition that makes surgery unsafe. In those special cases, you may need regular or lifelong treatment to remove or break up gallstones.
Nonsurgical treatment options for gallstones include:
- Endoscopic retrograde cholangiopancreatography (ECRP): Your doctor may use this procedure to remove gallstones stuck in your bile ducts.
- Medication. Chenodiol (Chenix) and ursodiol (Actigal) contain chemicals that dissolve small cholesterol gallstones. You may need to take these pills for years to break up the stones, and your gallstones may come back after you stop treatment. This drug treatment may cause mild diarrhea.
- Shock wave lithotripsy: Rarely, your doctor may use shock waves to break up your stones. They may suggest doing this alongside drug treatment with something such as ursodiol.
Gallstone Complications
Gallstones can cause serious problems, including:
- Gallbladder inflammation (acute cholecystitis). This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst if you don’t get treatment right away.
- Blocked bile ducts. This can cause fever, chills, and the yellowing of your skin and eyes (jaundice). If a stone blocks the duct leading to your pancreas, that organ may become inflamed (pancreatitis).
- Blocked pancreatic ducts. If gallstones block your pancreatic duct, it can cause pancreatitis, which is swelling and inflammation of your pancreas.
- Infected bile ducts (acute cholangitis). A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis.
- Gallbladder cancer. It’s rare, but gallstones raise your risk of this kind of cancer.
Gallstone surgery side effects
You can live and digest food without a gallbladder, and most people feel fine when they have it removed. But there’s a chance you could notice some side effects afterward. Most are mild and get better over time.
Side effects of gallbladder surgery include:
- Loose or more frequent stools
- Gas
- Bloating
- Change in bowel habits
You’re unlikely to have serious problems after gallbladder surgery, but all medical procedures come with risks. The most common one with this treatment is bile duct injury, which can lead to an infection. You may need another surgery to fix your bile duct if this happens to you.
How to Prevent Gallstones
Genes play a role in who gets gallstones, and you might not be able to prevent them. But some lifestyle changes might help lower your risk, such as:
- Eat a nutritious diet with plenty of fiber from vegetables and whole grains, along with unsaturated fats from nuts, olive oil, and fish.
- Limit or avoid highly processed foods, sugary foods and drinks, and saturated and trans fats.
- Get regular exercise. Aim for at least 30 minutes per day, 5 days a week.
- If you’re overweight or have obesity, talk to your doctor about how to get to a healthy weight.
- Although obesity is a risk factor, avoid diets that make you lose a lot of weight in a short time. Talk to your doctor about your risk of gallstones if you get weight loss surgery.
- If you’re a woman or someone assigned female at birth who’s at a high risk of gallstones (for example, because of your family history, obesity, or another health condition), talk to your doctor about whether you should be cautious about using hormonal birth control or hormone replacement therapy.
Gallstones diet
There isn’t one food that’ll prevent gallstones, but you may be less likely to get them if you:
- Eat frequently. Your gallbladder stores bile from your liver, but it empties when you eat. Doing this regularly may prevent the formation of gallstones in people who are prone to developing them.
- Fill up on plant foods. Fiber can help flush excess cholesterol out of your body. High-fiber foods include fruits, vegetables, beans, and whole grains such as brown rice, oatmeal, and whole-wheat bread.
- Choose unsaturated and omega-3 fats. People who eat more monounsaturated and polyunsaturated fats (olive oil, canola oil, nuts) and omega-3 fatty acids (flaxseed, fish, and fish oil) are less likely to get gallstones.
- Limit fast food and red meat. Both are high in saturated fat. This kind of fat can raise your low-density lipoprotein (LDL) cholesterol, which may raise your risk of gallstones.
- Cut back on refined carbs. Foods such as white rice, white bread, and white tortillas are usually low in fiber and other nutrients.
- Limit sugar. People who eat a lot of sweet foods and drinks are more likely to get gallstones. This might happen because sugar raises your blood sugar and causes your liver to release more bile into your gallbladder.
