Introduction
Gallstones affect roughly one in ten Indian adults and are particularly common in women over 30. Many people carry them silently for decades. The trouble starts when a stone briefly blocks the gallbladder's outlet - and a single attack of biliary colic is something patients rarely forget.
Most patients describe gallstone pain as a tight, gripping ache in the upper right abdomen, often after a fatty or rich meal, sometimes radiating to the right shoulder blade. It can last minutes to hours, peaks then slowly settles, and often comes with nausea.
This guide explains what gallstone symptoms feel like, what they mean, and where the line is between 'manageable for now' and 'time to see a surgeon'.
What are gallstones?
The gallbladder is a small pear-shaped sac under the liver that stores bile - the digestive juice your liver makes to help break down fats. When the chemical balance in bile shifts, tiny crystals form, and over months or years these grow into stones.
Most gallstones are made of cholesterol. Some are pigment stones, more common in patients with certain blood disorders. Stones can range from a few millimetres to over a centimetre across, and patients can have anything from one to dozens.
Stones cause symptoms when they intermittently block the gallbladder's outlet (biliary colic), block it for longer (acute cholecystitis), pass into the main bile duct (jaundice), or block the pancreatic duct (gallstone pancreatitis). Each of these escalates in severity and the safe long-term answer is to remove the gallbladder.
Symptoms & when to seek help
- Right upper abdominal pain, often after fatty meals - the classic biliary colic
- Pain that wraps around to the back or right shoulder blade
- Episodes lasting 30 minutes to several hours
- Nausea or vomiting with the pain
- Bloating, indigestion or intolerance to fatty food
- Yellowish discolouration of the eyes or skin (jaundice) - urgent
- Fever with abdominal pain - urgent (acute cholecystitis)
Causes & risk factors
- Female sex, especially after pregnancy
- Age over 30
- Family history of gallstones
- Obesity and rapid weight loss
- High-cholesterol or low-fibre diet
- Diabetes and metabolic syndrome
- Certain medications, including some hormonal contraceptives
How it is diagnosed
- Outpatient consultation and physical examination
- Abdominal ultrasound - the single most useful test, picks up over 95% of stones
- Liver function tests to check for bile duct involvement
- CT or MRCP for stones suspected in the bile duct
- ECG and pre-anaesthetic check before surgery is planned
Treatment options
- Asymptomatic stones found incidentally are usually watched, not operated
- Symptomatic stones - even one episode - are an indication for surgery
- Laparoscopic cholecystectomy: 4 small incisions, 45 to 60 minute operation, day-care or 24-hour stay
- Stones in the bile duct are removed first by ERCP, then the gallbladder is removed laparoscopically
- Acute cholecystitis is best operated within the first week of symptoms
- Open surgery is rarely needed today - usually only for very inflamed or unusual cases
Recovery & aftercare
- Day 0: walk around the room, sips of water within hours
- Day 1: discharge home, normal soft diet
- Day 2 to 5: mild soreness, paracetamol-based painkillers
- Day 5 to 7: most patients back to office work and driving
- Week 2: full normal diet and activity
- Long term: no special diet - most patients eat exactly as before
Risks of delaying care
- Acute cholecystitis - severe gallbladder infection requiring emergency hospitalisation
- Stones can pass into the main bile duct, causing jaundice and cholangitis
- Gallstone pancreatitis - a potentially life-threatening inflammation of the pancreas
- Chronic gallbladder inflammation can rarely lead to gallbladder cancer over decades
- Repeated attacks make eventual surgery harder and longer
Frequently asked questions
Reviewed by
Dr. Sanjay Yadagiri
Consultant - Minimal Access Surgery & Surgical Oncology
Over three decades of surgical experience. UK-trained, France-certified in laparoscopic and colorectal surgery, with a long association with the Indo-American Cancer Institute and Omega Hospitals, Hyderabad.
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