Gallstones symptoms and causes explained

Gallstones are a fairly common condition that affects an estimated one in 10 adults in the UK. While many people are thought to have gallstones, a much smaller number develop symptoms or need treatment. 

What are gallstones?

Gallstones form in the gallbladder, which is a small organ on the right side of your abdomen, located just below your liver. The gallbladder is part of your digestive system, holding a fluid called bile, which gets released into your small intestine to help break down fats. 

When the bile reacts with fatty substances, it hardens to create small stones in the gallbladder. These stones can be tiny, no bigger than a grain of sand, or as large as a golf ball. You can develop just one gallstone or several. 

In many cases, gallstones cause no problems at all, which is why people aren’t aware that they have them. However, when symptoms do occur, gallbladder removal surgery is usually needed. 

What are the symptoms of gallstones?

If gallstones do cause symptoms, you may experience pain and discomfort. This usually happens if a gallstone gets stuck in a duct and causes a blockage — this is called biliary colic, and the pain is sudden and severe.

Biliary colic

Biliary colic causes sudden and intense pain due to gallstones blocking bile ducts in the gallbladder. Typically, it lasts between one and five hours, although sometimes it can be experienced for just a few minutes.

When this happens, the pain can be felt in the centre of your abdomen, as well as on your right-hand side just below the ribs. You may find that the pain spreads from under your ribs to your shoulder blade or side. In some cases, the pain can cause you to be sick or to sweat a lot.

Once this pain starts, it is constant and can’t be relieved by vomiting, going to the toilet or passing gas. However, once the pain has passed, it can be quite some time, weeks or even months, until you have another episode of biliary colic or you may not ever experience it again.

If you think that you have experienced biliary colic or you’re having regular episodes, you should make an appointment with your GP to discuss your symptoms.

Other gallstones symptoms

Gallstones can sometimes cause symptoms aside from pain and discomfort. This may happen if they block a bile duct for a longer period of time or if they move into other organs, such as the small intestine or pancreas.

In these cases, symptoms can include:

• Chills or extreme shivering
• Confusion or a high temperature of 38°C or above
• Diarrhoea, vomiting or loss of appetite
• Itchy skin or yellowing of the whites of the eyes and skin (jaundice)
• Persistent abdominal pain
• Rapid heartbeat

Experiencing these symptoms is known as gallstone disease or cholelithiasis. If you experience these symptoms or your abdominal pain from biliary colic lasts over eight hours, you should contact your GP immediately.

What causes gallstones?

It isn’t entirely clear what causes gallstones to form, however, doctors think there could be a few different causes.

Too much cholesterol in your bile

Bile should be able to effectively dissolve the cholesterol that is excreted by your liver. However, if your liver excretes too much cholesterol, the bile in your gallbladder can’t effectively dissolve it. As a result, the excess cholesterol may become solid, forming crystals that can eventually turn into stones.

This type of gallstone is the most common, making up around 80% of all gallstones.

Too much bilirubin in your bile

When your body breaks down red blood cells it produces a chemical called bilirubin. In some cases, your liver can make too much bilirubin, which enters the bile in your gallbladder. This can be a result of liver cirrhosis, biliary tract infections and some blood disorders. Having too much of this chemical in your bile can cause gallstones to form.

Your gallbladder doesn’t empty properly

If your gallbladder cannot empty correctly or cannot empty enough, the bile in it may become more concentrated. This can then contribute to gallstone formation.

How do you prevent gallstones?

Several different factors can put you at risk of gallstones, including:

• A family history of gallstones
• Being female or overweight 
• Eating a high-fat, high-cholesterol or low-fibre diet
• Having certain blood disorders, diabetes or liver disease
• Losing a lot of weight in a short space of time
• Pregnancy or taking medications that contain oestrogen

While some of these risk factors are unavoidable, there are steps you can take to reduce your risk of gallstones, especially if you’re at high risk.

To start, avoid skipping meals or fasting, as this can increase your chances of gallstones. Aim to stick to a routine with your meals and avoid regularly skipping them.

Your meals should also contain low-cholesterol foods. Eat healthy fats rather than saturated fats and balance your diet with plenty of fibre, such as vegetables, whole grains and fruits. 

Eating healthier is a good way to regulate your weight, which is also important for gallstone prevention. If you’re overweight, reducing your calorie intake and increasing your daily activity levels can help you lose weight in a healthy way. You should avoid crash diets or losing weight too quickly as not only is this not healthy for your body, it can also put you at risk of gallstones. 

Once you have reached a healthy weight, continuing with your healthy diet and exercise can help you maintain it and keep your chances of developing gallstones down.