Ask the expert: what are gallstones?

Gallstones form in the gallbladder, which is a pear-sized sac that sits below the liver. It’s connected to the main bile duct, which drains the liver. The gallbladder stores bile, which breaks down fats from food and drink. If there is an imbalance in the substances that make up the bile in your gallbladder — especially cholesterol — it can cause gallstones to form. You may develop one large gallstone or multiple, smaller gallstones. 

Who is at risk of gallstones?

Gallstones are very common. It’s thought that one in 10 adults in the UK has gallstones, but they don’t always cause symptoms. 

You’re more at risk of developing gallstones if you are:

• Female
• Overweight
• Over the age of 40

What are the symptoms of gallstones?

Often, people don’t realise they have gallstones because they don’t develop symptoms. However, sometimes gallstones can cause abdominal pain called biliary colic. This pain occurs in the upper abdomen, usually on the right-hand side. This pain is usually sudden and intense, lasting one to five hours. It’s caused by a gallstone becoming trapped in a duct inside the gallbladder. 

Biliary colic is often brought on by eating rich or fatty foods, which causes the gallbladder to squeeze against a gallstone. However, you may only experience the pain once the gallstone passes out via a duct in your gallbladder. 

If you experience regular gallstone pain, you should make an appointment to see your GP. 

Can gallstones cause other complications or conditions?

Sometimes, gallstones can cause more serious problems. If a gallstone gets stuck in a duct inside the gallbladder and blocks it, this can cause severe inflammation called cholecystitis. Symptoms include:

• Abdominal pain — symptoms are similar to biliary colic
• Continuous pain
• Fever
• Jaundice — yellowing of your skin or whites of your eyes
• Vomiting

If the pain caused by your gallstone lasts longer than eight hours, contact your GP. 

If you have small gallstones, these can work their way out of your gallbladder and block the main bile duct. This stops bile from draining from the liver. As bile builds up in your body, it causes jaundice. 

A gallstone passing into the bile duct can also cause pancreatitis (inflammation of the pancreas). While most cases of pancreatitis improve in a few days, this can be a very serious condition that needs medical attention to avoid life-threatening complications. 

Pancreatitis symptoms include:

• A fast heartbeat
• Diarrhoea
• Fever
• Indigestion
• Tenderness or swelling of the stomach
• Vomiting

If you experience these symptoms, speak to your GP immediately.

How are gallstones treated?

If you have gallstones that are causing repeated severe symptoms, the usual course of treatment is to have surgery to remove your gallbladder. In most cases, gallbladder removal (cholecystectomy) is done via keyhole surgery. This usually takes 30-45 minutes and most people can go home on the same day. 

Although much less common, open surgery is sometimes needed eg if you’ve experienced a lot of complications as a result of your gallstones.

How can you avoid gallstones?

Although gallstones are common, there are ways you can reduce your chances of developing them.

As cholesterol is linked to the formation of gallstones, maintaining a healthy diet that avoids foods high in saturated fats can help reduce your risk of gallstones. This means avoiding foods such as butter, ghee, cream, fatty cuts of meat, hard cheese, cakes, biscuits and food containing coconut or palm oil. 

A balanced diet that includes lots of fresh fruit and vegetables, whole grains and nuts can also reduce your risk of gallstones, as well as several other conditions.