Biliary colic: gallstone pain symptoms, causes, diet and treatment

The NHS says gallstones are common and often do not cause symptoms, but if a gallstone blocks a bile duct it can cause tummy pain. The pain may feel severe, be constant, last longer than 30 minutes and up to several hours, be in the middle of your tummy or just under your ribs on the right side, and make you feel sick or vomit. This tummy pain is called biliary colic.

Despite the word colic, the NHS describes the pain as constant rather than coming in waves. The NHS says you may need treatment if gallstones are causing symptoms, because the gallstones are still there after an attack.

• Severe, constant pain in the middle of the tummy or under the right ribs.

• Pain lasting more than 30 minutes, up to several hours.

• Feeling sick or vomiting.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have pain in your tummy that lasts longer than 30 minutes. It says to call 999 or go to A&E if you have sudden, severe pain in your tummy, pain that spreads from your tummy to your back and you are being sick, a very high temperature or you feel hot, cold or shivery, or your skin or the whites of your eyes look yellow.

The NHS says not to drive to A&E: ask someone to drive you or call 999 and ask for an ambulance, and bring any medicines you take with you. Complications of gallstones are rare, but a blockage can cause inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis), or jaundice.

The gallbladder is a small organ in the top part of your tummy that helps you digest food, according to the NHS. Gallstones are small stones that form in the gallbladder and may be found in the gallbladder or the bile ducts, which are small tubes connecting the gallbladder to organs such as the liver and pancreas.

Biliary colic is the name for the pain when a gallstone blocks a bile duct. It is a symptom of gallstone disease rather than a separate illness, and the NHS says most people who have gallstones do not get symptoms.

The NHS says if gallstones are causing pain in your tummy you may need surgery to remove your gallbladder (cholecystectomy). You might not need treatment if gallstones are not causing symptoms, though you may need follow-up appointments in the future. You may need treatment if you have symptoms of gallstones, complications, or stones found in the common bile duct.

NICE guidance says to offer laparoscopic cholecystectomy (keyhole surgery) to people diagnosed with symptomatic gallbladder stones, and day-case laparoscopic cholecystectomy for planned procedures unless circumstances make an inpatient stay necessary. For stones in the common bile duct, it says to offer bile duct clearance and laparoscopic cholecystectomy, clearing the bile duct surgically at the time or with ERCP.

While waiting for surgery, the NHS says you may take painkillers such as paracetamol and ibuprofen, be offered stronger painkillers for severe pain if you need them, want to avoid foods that cause symptoms, and be advised to eat a low-fat diet.

The NHS says that while waiting for surgery you may want to avoid foods that cause symptoms and may be advised to eat a low-fat diet, and it points to dietary advice for patients with gallstones from Cambridge University Hospitals. NICE says to advise people to avoid food and drink that triggers their symptoms until they have their gallbladder or gallstones removed.

NICE also says that people should not need to avoid the food and drink that triggered symptoms after the gallbladder or gallstones have been removed, and to seek advice from their GP if eating or drinking triggers existing symptoms or causes new symptoms after recovery.

The NHS lists a diet that is high in fat and low in fibre, and losing weight quickly, among the things that can make gallstones more likely.

The NHS describes pain from gallstones as lasting longer than 30 minutes and up to several hours. Pain that lasts longer than 30 minutes is a reason to ask for an urgent GP appointment or call NHS 111, and pain with fever, yellow skin or eyes, or pain spreading to the back with sickness needs 999.

Attacks can come and go over time until the gallstones are dealt with. The NHS says the main treatment is surgery to remove the gallbladder, and that many people do not get symptoms at all.

Biliary colic happens when a gallstone blocks a bile duct. The NHS says you may be more likely to get gallstones if you are over 40, are a woman, are living with obesity, have a diet that is high in fat and low in fibre, have lost weight quickly (for example through weight loss surgery), or have a condition such as diabetes or Crohn's disease.

The NHS says gallstones are common and there are usually no symptoms, so you may not know you have them. If you do not have symptoms, they may be found by chance at a scan or X-ray for another health issue.

The NHS says that if you have symptoms of gallstones you may have an ultrasound scan and a blood test. NICE says to offer liver function tests and ultrasound to people with suspected gallstone disease.

NICE says to consider magnetic resonance cholangiopancreatography (MRCP) if ultrasound has not detected common bile duct stones but the bile duct is dilated or liver function tests are abnormal, and to consider endoscopic ultrasound if MRCP does not allow a diagnosis. It says to refer people for further investigations if conditions other than gallstone disease are suspected.

The sources used for this page do not give separate advice for pregnancy. The NHS gives the same urgent advice to anyone: ask for an urgent GP appointment or get help from NHS 111 if tummy pain lasts longer than 30 minutes, and call 999 or go to A&E for the severe symptoms listed above.

If you are pregnant and have severe or persistent upper tummy pain, tell your midwife or GP promptly so the cause can be assessed in the context of your pregnancy.

On the NHS, gallstone pain is assessed through the GP, with ultrasound and blood tests and, if needed, referral to a general or upper gastrointestinal surgeon for gallbladder removal. NICE says planned laparoscopic cholecystectomy is usually done as a day case where possible.

Private surgeons also offer gallbladder removal. Whichever route you use, ask who will manage your care if you have an attack while waiting, and how complications such as jaundice or fever would be handled.