Gallstones: 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, they can cause tummy pain called biliary colic. NHS inform says the pain usually lasts between 1 and 5 hours, although it can sometimes last just a few minutes.

NHS inform adds that the pain is constant and is not relieved when you go to the toilet, pass wind or are sick. It is sometimes triggered by eating fatty foods, but may occur at any time of day and may wake you at night. Biliary colic does not happen often; after an episode it may be several weeks or months before another.

• Severe, constant tummy pain.

• Pain that lasts longer than 30 minutes, and up to several hours.

• Pain in the middle of your tummy, or just under your ribs on the right side. NHS inform says it may spread to your side or shoulder blade.

• Feeling sick or vomiting. Some people also sweat excessively.

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.

The NHS says to call 999 or go to A&E if you have any of the following, and not to drive yourself to A&E.

• 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.

• Your skin or the white part of your eyes looks yellow.

NHS inform explains that the gallbladder is a small, pouch-like organ underneath the liver that stores and concentrates bile, a liquid produced by the liver to help digest fats. Gallstones are thought to develop because of an imbalance in the chemical make-up of bile. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones. About 4 in every 5 gallstones are made up of cholesterol and about 1 in 5 are made up of bilirubin.

The stones can be as small as a grain of sand or as large as a pebble. Sometimes only one forms but there are often several. The NHS says gallstones may be found in the gallbladder or in the bile ducts.

While you wait for surgery, the NHS says you may want to avoid foods that cause symptoms and may be advised to eat a low-fat diet. NICE advises people to avoid food and drink that triggers their symptoms until they have their gallbladder or gallstones removed, and says that after removal they should not need to avoid those foods. If eating or drinking triggers symptoms after recovery, NICE advises seeking advice from your GP.

NHS inform says some people may experience bloating and diarrhoea after eating fatty or spicy food after gallbladder removal, and that if certain foods trigger symptoms you may wish to avoid them.

On preventing gallstones, NHS inform says that from the limited evidence available, changes to your diet and losing weight (if you are overweight) may help. It advises avoiding too many foods high in saturated fat, such as meat pies, sausages and fatty cuts of meat, butter, ghee and lard, cream, hard cheeses, cakes and biscuits, and foods containing coconut or palm oil. It recommends a healthy, balanced diet with at least 5 portions of fruit and vegetables a day and wholegrains, and says there is evidence that regularly eating nuts can help reduce the risk. It says to avoid low-calorie, rapid-weight-loss diets, because they may disrupt bile chemistry and increase the risk.

The NHS says you might not need any treatment if gallstones are not causing symptoms, although you may need follow-up appointments to check they are not getting worse. You may need treatment if you have symptoms, complications, or gallstones in the common bile duct. NICE says to reassure people with asymptomatic gallbladder stones that they do not need treatment unless symptoms develop.

The main treatment is surgery to remove the gallbladder (cholecystectomy). NICE says to offer laparoscopic (keyhole) cholecystectomy to people with symptomatic gallbladder stones, and day-case surgery for planned procedures unless circumstances make an inpatient stay necessary.

The NHS says you may be more likely to get gallstones if the following apply to you. NHS inform adds more risk factors and notes it is still unclear exactly what leads to the imbalance in bile.

• You are over 40 years old, and NHS inform says the older you are the more likely.

• You are a woman, particularly if you have had children, are taking the combined pill or are having high-dose oestrogen therapy.

• You are living with obesity or overweight.

• You have a diet that is high in fat and low in fibre.

• You have lost weight quickly, for example through dieting or weight loss surgery.

• You have a condition such as diabetes or Crohn's disease; NHS inform also lists cirrhosis, primary sclerosing cholangitis, obstetric cholestasis, IBS and a close family member with gallstones.

The NHS says that if you do not have symptoms, gallstones may be found by chance at a scan or X-ray for another health issue. If you have symptoms 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.

NHS inform says a GP may do the Murphy's sign test to help determine whether the gallbladder is inflamed. If gallstones may have passed into the bile duct, you may need an MRI scan or a cholangiography. NICE says to consider MRCP if ultrasound has not detected common bile duct stones but the bile duct is dilated or liver function tests are abnormal. NHS inform says a CT scan may be done in an emergency to look for complications such as acute pancreatitis.

NHS inform lists being female, particularly if you have had children, among the risk factors. It says that keyhole gallbladder surgery may not always be recommended in the third trimester (the last three months) of pregnancy, in which case an open cholecystectomy may be recommended. It also says ursodeoxycholic acid tablets are not usually recommended for pregnant or breastfeeding women.

If you are pregnant and have severe tummy pain, a fever or yellowing of the skin, get urgent medical advice. Tell any clinician that you are pregnant so that tests and treatment can be chosen accordingly.

The NHS says complications of gallstones are rare, but sometimes gallstones can cause a blockage that leads to serious complications such as inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis), or jaundice, which can cause yellow skin or eyes, itchy skin, darker pee and paler poo than usual. Treatment for complications is usually pain relief and surgery to remove the gallbladder.

NHS inform describes the rare but serious complications in more detail: infection of the bile ducts (acute cholangitis), gallstone ileus (a gallstone obstructing the bowel) and, rarely, gallbladder cancer. It says that people with a history of gallstones have a less than 1 in 10,000 chance of developing gallbladder cancer. NHS inform says to contact your GP immediately if you develop jaundice, abdominal pain lasting longer than 8 hours, a high temperature and chills, or pain so intense that you cannot find a position to relieve it.

On the NHS, gallstones are diagnosed with blood tests and an ultrasound arranged by your GP, with referral to a general surgery team if you have symptoms. NICE says early laparoscopic cholecystectomy within 1 week of diagnosis should be offered to people with acute cholecystitis.

Some people choose a private surgeon for a quicker date for a planned operation. Whichever route you take, you can ask about the type of operation, the expected recovery and who to contact if problems arise after discharge, and your GP should be kept informed.