Gallstones: symptoms, when to wait and when surgery helps

In short

• Most gallstones cause no symptoms, and stones without symptoms usually need no treatment.
• A gallbladder attack is pain in the upper right abdomen that can last for several hours.
• Pain with fever, chills or yellow skin is an emergency, not something to wait out.
• Surgery to remove the gallbladder is the usual treatment when stones cause symptoms.
• You can live normally without a gallbladder.

What gallstones are

Gallstones are hard, pebble-like pieces, usually made of cholesterol or bilirubin, that form in the gallbladder, the small organ under the liver that stores bile. Stones can form when bile contains too much cholesterol or bilirubin or too few bile salts, or when the gallbladder does not empty often enough. Researchers do not fully understand why this happens. Stones that do not block a bile duct usually cause no symptoms.

They are more common in older adults, in women and in people with overweight or obesity, and some groups, including Native American and Mexican American people, are affected more often. Eating a diet high in fat and low in fiber, diabetes and Crohn's disease also raise the risk, and so does losing weight very quickly.

What a gallbladder attack feels like

When a stone blocks a bile duct, bile builds up in the gallbladder and causes a gallbladder attack, also called biliary colic.

• Severe, often constant pain in the upper right abdomen or the middle of the abdomen under the ribs.
• Pain that can spread toward the back.
• Attacks that often follow heavy meals and tend to happen in the evening or overnight.
• Pain lasting from about 30 minutes to several hours, then easing.
• Nausea or vomiting.
• More attacks are likely after the first one.

A doctor starts with your history and a physical exam. Blood tests can show signs of infection or inflammation in the bile ducts, gallbladder, pancreas or liver, and imaging, most often an ultrasound, can show stones. Stones in the common bile duct can be cleared with a procedure called ERCP.

Stones without symptoms: watch or operate

If stones were found by chance and never caused symptoms, you probably do not need treatment, although follow-up visits may be arranged. Surgery carries its own risks, so removing a gallbladder just in case is not the usual approach. A surgeon makes individual decisions with you based on your age, other conditions and what the scans show.

Complications

Complications are uncommon, but they can be serious. If a bile duct stays blocked for more than a few hours, the gallbladder, the liver or the pancreas can become infected or inflamed. Untreated blockages of the bile ducts or the pancreatic duct can be fatal. Jaundice, a yellowing of the skin or the whites of the eyes, can also occur.

• Fever, even a low-grade one, or chills.
• Jaundice.
• Tea-colored urine and light-colored stools.
• Pain that lasts for several hours, with nausea and vomiting.
• Pain that spreads to the back with vomiting.

Treatment options in general terms

Surgery to remove the gallbladder (cholecystectomy) is the usual treatment for stones that cause attacks. It is one of the most common adult operations in the United States, and most surgeons use the laparoscopic method through small incisions. Many patients go home the same day and return to normal activity in about a week. An open operation is used when the gallbladder is severely inflamed, infected or scarred, and recovery takes longer.

Nonsurgical treatment is used mainly for small cholesterol stones in special cases. Bile acid medicines can dissolve such stones, but treatment may take months or years and stones can return. While waiting for surgery, your clinician may suggest pain relief and a low-fat diet. Do not try home "liver or gallbladder cleanses" instead; none of the sources listed here treats them as a recognized option, and an attack of pain needs medical assessment.

Eating and weight

• Aim for a healthy weight through diet and activity, and lose weight gradually, because losing it very quickly raises the risk of stones.
• A diet high in fat and low in fiber raises risk, so build meals around vegetables, whole grains and legumes.
• While waiting for surgery, a low-fat diet and avoiding foods that trigger attacks may be advised.
• Talk to your clinician before changing your eating plan, especially if you already have stones.

Life without a gallbladder

After the gallbladder is removed, bile flows directly into the small intestine instead of being stored. People can live normally without it. A small number notice softer, more frequent stools, which is usually temporary. If this does not settle, tell your provider rather than putting up with it.

Red flags and when to see a doctor

Red flags: call 911 for sudden severe abdominal pain, pain that spreads to the back with vomiting, a very high temperature or shivering, or yellowing of the skin or eyes. Do not drive yourself. Sudden pain with chills or dark urine and pale stools also needs immediate care.

See your primary care provider after a first episode of colic, because more attacks are likely and a surgeon can discuss whether you need an operation. Also book a visit if gallstones are found on a scan, if you often feel heavy or uncomfortable on the upper right side, or if fatty food does not sit well. Bring your scan report and note how many attacks you had, how long they lasted and what seemed to trigger them.

Questions and answers

Sources

1. NIDDK — Gallstones
2. NIDDK — Symptoms & Causes of Gallstones
3. NIDDK — Treatment for Gallstones
4. MedlinePlus — Gallstones
5. NHS — Gallstones

Sources checked on 29 October 2026.