Gallstones are solid particles that develop in the gallbladder, a small organ located beneath the liver. The gallbladder stores bile—a digestive fluid produced by the liver that helps break down fats during digestion. Under certain conditions, bile components such as cholesterol, bilirubin, and calcium can become imbalanced and crystallize, forming stones of various sizes.

These stones may range in size from a grain of sand to the size of a golf ball. While some individuals may have a single gallstone, others can develop multiple. Many people live with gallstones unknowingly, as they often remain asymptomatic. However, complications may arise when stones obstruct the bile ducts, leading to severe pain, inflammation, and other symptoms.

Types of Gallstones

There are two primary types of gallstones:

Cholesterol Gallstones These are the most common type, making up around 75% of all cases. They are mainly composed of cholesterol and typically have a yellow-green appearance. They form when there is too much cholesterol in bile or when the gallbladder fails to empty completely.

Pigment Gallstones These stones consist primarily of bilirubin, a substance produced when red blood cells break down. Pigment gallstones are usually dark brown or black and are more common in individuals with liver disease, hemolytic anemia, or bile duct infections.

Some people may develop a combination of both types.

Symptoms

Many people with gallstones have no symptoms. These are known as silent gallstones and are often discovered incidentally during imaging tests for other conditions.

When symptoms do occur, they may include:

  • Sudden, intense abdominal pain (especially in the upper right side or center)

  • Pain that radiates to the back or right shoulder

  • Nausea and vomiting

  • Bloating, indigestion, or gas after meals

  • Fever and chills

  • Jaundice (yellowing of skin and eyes)

  • Dark urine or pale stools

  • Chest or upper abdominal discomfort

Pain episodes, known as biliary colic, often follow meals high in fat and can last for several minutes to hours.

Common Causes

Gallstones form due to an imbalance in the composition of bile. While the exact mechanisms are still being studied, researchers have identified several contributing factors:

  • Excess cholesterol in bile, leading to crystallization

  • High bilirubin levels, often due to liver disease or blood disorders

  • Inadequate gallbladder emptying, which causes bile to become stagnant and concentrated

Risk Factors

Certain traits and conditions can increase your likelihood of developing gallstones:

  • Age over 40

  • Female sex, particularly during pregnancy or when using hormonal birth control

  • Family history of gallstones

  • Obesity or rapid weight loss

  • Diabetes and insulin resistance

  • Liver conditions such as cirrhosis

  • Hemolytic anemia

While having risk factors doesn’t guarantee you’ll develop gallstones, being aware of them can encourage preventive lifestyle choices.

Diagnosis

If you show signs of gallstones, your healthcare provider may use several diagnostic tools:

Abdominal Ultrasound This is the most commonly used imaging test. It’s painless, non-invasive, and effective at detecting stones within the gallbladder.

CT Scan A CT scan can help visualize gallstones, blockages, or complications involving the bile ducts or liver.

HIDA Scan The hepatobiliary iminodiacetic acid (HIDA) scan evaluates gallbladder function and bile flow using a radioactive tracer.

ERCP and MRCP Endoscopic retrograde cholangiopancreatography (ERCP) uses a flexible tube and dye to visualize bile ducts. MRCP is a non-invasive alternative using MRI.

Blood Tests Bloodwork can detect liver function abnormalities, signs of infection, and elevated bilirubin levels.

These tests help determine not only the presence of gallstones but also whether they are causing complications.

Treatment Options

Treatment for gallstones depends on the presence and severity of symptoms. If you have silent gallstones, no treatment may be necessary. If symptoms or complications occur, the following options are available:

Surgical Removal (Cholecystectomy) The most effective and common treatment for symptomatic gallstones is gallbladder removal. Laparoscopic cholecystectomy is the preferred method due to its minimally invasive nature and shorter recovery time.

Medications If surgery is not viable, medications such as ursodiol (Actigall) and chenodiol (Chenix) can help dissolve cholesterol gallstones. However, this method is typically slow and only suitable for certain types of small stones.

Note: These medications are less effective for pigment stones and require long-term use with regular monitoring.

Preventive Measures

While gallstones can't always be prevented, you can reduce your risk through healthy lifestyle habits:

  • Maintain a healthy weight

  • Avoid crash diets or rapid weight loss

  • Eat a balanced diet rich in fiber, fruits, and vegetables

  • Limit saturated fats and cholesterol-rich foods

  • Stay physically active

  • Drink plenty of water to aid digestion

If you're at higher risk, these steps are especially important. Consult your healthcare provider for personalized strategies.

Possible Complications

Untreated gallstones can cause significant health issues, including:

Cholecystitis Inflammation of the gallbladder, usually due to a blocked cystic duct, resulting in pain, fever, and infection.

Choledocholithiasis Gallstones migrating into the common bile duct, blocking bile flow and leading to jaundice, dark urine, and pale stools.

Cholangitis Infection of the bile ducts, which may cause fever, chills, and severe abdominal pain. It can become life-threatening if not treated promptly.

Pancreatitis Gallstones can block the pancreatic duct, causing inflammation of the pancreas. This condition requires immediate medical care.

Living With Gallstones

If you’ve been diagnosed with gallstones, lifestyle modifications and medical supervision can help you manage the condition.

  • Plan low-fat, gallbladder-friendly meals

  • Track and avoid foods that trigger discomfort

  • Follow your treatment plan closely

  • Manage stress with mindfulness, yoga, or journaling

  • Keep regular check-ups with your healthcare provider

In most cases, gallstones do not significantly affect long-term health when managed properly. Surgical removal of the gallbladder usually resolves painful symptoms and prevents recurrence.