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What an attack feels like

Biliary colic is a steady, intense pain in the upper right abdomen or centrally under the ribs, often radiating to the right shoulder blade. Despite the name it does not come and go in waves — it builds, plateaus for anywhere from 30 minutes to a few hours, then eases. It commonly begins in the evening or at night, frequently after a fatty meal, and is often accompanied by nausea and vomiting.

During an attack

• Take paracetamol, or an anti-inflammatory if it suits you.
• Avoid food until the pain settles; sip clear fluids.
• A warm compress may help. Movement often makes it worse, so find a position and stay in it.
• If the pain has not settled within a few hours, or you develop fever or jaundice, seek help rather than waiting it out.

Diet

Diet does not dissolve gallstones, but reducing fat reduces how often the gallbladder contracts and therefore how often attacks happen. This buys time and comfort; it is not a cure.

Treatment

Stones found incidentally with no symptoms are usually left alone. Once they have caused symptoms, however, attacks tend to recur and complications become more likely, so removal is generally recommended.

• Laparoscopic cholecystectomy — keyhole removal of the gallbladder — is the definitive treatment. It is usually a day case, with most people back to normal activity within one to two weeks.
• You do not need a gallbladder; bile simply flows continuously into the intestine instead.
• Around one in ten people has looser stools afterwards, usually temporary. Persistent diarrhoea after gallbladder removal is often bile acid diarrhoea, which is easily treatable — and frequently missed.
• ERCP is used to remove stones that have passed into the bile duct.
• Medicines to dissolve stones are rarely effective and are seldom used.