Health Insights · Gastroenterology
Gallstones: when they cause pain and what to do
Gallstones are extremely common and most people who have them never know. Problems arise when a stone blocks the outlet, producing severe pain, or moves further and causes complications. The distinction between an attack of pain and a complication is what determines how urgently you need help.
Go to an emergency department if you have
- pain lasting more than six hours, or pain with a fever and shivering
- yellowing of the skin or eyes, dark urine or pale stools
- severe pain spreading through to the back with persistent vomiting
- a tender, rigid abdomen, or pain on the slightest movement
- confusion, low blood pressure or feeling seriously unwell
Fever with gallstone pain suggests infection of the gallbladder or bile duct; jaundice suggests a stone has blocked the bile duct; severe back pain with vomiting suggests pancreatitis. All three are emergencies. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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.
Reduce
- Fried food, pastry, cream, butter and full-fat dairy
- Fatty meats, sausages and processed meat
- Chocolate, cakes and biscuits
- Large meals, particularly late in the evening
Better tolerated
- Lean protein, fish, pulses and vegetables
- Wholegrains and fruit
- Smaller, more frequent meals
- Steady weight loss rather than rapid — crash dieting causes gallstones
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.
Book an appointment if you have had episodes of upper abdominal pain, particularly after fatty meals. We can arrange an ultrasound — the test of choice for gallstones — and blood tests on site, usually the same day, and refer for surgery without a wait.
Private gallstone assessment and ultrasound in London
Many gallstones cause no symptoms, but they can trigger bouts of upper-right tummy pain, especially after fatty food. A private GP in East London can assess you and arrange an ultrasound and blood tests, and our private gastroenterology clinic in London can advise on treatment. Severe pain with fever or yellowing of the skin or eyes needs urgent assessment. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Gallstones in London: common questions
Do gallstones always need treatment?
No — stones causing no symptoms are often left alone; treatment (usually removing the gallbladder) is for those causing pain or complications.
What are the symptoms of gallstones?
Bouts of upper-right or central tummy pain, often after fatty meals, sometimes with nausea; complications cause fever or jaundice.
When is it urgent?
Severe pain with fever, or yellowing of the skin or eyes (jaundice), needs urgent assessment.
How are gallstones diagnosed?
With an ultrasound, which we can arrange, along with blood tests.
Ultrasound and surgical referral without a wait
7 days a week, 9am–7pm, on Whitechapel Road.