Gallstones Symptoms: Biliary Colic and When It Is Urgent

Gallstones are small, hard lumps that form inside the gallbladder. Many people have them and never notice. When they do cause symptoms, the classic sign is sudden, severe pain in the upper right or middle of the tummy, often after a big meal. In Spain they are called piedras en la vesícula or cálculos biliares. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What are gallstones?

The gallbladder is a small pouch under the liver. It stores bile, a fluid that helps you digest fat. If bile holds too much cholesterol or bilirubin, or the gallbladder does not empty well, stones can form. They can be as small as a grain of sand or as big as a golf ball.

What are the symptoms of gallstones?

Most gallstones cause no symptoms. They are often found by chance on a scan. When a stone blocks the gallbladder outlet, you get biliary colic:

• strong, steady pain in the upper right tummy or below the breastbone;
• pain that may spread to your back or right shoulder;
• pain that starts suddenly, sometimes after a large meal or at night;
• pain that lasts from about 30 minutes to several hours;
• feeling sick or being sick.

Between attacks, most people feel fine. Wind, bloating or a heavy feeling after meals without strong pain are not usually caused by gallstones.

Who is more likely to get gallstones?

• Women, especially over 40.
• People who are overweight or live with obesity.
• People who lose weight very fast, for example on a very strict diet or after weight-loss surgery. Some weight-loss medicines are also linked to more gallbladder problems, so tell your doctor if you take one and get pain.
• Pregnancy and some hormone treatments.
• Diabetes, and a family history of gallstones.

What problems can gallstones cause?

Sometimes a stone gets stuck and causes something more serious. These are treated in hospital:

• Cholecystitis: the gallbladder becomes inflamed. Pain lasts more than a few hours, often with a fever.
• Jaundice: a stone blocks the tube that carries bile to the gut. Skin and eyes turn yellow, urine goes dark and stools go pale.
• Cholangitis: an infection of that tube, with high fever, chills and jaundice.
• Pancreatitis: the stone irritates the pancreas. It causes very bad pain below the breastbone that spreads to the back.

How are gallstones diagnosed?

The main test is an abdominal ultrasound (ecografía abdominal). It is simple, painless and uses no radiation, so it is safe in pregnancy. The doctor usually also orders blood tests: a blood count, liver tests, bilirubin and pancreas enzymes. If a stone may be stuck in the bile duct, more tests are done in hospital.

Do gallstones always need surgery?

No. If gallstones cause no symptoms, they are usually left alone. If they have caused pain or problems, the most effective treatment is to remove the gallbladder. This is called a cholecystectomy (colecistectomía). It is nearly always keyhole surgery. You can live a normal life without a gallbladder, because the liver still makes bile. Some people have looser stools for a while.

There are medicines that dissolve some kinds of stones. They work slowly, suit only a few people, and the stones can come back. A specialist decides.

What should I eat if I have gallstones?

No diet dissolves gallstones. Still, smaller meals with less fat help some people have fewer attacks. To lower your risk, keep a healthy weight, avoid crash diets and stay active every day. If you want to lose weight, do it slowly.

What should I do during a gallstone attack?

If you already know you have gallstones and the pain feels like before, your doctor will have told you which painkiller to use. Follow the prescription or the leaflet. Do not eat while the pain lasts. If the pain does not settle, is worse than usual, or you get a fever, do not wait: go to A&E. You can also read about other causes of right-side tummy pain.

When to go to A&E or call 112

• Pain lasts more than a few hours, or is so bad you cannot keep still.
• Fever, chills or shivering.
• Yellow skin or whites of the eyes, or very dark urine.
• Vomiting that will not stop.
• Confusion or feeling very faint.

Call 112 if the pain is severe and comes with a cold sweat, trouble breathing or chest pain. A heart problem can feel like stomach pain.

Frequently asked questions about gallstones

Getting a medical assessment

If you have gallbladder pain or have been told you have gallstones, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about tummy pain and which records to keep for gallbladder follow-up. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.