More than 1 in 10 adults in the U.S. has gallstones, but most never know it. The real problem starts when one of those stones gets stuck - and that’s when the pain hits. It doesn’t come with warning signs. One moment you’re fine, the next you’re doubled over, sweating, and wondering if you’re having a heart attack. This isn’t just a stomach ache. This is gallstones causing biliary colic - and if it keeps happening, your gallbladder might be in serious danger.
What Happens When a Gallstone Gets Stuck?
Biliary colic is the name for the sudden, intense pain that happens when a gallstone blocks the cystic duct - the pipe that lets bile flow out of your gallbladder. The pain usually starts in the upper right side of your belly, sometimes spreading to your back or right shoulder. It’s not crampy or gassy. It’s steady, deep, and doesn’t get better when you burp, poop, or vomit. Most episodes last between one and five hours. Then, just as suddenly, it fades.
This isn’t a one-off. The American Academy of Family Physicians found that over 90% of people who have one episode of biliary colic will have another within 10 years. Two out of three will be back in pain within two years. And each time it happens, the risk of something worse grows.
When Biliary Colic Turns Into Cholecystitis
When a stone blocks the duct for more than a few hours, the gallbladder starts to swell. That’s acute cholecystitis - inflammation of the gallbladder. It’s no longer episodic pain. It’s constant. You’ll feel feverish. Your belly will be tender to touch. You might feel nauseous all day. This isn’t something you can wait out. Left untreated, it can lead to infection, tissue death, or even a ruptured gallbladder.
About 20% of people who have biliary colic will develop cholecystitis. The National Health Service says that if you have symptomatic gallstones and don’t get treated, 20-30% of them will end up in the emergency room within five years. That’s not a gamble worth taking.
Why Cholesterol Stones Are the Main Culprit
Not all gallstones are the same. In Western countries, about 80% are made of cholesterol. These form when your bile has too much cholesterol, not enough bile salts, or when your gallbladder doesn’t empty properly - often because you skip meals, lose weight too fast, or have insulin resistance. The other 20% are pigment stones, made of bilirubin. These are more common in people with liver disease or blood disorders like sickle cell anemia.
Obesity is a big driver. The CDC says nearly 40% of U.S. adults are obese. That’s why gallstone rates are rising. Women are two to three times more likely to get them than men - especially after pregnancy or while on birth control. Hispanic populations have a 45% higher risk than non-Hispanic whites, according to the 2023 National Health and Nutrition Examination Survey.
Surgery Isn’t Just an Option - It’s the Standard
There’s no magic pill that reliably makes gallstones disappear. Ursodeoxycholic acid can dissolve small cholesterol stones, but only in 30-50% of cases - and it takes months. Even then, half of those stones come back within five years. Shock-wave therapy sounds cool, but it’s rarely used anymore because stones return too often.
That’s why surgery - specifically, laparoscopic cholecystectomy - is the gold standard. It’s not some risky, old-school operation. It’s routine. In the U.S., 90% of gallbladder removals are done this way. You get four small cuts, a camera, and tiny tools. Most people go home the same day. Recovery takes about a week, not a month. Open surgery? That’s only needed in 5-10% of cases, usually when the gallbladder is too inflamed or scarred.
Dr. David Flum from the University of Washington says patient satisfaction after laparoscopic cholecystectomy is 95%. Complication rates are under 2% when done by experienced surgeons. That’s better than most elective procedures.
Timing Matters: The 72-Hour Rule
If you’re diagnosed with acute cholecystitis, waiting isn’t smart. The Society of American Gastrointestinal and Endoscopic Surgeons says surgery should happen within 72 hours. Why? Because delaying increases the chance your surgeon will have to switch from a minimally invasive laparoscopic approach to a big, open cut. That raises your recovery time from 7 days to 30. It also raises your risk of infection and complications.
Studies show that early surgery cuts the conversion rate from 25% down to just 7%. That’s not a small difference. That’s the difference between going home in two days or being in the hospital for a week.
Who Should Think Twice About Surgery?
Most people with symptomatic gallstones should have their gallbladder removed. But not everyone. For patients over 75 with multiple health problems - heart disease, diabetes, lung issues - the risk of surgery goes up. Dr. Emily Finlayson at UCSF points out that for someone over 75 with three or more chronic conditions, the 30-day mortality rate jumps from 0.1% to 2.8%. That’s not a risk to take lightly.
In those cases, doctors may try to control the inflammation with antibiotics and fluids first. Some high-risk patients might get a temporary gallbladder drain placed through the skin using ultrasound guidance - a newer option approved by the FDA in 2023. It’s not a cure, but it buys time.
What Life Is Like After Gallbladder Removal
Most people feel better than they have in years. A Healthline survey of over 1,200 patients found 78% chose surgery after their third or fourth painful episode. Sixty-five percent said they’d been to the ER because the pain was unbearable. After surgery, nearly 80% reported a big improvement in their quality of life within two weeks.
But it’s not perfect for everyone. About 12% get diarrhea - especially after fatty meals. That’s because without a gallbladder to store bile, your liver dumps it continuously into your gut. Most people adjust in a few months. A smaller group - about 6% - develop post-cholecystectomy syndrome: ongoing pain, bloating, or nausea. That’s often due to bile duct issues or other conditions like IBS, not the surgery itself.
One patient from Cleveland Clinic had 17 episodes of biliary colic over 18 months. After surgery, her pain vanished in 10 days. She was back to running and lifting weights in two weeks.
What to Expect Before and After Surgery
Before surgery, you’ll need a few weeks to get ready. If you’re overweight, your doctor might ask you to lose a little weight. If you have diabetes, your blood sugar needs to be under control. Smoking? Stop. Alcohol? Cut back. These things reduce your risk of complications.
On the day of surgery, you’ll fast for 6-8 hours. The procedure takes about 45 to 60 minutes. You’ll wake up with soreness, not agony. Most hospitals now use enhanced recovery protocols - you’re encouraged to walk within 4 hours and drink liquids within 6. Many go home the same day.
After surgery, you’ll eat light for a few days. Avoid fried food and big fatty meals at first. Your body will adapt. Most people are back to normal activity in 7-10 days. No heavy lifting for 4-6 weeks.
Why So Many People Are Diagnosed Too Late
One of the biggest problems? Delayed diagnosis. A Healthline survey found 41% of patients saw three or more doctors before getting the right answer. Pain gets written off as indigestion, gas, or stress. ER doctors sometimes miss it too - especially if the ultrasound isn’t done right.
And pain management? Too often, it’s inadequate. Some patients are given weak painkillers that don’t touch the biliary colic pain. NSAIDs like ketorolac work better than opioids for this kind of pain - and have fewer side effects. But not every ER knows that.
If you’ve had repeated right-upper-quadrant pain, especially after eating, ask for an ultrasound. It’s cheap, safe, and 95% accurate for gallstones.
What’s Next for Gallstone Treatment?
Researchers are working on better ways to predict who’s at risk. New tools are being tested to identify patients who might have silent stones that could turn dangerous. There’s also growing interest in single-incision laparoscopic surgery (SILS), but early data shows it has a 20% higher complication rate than standard laparoscopy - so it’s not yet the standard.
For now, the best advice is simple: if you have symptoms, don’t wait. Gallstones don’t fix themselves. And while your gallbladder might seem like a luxury organ, it’s not. Removing it doesn’t mean you can’t eat normally - it means you can finally live without pain.
Can gallstones go away on their own?
Sometimes, a stone may pass on its own and cause no lasting damage - but that’s rare. Most symptomatic gallstones don’t disappear without treatment. Even if the pain fades, the stone is still there. And without surgery, the chance of another episode is over 90% within 10 years. Waiting doesn’t make the problem go away - it just increases the risk of serious complications like cholecystitis or pancreatitis.
Is gallbladder surgery risky?
Laparoscopic cholecystectomy is one of the safest common surgeries. In experienced hands, the complication rate is under 2%. The biggest risks are injury to the bile duct or bleeding, but these are rare. For healthy patients under 75, the benefits far outweigh the risks. For older patients with multiple health problems, the risk increases - so doctors carefully weigh the decision. But for most people, the risk of leaving gallstones untreated is much higher than the risk of removing the gallbladder.
Do I need surgery if I only had one episode of pain?
Not always - but it’s strongly recommended. Even one episode means your gallbladder is reacting to stones. The American Academy of Family Physicians found that two-thirds of people have another episode within two years. Most end up needing surgery anyway. If you’re young, active, and otherwise healthy, getting it done early avoids future ER visits, missed work, and the chance of developing a dangerous infection. It’s a one-time fix for a recurring problem.
Can I dissolve gallstones with diet or supplements?
No. There’s no proven diet, herb, or supplement that reliably dissolves gallstones. Some people swear by apple cider vinegar or lemon juice, but there’s no scientific backing. The only medication that has any effect is ursodeoxycholic acid - and even then, it only works for small cholesterol stones, takes months, and has a 50% recurrence rate. Surgery remains the only permanent solution for symptomatic gallstones.
What happens to digestion after gallbladder removal?
Your liver still makes bile - it just doesn’t store it anymore. Without the gallbladder, bile flows continuously into your small intestine. That can cause loose stools, especially after fatty meals. Most people adjust within a few weeks to months. Eating smaller, low-fat meals helps. A small number (about 6%) develop ongoing digestive issues called post-cholecystectomy syndrome, but that’s often due to other conditions like IBS, not the surgery itself.
How do I know if my pain is from gallstones and not something else?
Gallstone pain is different. It’s steady, not crampy, and doesn’t improve with gas or bowel movements. It’s usually in the upper right abdomen or center of the belly, often after eating - especially fatty food. It may radiate to your back or shoulder. An ultrasound is the fastest, most accurate test. If you’ve had multiple episodes like this, don’t assume it’s just indigestion. Ask for an abdominal ultrasound - it takes 15 minutes and can rule out gallstones with 95% accuracy.
