If you’ve ever had sudden, intense pain under your right rib cage that came out of nowhere and lasted for hours, you might have experienced biliary colic. It’s not just a stomachache. It’s your gallbladder screaming because a stone is blocking the flow of bile. And if it keeps happening, you’re not just dealing with discomfort-you’re at risk for something far worse: cholecystitis, infection, or even pancreatitis.
What Actually Happens When You Have Gallstones?
Gallstones aren’t like kidney stones you can pass. They form inside your gallbladder, a small pear-shaped organ tucked under your liver. About 80% of them are made of cholesterol, the same kind that builds up in your arteries. The rest are pigment stones, made from bilirubin, a waste product from old red blood cells. These stones don’t just sit there. They move. And when one gets stuck in the cystic duct-the tube that lets bile leave your gallbladder-it causes biliary colic.The pain hits fast. It’s steady, not crampy. It doesn’t get better with burping, pooping, or vomiting. It usually starts in the upper right side of your belly or just below your breastbone, and it can radiate to your right shoulder or back. It peaks within an hour and can last anywhere from one to five hours. Then, as the stone shifts, the pain fades. It feels like a miracle… until it comes back.
Here’s the scary part: if you’ve had one episode of biliary colic, you’re very likely to have another. More than 90% of people will get it again within 10 years. Two out of three will have another attack within just two years. And each time, the risk of complications grows.
When Biliary Colic Turns Into Cholecystitis
Biliary colic is temporary. Cholecystitis is not. When a gallstone blocks the duct for more than a few hours, the gallbladder starts to swell and get inflamed. That’s cholecystitis. The pain doesn’t go away. It becomes constant. You might run a fever. Your belly might feel tender to the touch. Nausea and vomiting stick around. This isn’t just bad pain-it’s an emergency.About 20% of biliary colic episodes turn into cholecystitis. And if it’s not treated quickly, the gallbladder can rupture. That’s life-threatening. That’s why the Society of American Gastrointestinal and Endoscopic Surgeons says: if you have acute cholecystitis, get your gallbladder removed within 72 hours. Waiting increases the chance your surgery will need to be done the old-fashioned way-with a big cut instead of small keyhole incisions. And recovery? It takes weeks longer.
Why Surgery Is Usually the Answer
There’s no magic pill that reliably gets rid of gallstones. Ursodeoxycholic acid can dissolve small cholesterol stones, but only in about 30-50% of cases-and it takes months. Even then, half the people who get rid of their stones with medication get them back within five years. Shock-wave therapy? It used to be popular, but it’s rarely used now. The stones come back. The procedure is expensive. And it doesn’t work for most people.That’s why surgery-specifically, laparoscopic cholecystectomy-is the gold standard. It’s not a big deal anymore. In the U.S., 90% of gallbladder removals are done this way. Surgeons make four tiny cuts, insert a camera and tools, and remove the gallbladder in under an hour. Most people go home the same day. Recovery? About a week. Compare that to open surgery, which requires a 4-6 week recovery and a 6-inch scar.
Studies show 95% of patients are happy with the results. The pain vanishes. No more midnight emergencies. No more dreading meals. One woman in Cleveland Clinic’s patient newsletter had 17 attacks over 18 months. After surgery, she was back to running and cooking within two weeks.
Who Shouldn’t Have Surgery?
Not everyone needs it. If you have gallstones but never have symptoms, you don’t need surgery. That’s true for about 80% of people who have them. But if you’ve had even one episode of biliary colic, the odds shift. The American Academy of Family Physicians found that 64% of people who waited ended up needing surgery within 5.6 years.But there’s an exception: older adults with other health problems. For someone over 75 with heart disease, diabetes, or lung issues, the risk of surgery goes up. The 30-day death rate jumps from less than 0.1% in healthy people to nearly 3% in those with three or more chronic conditions. That’s why doctors now weigh risk carefully. For a frail 80-year-old with no symptoms, watching and waiting might be the safer choice. But if that same person starts having pain? The calculus changes. Surgery is still often the best option-but it needs to be done by a team experienced in high-risk cases.
What to Expect Before and After Surgery
Before surgery, you’ll likely have an ultrasound. That’s the best test. It’s quick, safe, and shows stones with 95% accuracy. Blood tests might be done to check for infection or liver problems. If you’re overweight or have diabetes, your doctor might ask you to lose a few pounds or get your blood sugar under control first. That lowers surgical risk.On the day of surgery, you’ll be under general anesthesia. You won’t feel a thing. Most people wake up with mild soreness around the incisions and some bloating from the gas used during the procedure. You’ll be encouraged to walk within four hours. Eat a light meal within six. Most go home the next day.
After surgery, you might notice changes in digestion. About 12% of people get diarrhea, especially after fatty meals. It’s usually temporary, lasting a few weeks to months. A small number-around 6%-get something called post-cholecystectomy syndrome: ongoing pain, bloating, or nausea. This isn’t always due to leftover stones. Sometimes, it’s bile reflux or a problem with the bile ducts. If it lasts more than three months, you’ll need more tests.
The Real Cost of Waiting
In the U.S., about 700,000 gallbladder surgeries are done every year. That’s $6.2 billion in healthcare spending. But the real cost isn’t just money. It’s missed work. Emergency room visits. Sleepless nights. The 2022 Healthline survey found that 65% of patients waited until they were in the ER, screaming in pain, before deciding to get surgery. Four out of ten saw three or more doctors before getting the right diagnosis.Delaying surgery doesn’t save money-it just moves the cost to the emergency system. And it puts you at risk. About 20-30% of people with untreated symptomatic gallstones end up in the hospital with complications within five years. That’s not a gamble worth taking.
What’s New in Gallstone Treatment?
There’s one promising new option for people who can’t have surgery. In 2023, the FDA approved a technique called endoscopic ultrasound-guided gallbladder drainage. It’s not a cure-it’s a bridge. A tiny tube is placed through the stomach into the gallbladder to drain infected bile. It’s life-saving for high-risk patients who need time to stabilize before surgery. But it’s not a replacement for removal.Another trend is single-incision laparoscopic surgery (SILS), where everything goes through one cut near the belly button. It leaves no visible scars. But it’s harder for surgeons, takes longer, and has a 20% higher complication rate than standard laparoscopy. Most experts don’t recommend it unless it’s for cosmetic reasons.
The future is in faster recovery. Hospitals using Enhanced Recovery After Surgery (ERAS) protocols are seeing 30% shorter hospital stays and 25% fewer readmissions. That means less time in bed, less pain, and quicker return to normal life.
Final Thoughts
Gallstones aren’t just a nuisance. They’re a ticking clock. If you’ve had biliary colic, you’re not just waiting for the next attack-you’re waiting for something worse. Surgery isn’t scary anymore. It’s routine. Safe. Effective. And for most people, it’s the only way to truly be free of the pain.Don’t wait for an emergency. If you’ve had one episode of gallstone pain, talk to your doctor about cholecystectomy. The sooner you act, the easier the surgery, the faster you recover, and the less likely you are to end up in the ER again.
Can gallstones go away on their own?
Gallstones rarely disappear without treatment. While very small cholesterol stones might dissolve with medication like ursodeoxycholic acid, this only works in about half the cases-and even then, the stones usually return within five years. Most stones stay put and can cause repeated pain or serious complications like cholecystitis or pancreatitis. Waiting for them to vanish is not a safe strategy.
Is gallbladder surgery risky?
Laparoscopic cholecystectomy is one of the safest major surgeries performed today. In experienced hands, the complication rate is under 2%. Risks include infection, bleeding, or injury to the bile duct, but these are rare. The bigger risk is not having surgery if you have symptoms. Untreated gallstones lead to emergency surgery, which carries a much higher risk of complications and longer recovery.
Will I need to change my diet after gallbladder removal?
You don’t need a special diet, but your body may need time to adjust. Without a gallbladder, bile flows directly from the liver into the intestine instead of being stored. Some people get diarrhea after fatty meals-this usually improves over weeks or months. Eating smaller, low-fat meals for the first few weeks helps. Most people return to their normal diet without issues.
Can I get gallstones again after surgery?
No. Once your gallbladder is removed, you can’t form new gallstones. The stones form inside the gallbladder. Without it, there’s no place for them to develop. Any lingering symptoms after surgery-like pain or bloating-are usually due to other causes, such as bile reflux, sphincter of Oddi dysfunction, or unrelated digestive issues. They’re not gallstones.
How do I know if my pain is from gallstones?
Gallstone pain is typically sudden, steady, and located in the upper right abdomen or center of the belly. It often radiates to the right shoulder or back, lasts 1-5 hours, and doesn’t improve with gas, vomiting, or bowel movements. It’s often triggered by fatty meals. The best way to confirm it’s gallstones is with an ultrasound-simple, painless, and over 95% accurate. If you’re unsure, don’t guess. Get checked.
Why do women get gallstones more often than men?
Hormones play a big role. Estrogen increases cholesterol levels in bile and slows gallbladder emptying. Women, especially those who’ve been pregnant, on birth control, or using hormone therapy, are 2-3 times more likely to develop gallstones. Obesity and rapid weight loss also raise risk, which explains why rates are higher in women over 40 and in Hispanic populations.
Is there a way to prevent gallstones?
You can lower your risk. Avoid rapid weight loss-aim for no more than 1-2 pounds per week. Eat regular meals-skipping meals slows gallbladder emptying. Choose healthy fats like olive oil and fish over fried foods and processed snacks. Maintain a healthy weight. Stay active. These steps won’t guarantee you’ll never get stones, but they significantly reduce your chances.
