How does gallbladder pain feel?
Classic gallbladder pain (biliary colic) starts in the right upper abdomen or upper mid-abdomen and can radiate to the back or under the right shoulder blade. It usually begins 30 minutes to 2 hours after a fatty or heavy meal, lasts 30 minutes to several hours and then eases. It is not worsened by movement, but patients often struggle to find a comfortable position.
How is it different from other abdominal pains?
- Gastritis/reflux: burning behind the breastbone, worse when hungry or lying down
- Peptic ulcer: mid-upper abdomen, relieved by food or worsened by it
- Appendicitis: starts around the navel and settles in the right lower abdomen, worse with movement
- Kidney stone: flank pain radiating to the groin, cramp-like
- Cardiac pain: chest pressure, exertion-related, with sweating or shortness of breath
Most common causes
- Gallstones (cholelithiasis) — the most common cause
- Acute or chronic cholecystitis (gallbladder inflammation)
- Biliary sludge
- Common bile duct stone (choledocholithiasis)
- Gallbladder polyps (rarely cause pain)
- Gallbladder dyskinesia — a functional contraction disorder without stones
- Rarely: gallbladder cancer
When to go to the emergency room
- Pain lasting more than 5–6 hours or getting worse
- Fever above 38 °C with chills
- Yellowing of the eyes or skin (jaundice)
- Dark urine and pale stools
- Severe vomiting, abdominal distension and tenderness on touch
- In a person with known heart disease: sweating, chest pressure or shortness of breath accompanying the pain
Which tests are used for diagnosis?
- Abdominal ultrasound — first-line, high sensitivity for stones and inflammation
- Liver function tests, amylase/lipase, complete blood count
- MRCP — when a common bile duct stone or biliary anatomy is in question
- Endoscopic ultrasound (EUS) — for small stones and microlithiasis
- ERCP — for both diagnosis and stone removal in selected cases
- HIDA (cholescintigraphy) — for suspected dyskinesia or ambiguous acute cholecystitis
Treatment options
Treatment depends on the cause and severity. Current international guidelines (SAGES 2010/2020, EAES 2020, NICE CG188, WSES acute cholecystitis) define laparoscopic cholecystectomy as the standard treatment for symptomatic gallstones. Routine surgery is not generally recommended for asymptomatic stones; selected situations such as porcelain gallbladder, stones larger than 3 cm, coexistence of gallstones with polyps or immunosuppression are evaluated individually.
- Recurrent biliary colic — elective laparoscopic cholecystectomy
- Acute cholecystitis — early (within 7–10 days) laparoscopic cholecystectomy is preferred
- Common bile duct stone — ERCP for stone removal ± cholecystectomy
- Biliary sludge — surgery if symptomatic, otherwise observation and trigger avoidance
- Dyskinesia — surgery may be considered in selected patients meeting defined criteria
How much do diet and lifestyle help?
Avoiding fatty, fried and heavy meals may reduce attack frequency, but diet alone does not dissolve existing stones. Gradual weight loss is beneficial, while very rapid weight loss can trigger new stone formation. Claims of dissolving gallstones with herbal remedies are not supported by evidence and may cause complications such as bile duct obstruction.
Frequently Asked Questions
How long does gallbladder pain last?
Where does gallbladder pain radiate?
Can gallbladder inflammation occur without fever?
Does everyone with gallstones need surgery?
Does the pain always appear after fatty food?
If ultrasound shows no stone, does that rule out the gallbladder as the source?
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