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Gallstones: why do they cause pain and discomfort?

Introduction

In most instances, gallstones do not produce any symptoms. However, in some instances they can produce abdominal pain which can require treatment and intervention. Expert surgeon, Professor Hemant Kocher explains when gallstones become a problem and how they can be treated.

Gallstone Patient

What are the risks of gallstones?

Most gallstones are not dangerous, but they can become dangerous, and if left untreated can pose a severe threat to your health. Gallstones can pose a danger if they block the exit of gallbladder and the flow of bile through it. In this instance, you may get an infection within the gallbladder. This is what is known as cholecystitis which can be either acute or chronic (long-standing).

When gallstones leave the gallbladder they usually go via the bile duct. If gallstones get stuck in the bile duct this can lead to jaundice. Jaundice means yellowing of the eyes and the production of dark yellow urine. Gallstones can also irritate the pancreas and cause pancreatitis. Both pancreatitis and jaundice can be serious, life-threatening illnesses.

In rare instances, gallstones can go into the bowel and cause blockage, meaning food cannot pass through. When this happens, patients would present with abdominal pain and vomiting which should be treated as a serious condition. How gallstones should be treated has to be decided with your specialist, who will consider your symptoms, scan results and blood test results before making any recommendations.

Where does gallstone pain present in the body

The pain from gallstones usually presents in the upper part of the tummy, close to the breastbone or just below the right ribcage. The pain is usually spasmodic or colicky which means it comes and goes in waves. Gallstone pain can sometimes move to the back towards the right shoulder blade too. Pain may be associated with vomiting or intolerance to fatty food. Gallstone pain may be avoided by avoiding fatty foods such as fried food, butter, cheese and dairy products with a high fat and cholesterol content.

For more information on what factors contribute to gallstones in families, visit this news article.

When is surgery needed?

Surgery is required for some conditions where gallstones are causing problems. Surgery is most commonly required to prevent future problems which the gallstones may cause. Surgery may also be required when the patient presents with symptoms from gallstones such as pain, vomiting, or intolerance to fatty food. Gallstone surgery may also be carried out when gallstones cause complications such as pancreatitis or obstructive jaundice.

Gallstones are not removed on their own but are removed along with the gallbladder. If one does not remove the gallbladder, gallstones are likely to form again as the gallbladder is unable to expel bile. Therefore, gallstone surgery is accompanied by removal of the gallbladder.

Gallstone surgery is commonly performed as laparoscopically (keyhole surgery), which means small incisions are made on the abdomen or tummy. This is called a laparoscopic cholecystectomy. Laparoscopic cholecystectomy is usually done as a day-case procedure. You may be required to stay in longer than a day depending on your physical condition, whether you have other health problems or if you have any complications from the gallstones.

What are the risks associated with gallstone surgery?

The most common problems experienced by patients after laparoscopic choleocystectomy include mild shoulder pain (from CO2 gas used during the procedure) and wound infection (signs of possible infection include increasing pain, swelling or redness and pus leaking from the wound – see your GP if you develop these symptoms). Much rarer complications, present in fewer than 1% of patients, include bleeding, bile leaks and deep vein thrombosis (although the latter is generally restricted to those already at higher risk of developing blood clots). Injuries to the bile duct or blood vessels are possible but are exceedingly rare.

How long does it take to recover from gallstone surgery

Most people who have keyhole surgery are able to leave hospital on the same day as their operation. It will usually take around 2 weeks to return to your normal activities.

Are there any non-surgical options to treat gallstones?

Gallstones can be treated without surgery, but only if they meet certain criteria. In some cases, gallstones can be treated with medicines such as ursodiol or chenodiol, which are able to thin the bile and allow gallstones to dissolve. While these medications can be effective and are generally well tolerated by patients, medical treatment of gallstones is limited to people whose stones are small and made of cholesterol. Additionally, these drugs can take over two years to work, and gallstones may still return after treatment ceases.

Another non-surgical method is extracorporeal shock-wave lithotripsy (ECSWL), which uses shock waves to break up or fragment gallstones; this method, however, is only effective for solitary gallstones that are less than 2 cm in diameter. If a patient has multiple gallstones, even when the stones are fragmented, a diseased gallbladder may not expel the fragments. Generally this treatment is not recommended.

How can I reduce the risk of developing gallstones in the future if I’ve never had them before

From the limited evidence available, changes to your diet and losing weight (if you are overweight) may help prevent gallstones. Since cholesterol appears to play a role in the formation of gallstones, it is advisable to avoid eating too many foods with a high saturated fat content. A healthy, balanced diet is recommended, including plenty of fresh fruit and vegetables, and wholegrains.

There’s also some slim evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones.

Additionally, being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones. You should control your weight by eating a healthy diet and taking plenty of regular exercise. However, you should avoid low-calorie, rapid weight loss diets, as there’s evidence that they can disrupt your bile chemistry and increase your risk of developing gallstones. As such, a more gradual weight loss plan is recommended.

 

This article was written by Professor Hemant Kocher, Consultant General and HPB (hepato-pancreatic-biliary) Surgeon at OneWelbeck, specialising in diseases of the gall bladder and bile duct, liver and pancreas.

If you are concerned that you might have gallstones please don’t hesitate to get in touch with us by completing the form below.