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Digestive Disorders > Lower Abdomen

What are the symptoms of gallstones?

Dr. med. André Sommer

Dr. med. André Sommer

Sudden, cramp-like pain after eating that is associated with nausea and vomiting may be an indication of gallstones. About 15 percent of the population suffer from gallstones. This makes gallbladder disease one of the most common civilization diseases of our time. But the symptoms of gallstones are often non-specific, if not asymptomatic, or are mistaken for other diseases.

What are gallstones?

Gallstones, also known as cholelithiasis are deposits in the gallbladder or biliary tract, which are differentiated from each other accordingly. The deposition of stones in the gallbladder occurs more frequently and is also known as choledocholithiasis.

How do gallstones develop?

Gallstones arise when the mixing ratio of the bile juice substances is no longer in the correct ratio. Essential components of the bile juice are cholesterol, bile acid and bilirubin. Much of the gallstones are made up of cholesterol.

Promoting factors that favor gallstone disease include:

  • Genetic inheritance
  • Overweight
  • Older age
  • Female
  • High cholesterol
  • Pregnancy, diabetes
  • Previous bacterial infections of the gallbladder
  • Taking medication (e.g. hormonal contraception)
  • Typhoid fever
  • Diet too high or low in fat
  • Unbalanced nutrition (diets)

Since diet can also influence the formation of gallstones, nutritional counseling is sometimes recommended. We have developed a nutritional therapy program that is tailored to your symptoms with your personal nutritionist. Learn more about therapy here and arrange a free initial consultation. It is also generously subsidized by health insurance companies.

What are symptom-free gallstones?

Biliary tract disease and the formation of gallstones occurs symptom-free in more than 66 percent of the cases. This means that existing gallstones can lie in the biliary tract for years without causing any complaints. The gallstones are usually discovered as a result of an operation or an X-ray examination. The treatment of symptom-free gallstones is controversial.

Most gallstones cause no symptoms.

What are symptoms of gallstones?

Just about 20 to 30 percent of all people with gallstones suffer from symptoms. **If symptoms occur, these are typically:

  • Indigestion,
  • Pain in the right upper abdomen and
  • Biliary colic,

If symptoms occur, it is advisable to clarify them with a doctor: The risk of developing further complications from gallstone disorders is then significantly higher than with symptom-free gallstones.

The main symptoms of gallstones include: Gallstone colic, back pain, abdominal pain, indigestion, fever, nausea, vomiting, fatigue, weight loss and headache

What is gallstone colic?

With gallstone colic, gallstones migrate from the gallbladder into the bile duct. The wandering gallstones cause symptoms such as back pain, pain in the right or middle upper abdomen as well as indigestion such as diarrhea or nausea and vomiting. Circulatory problems and sweating can also occur as side effects. Chronic indigestion, colic or jaundice may be part of the previous medical history.

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How do you recognize gallstone colic?

Bile colic often begins after a rich and heavy meal. The pain can be either creeping or sudden. Often the pain is preceded by a feeling of fullness or a pressure in the upper abdomen. In any case, the pain is of a massive character, which can radiate to the back or to the right shoulder. It is particularly painful when inhaling.

The symptoms here are like a seizure: If the pain is severe and intense at first, it subsides at intervals, so that it rises again after a short time. People often try to find a comfortable position to alleviate the pain. They sway back and forth or have an urge to move, such as constant standing and sitting. If biliary colic is not treated, these symptoms appear at intervals of one to three days or even with abatement of symptoms.

Remember: Right-sided pain in the upper abdomen, between the costal arch and the navel, which has an oppressive, boring character, indicate biliary colic.

What to do in case of gallstone colic?

It is important to stop eating in the first 24 hours. After that, you should first eat smaller meals and avoid fatty, baked, flatulent or chilled foods. A visit to the doctor is essential at the latest after the colic is over.

Important: Acute, boring pain does not always only result from colic: A feeling of pressure in the abdomen, the intolerance to fatty foods, as well as narrowing feelings when wearing clothing close to the body such as corsets, belts or corsages can also indicate a biliary tract disease.

Complicated course of gallstone problems: What are typical symptoms?

If there are other symptoms such as itching or fever in combination with colic, this indicates a complicated course of the gallstone disease. In any case, a doctor should be consulted then. Gallstone symptoms often arise in connection with other diseases. This includes the tendency to kidney stones or diseases of the upper abdomen.

How do you recognize a complicated course of gallstone disease?

In addition to biliary colic, other symptoms caused by gallstones can also occur. Possible symptoms include fever, jaundice, or itching. These symptoms occur in addition to the symptoms of colic and indicate a complicated course of the biliary problems. In any case, a doctor should be consulted.

Gallstones and fever

Inflammation of the gallbladder, also called cholecystis, usually occurs as a result of biliary colic. When the gallstones move, the gallbladder is so irritated that it becomes inflamed. This is often caused by bacteria, so fever and chills are also typical signs. Other symptoms of gallbladder inflammation are: Vomiting, diarrhea, constipation and gas.

Gallstones and itching

With inflammation of the bile ducts, also called cholangitis, the drainage of the bile is blocked. This difficult drainage is often due to the presence of gallstones. If, for example, the gallstones could not migrate into the intestine in the course of a biliary colic, but instead settled, a backflow of the bile flow develops. The symptoms include severe upper abdominal pain, fever, jaundice and severe itching, The stool is then also lightly colored because there is no biliary juice that normally gives the stool its dark color. Gall stasis can sometimes be life-threatening. Cholangitis is mostly difficult to diagnose due to the unspecific symptoms. Flare-ups, itching and a drop in blood pressure can be indicative.

Remember: Signs of jaundice indicate a bile drainage disorder, for example due to entrapment of gallstones.

Why are gallstones more common in women?

Gallstones are more common in women than in men. Factors such as weight, age and hormonal influences play an important role in this. Women who have already given birth to children, who are forty years old and who are also overweight, have a significantly higher risk of developing gallstones. The symptoms in women and men are however the same.

Keep in mind: Women suffer from gallstones up to three times more often.

According to scientific evidence, gallstones seem to be related, among other things, to the female hormone estrogen. Estrogen dominance or an increased estrogen level favors the development of gallstones. Women who use hormonal contraception, for example, are also more likely to be affected.

Conclusion: If gallstones are suspected, a doctor should always be consulted to ensure the diagnosis and to discuss possible treatment options. If severe symptoms such as colic and itching or fever occur, the patient should be transported to a hospital immediately. A doctor should also be consulted at the latest after the first pain interval has subsided.

Lammert, F., Neubrand, M. W., Bittner, R., Feussner, H., Greiner, L., Hagenmüller, F., ... & Riemann, J. F. (2007). S3-Leitlinie der Deutschen Gesellschaft für Verdauungs-und Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen. Zeitschrift für Gastroenterologie, 45(09), 971-1001. Online here

Diagnose und Therapie in der Praxis, K.-H. Huhnstock, W. Kutsch, H. Dehmel (Hrsg.), 2013

Halldestam, I., Enell, E. L., Kullman, E., & Borch, K. (2004). Development of symptoms and complications in individuals with asymptomatic gallstones. British journal of surgery, 91(6), 734-738.

Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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