When your right upper abdomen suddenly locks up in sharp, unrelenting pain, it’s not just indigestion. It could be a gallstone blocking the flow of bile. This isn’t rare - about 1 in 10 adults in the U.S. has gallstones. But most never know it. The real problem starts when those stones cause biliary colic - the first warning sign that something’s wrong.
What Happens During Biliary Colic?
Biliary colic isn’t a disease. It’s a symptom. It happens when a gallstone gets stuck in the cystic duct, the tube that drains bile from your gallbladder. The gallbladder contracts, trying to push bile through, but the stone blocks it. That’s when the pain hits.The pain is steady, not crampy. It doesn’t come and go with gas or vomiting. It starts suddenly, peaks within an hour, and lasts 1 to 5 hours. You’ll feel it under your right ribs or in the center of your belly, sometimes radiating to your right shoulder. It’s not the kind of pain you can ignore. Most people end up in the ER because of it.
Cholesterol stones make up 80% of cases in the U.S. They form when bile has too much cholesterol and not enough bile salts. The rest are pigment stones, made of bilirubin, often linked to liver disease or blood disorders. Women are 2 to 3 times more likely to get them than men. Obesity, rapid weight loss, and being over 40 also raise your risk.
When Biliary Colic Turns Into Cholecystitis
If the stone doesn’t move and the blockage lasts more than a few hours, your gallbladder starts to swell and get inflamed. That’s acute cholecystitis. It’s not just pain anymore - it’s infection waiting to happen.Signs include fever, nausea, vomiting, and tenderness when you press on your upper right abdomen. The pain doesn’t go away like it does with biliary colic. It sticks around for days. About 1 in 5 people who have biliary colic will develop cholecystitis. Left untreated, it can lead to a ruptured gallbladder, abscesses, or even sepsis.
Doctors use ultrasound to confirm it. That’s the go-to test - quick, no radiation, and 95% accurate for gallstones. Blood tests might show elevated white blood cells or liver enzymes. If the stone has moved into the common bile duct, you might turn yellow (jaundice) or have dark urine - that’s choledocholithiasis. It’s serious. It can also trigger pancreatitis, which is life-threatening.
Can You Dissolve Gallstones Without Surgery?
You might have heard about pills that dissolve gallstones. Ursodeoxycholic acid (UDCA) is real - but it’s not a magic fix. It only works on small, pure cholesterol stones. Success rates? 30% to 50% after 6 to 24 months of daily pills. And even if it works, half the people get stones back within five years.Shock wave therapy (lithotripsy) used to be an option. It breaks stones into tiny pieces, then you take pills to dissolve them. But it’s rarely used now. Why? It’s expensive, requires multiple sessions, and the stones come back. Plus, it doesn’t work on multiple stones or larger ones.
There’s no reliable medication to prevent stones from forming. Lifestyle changes - losing weight slowly, eating regular meals, avoiding high-fat junk food - help reduce risk, but they won’t make existing stones disappear. If you’ve had even one episode of biliary colic, the odds are stacked against you. More than 90% of people will have another episode within 10 years. Two-thirds get another one within two years.
Why Surgery Is the Standard - and When It’s Best
The only reliable fix for symptomatic gallstones is removing the gallbladder. That’s cholecystectomy. And in the U.S., 90% of these surgeries are done laparoscopically.Laparoscopic surgery means four small cuts, a camera, and tiny tools. Most people go home the same day or the next morning. Recovery? About 7 days. Compare that to open surgery - a big cut, 4 to 5 days in the hospital, and a month to feel normal again.
Studies show 95% of patients are happy with the results. Pain disappears. No more ER visits. No more anxiety before meals. A 45-year-old woman in Cleveland Clinic’s patient newsletter had 17 episodes of biliary colic over 18 months. After surgery, her pain was gone in 10 days. Back to work in two weeks.
But timing matters. If you have acute cholecystitis, the Society of American Gastrointestinal and Endoscopic Surgeons recommends surgery within 72 hours. Waiting increases the chance your surgery will need to be converted to open - from 25% down to just 7% if done early.
Who Should Avoid Surgery?
Not everyone is a good candidate. For healthy people under 75, the risk of surgery is low - under 2% for complications. But for older adults with heart disease, diabetes, or lung problems, the risk jumps.Dr. Emily Finlayson at UCSF points out that for patients over 75 with three or more chronic conditions, the 30-day death rate after surgery rises to 2.8%. That’s not a small number. In those cases, doctors may delay surgery and treat with antibiotics and pain control first. Some may never have surgery if their symptoms are mild and they’re not willing to take the risk.
There’s also a new option for high-risk patients: endoscopic ultrasound-guided gallbladder drainage. The FDA approved it in 2023. It’s not a cure - it’s a bridge. A thin tube is placed into the gallbladder to drain the infection. It buys time. It’s used when surgery is too dangerous right now. But eventually, most still need the gallbladder removed.
What to Expect After Surgery
Most people bounce back fast. You’ll be up and walking within 4 hours. Eat light - broth, toast, yogurt - within 6 hours. No heavy lifting for two weeks. You’ll feel fine in a week.But not everyone feels perfect. About 12% develop diarrhea after surgery. That’s because bile flows directly into the intestine instead of being stored. It’s usually temporary. A few people get what’s called post-cholecystectomy syndrome - ongoing pain, bloating, or nausea. That’s rare - about 6% - and often means another issue was missed, like a bile duct stone or a motility problem.
Some patients report feeling “off” for months. That’s often because they’re still eating the same high-fat meals they did before. Your body adapts. Give it time. Cut back on fried food, creamy sauces, and butter. Eat smaller, more frequent meals. Your digestion will adjust.
The Bigger Picture: Why This Matters
About 700,000 gallbladder surgeries are done in the U.S. every year. That’s $6.2 billion in costs. The global market for gallstone treatments is growing - mostly because obesity rates are rising. Nearly 40% of U.S. adults are obese. That’s a recipe for more gallstones.Hispanic populations have a 45% higher risk than non-Hispanic whites. Women, especially those who’ve had children, are at higher risk. Age matters. The older you are, the more likely you are to have stones - and the riskier surgery becomes.
But here’s the truth: if you’ve had biliary colic, waiting doesn’t help. The longer you wait, the more likely you are to end up in the hospital with cholecystitis. Emergency surgery is harder, riskier, and more expensive. Most people who delay surgery end up having it anyway - within 5 to 6 years.
Doctors now use ERAS protocols - Enhanced Recovery After Surgery. That means getting you moving fast, eating early, and minimizing pain meds. Hospitals using these protocols see 30% shorter hospital stays and 25% fewer readmissions.
There’s no perfect non-surgical cure. Pills don’t last. Shock waves are outdated. Drainage tubes are temporary. Surgery is the only thing that gives you back your life - without the fear of the next attack.
What to Do Next
If you’ve had one episode of biliary colic, talk to your doctor about surgery. Don’t wait for the next attack. Don’t assume it’ll go away. Get an ultrasound. See a surgeon. Ask about laparoscopic cholecystectomy. Ask about timing. Ask about risks based on your age and health.If you’re over 75 with multiple health problems, ask about drainage as a bridge - but don’t assume you’re off the hook. You still need a plan.
And if you’ve had surgery and still have symptoms? Don’t brush it off. Go back. Something might be missed. You’re not imagining it. You’re not alone.
Gallstones aren’t glamorous. But they’re common. And they’re fixable. The sooner you act, the less pain you’ll live with - and the better your life will be after.
Stacy Tolbert
I had my gallbladder out last year after 14 episodes of pain. I thought I was just ‘bad at digestion’ until I collapsed in the grocery store. The ER doc said, ‘You’re lucky you didn’t rupture.’ Now I eat salads like a healthy person and still miss fried chicken. But not enough to go back. 🤢
Ryan Brady
U.S. spends $6.2 BILLION on this? LOL. Just cut out carbs and butter like real people did before Big Pharma sold you pills. My grandpa had stones in the 50s, ate beans and eggs, never saw a surgeon. Now everyone’s a patient. 🇺🇸
Raja Herbal
So let me get this straight - we’ve got a whole medical industrial complex built around removing a perfectly functional organ because people won’t stop eating nachos? 🤔 I mean, sure, I get the pain. But also… maybe stop eating like a 24-hour buffet? I’m from India - we’ve had gallstones for centuries, and most folks just ate dal and rice. No surgery needed. Just less ghee.
Iris Carmen
so i had the surgery last summer and honestly? i still get bloated sometimes. like… is this normal? or did i just get scammed? also i miss butter on my toast. so much. 😭
Rich Paul
Look, if you’ve had biliary colic once, you’re already in the 90% group that’ll get it again. The gallbladder is a dumb evolutionary holdover anyway - a biological afterthought. The liver makes bile, the gallbladder just hoards it like a hoarder with expired coupons. Cholecystectomy isn’t surgery, it’s a liberation. Laparoscopic? That’s just a fancy way of saying ‘we poke holes and fix you with a camera.’ No big deal. You’re not losing a vital organ - you’re losing a liability. And if you’re worried about diarrhea? That’s just your body finally learning to stop storing grease like it’s the last day of a buffet. Eat smaller meals, stop pretending you’re a French chef, and you’ll be fine. Also - yes, UDCA is garbage. Don’t waste your money. Surgery is the only real ROI.
Delaine Kiara
My sister had cholecystitis and they told her to wait 72 hours for surgery - so she waited 7 days. By then, her gallbladder was so swollen it looked like a water balloon full of rage. They had to do open surgery. She’s got a scar that goes from her ribs to her hip. She says it feels like she’s got a zipper inside her. And now? She can’t eat pizza without crying. I’m telling you - if you’ve had one episode, just do it. Don’t wait for the horror movie version. I’ve seen people who waited. I’ve seen the scars. I’ve seen the tears. Just. Get. It. Out. 💔
Ruth Witte
YOU GOT THIS 💪🏽 After surgery, I felt like a new person - like I’d been running with a backpack full of rocks and someone finally took it off. 🥹 Start with broth, then toast, then… maybe avocado toast (yes, it’s okay). I still eat fatty stuff sometimes - but now I know my body’s limits. And guess what? I’m alive. I’m pain-free. I’m living. You can too. 💖 #GallbladderFreeAndProud
Noah Raines
My dad had the drainage tube thing last year - 78, diabetes, triple bypass. Doc said surgery was too risky. Tube in, infection cleared, he’s chillin’ for now. But here’s the kicker - he’s still gonna need the gallbladder out eventually. That tube? It’s not a fix. It’s a delay tactic. Don’t let anyone tell you it’s ‘better.’ It’s just ‘later.’ And later gets harder. Do it now. You’ll thank yourself.