Most gallstones don’t pass on their own. For a gallstone to travel naturally from your gallbladder through your bile ducts and into your intestines, it needs to be smaller than about 5 millimeters, roughly the size of a small pea. Stones larger than that are too wide for the ducts to accommodate, and the majority of gallstones that cause problems require some form of medical intervention to remove.
How Gallstones Pass Naturally
Your gallbladder stores bile and releases it into a narrow tube called the cystic duct, which connects to the common bile duct leading to your small intestine. The common bile duct is typically less than 6 to 7 millimeters wide in adults. That tight space is the bottleneck. A stone under 5 millimeters can sometimes squeeze through, drop into your intestine, and leave your body in your stool without you ever noticing.
When a stone does try to pass, it often causes what’s known as biliary colic: a sharp, building pain in your upper abdomen, usually on the right side, that can last anywhere from 20 minutes to several hours. Many people feel it shortly after eating, especially after a fatty meal, because that’s when your gallbladder contracts to release bile. The pain eases when the stone shifts enough to let bile flow again, or when digestion slows and the gallbladder stops squeezing. If the stone successfully passes through, the episodes stop. If it gets stuck partway or keeps shifting back into a blocking position, the pain returns in repeated episodes.
When Gallstones Don’t Need Treatment
Most people with gallstones never know they have them. If stones are discovered incidentally on an imaging scan but aren’t causing any symptoms, the standard approach is to leave them alone. According to guidelines from the World Gastroenterology Organisation, surgery offers no benefit for asymptomatic gallstones, and the risks of an operation outweigh the small chance of future complications. The annual rate of serious problems like pancreatitis, infection, or bile duct blockage in people with silent gallstones is only 0.2 to 0.8 percent.
There are a few exceptions. People who are immunosuppressed (such as organ transplant recipients), those with insulin-dependent diabetes, people experiencing rapid weight loss, and anyone with a calcified “porcelain” gallbladder may be advised to have surgery even without symptoms because their risk of dangerous complications is higher.
Medication to Dissolve Gallstones
A prescription medication called ursodiol can slowly dissolve certain gallstones without surgery. It works by reducing the amount of cholesterol your liver puts into bile, gradually breaking down stones made of cholesterol. The catch is that it only works on cholesterol stones, and it’s most effective on small, “floating” stones. Pigment stones, which are made of bilirubin and calcium salts, don’t respond to it.
Even when it does work, dissolution therapy is slow. Treatment typically lasts months, and stones can recur after you stop taking the medication. It’s generally reserved for people who can’t safely undergo surgery due to other health conditions rather than used as a first-line option.
Procedures to Remove Stuck Stones
If a gallstone gets lodged in the common bile duct, a procedure called ERCP (endoscopic retrograde cholangiopancreatography) can retrieve it without open surgery. A thin, flexible scope is guided through your mouth, down through your stomach, and into the opening where the bile duct meets your small intestine. Through the scope, the doctor can make a small cut in the muscle that surrounds the duct opening to widen it, then use tiny instruments to break up the stone and pull the fragments out. You’re sedated during the procedure, and most people go home the same day or the next.
Shock wave therapy, which uses focused sound waves to shatter stones (similar to what’s done for kidney stones), is rarely used for gallstones anymore. Studies have shown it has low success rates, especially for multiple stones, and the recurrence rate is high.
Gallbladder Removal Surgery
When gallstones cause repeated painful episodes, inflammation of the gallbladder, blockage of the bile duct, or gallstone-triggered pancreatitis, the most definitive treatment is removing the gallbladder entirely. This surgery, called cholecystectomy, is one of the most common operations performed worldwide. The vast majority are done laparoscopically through a few small incisions, with most people returning to normal activities within a week or two.
You can live normally without a gallbladder. Your liver continues producing bile, but instead of being stored and released in concentrated bursts, it drips continuously into your small intestine. Some people notice looser stools or mild digestive sensitivity to fatty foods for a few weeks or months afterward, but this usually resolves on its own.
Why Gallbladder Flushes Don’t Work
You’ll find plenty of online advice about “gallbladder cleanses” or “liver flushes” involving olive oil, lemon juice, apple cider vinegar, or herbal mixtures. There is no reliable evidence that any of these prevent or treat gallstones. The lumpy, greenish globs that people sometimes see in their stool after a flush aren’t gallstones. They’re solidified clumps of oil, juice, and digestive fluids that formed in the gut during the cleanse itself.
Beyond being ineffective, these flushes carry real risks. They commonly cause nausea, vomiting, diarrhea, and abdominal pain. Some of the ingredients can interact with medications or cause problems of their own. If you actually have a stone large enough to cause symptoms, a flush won’t shrink it or help it pass, and delaying real treatment can lead to serious complications.
Dangerous Complications to Watch For
A gallstone that fully blocks a bile duct can trigger inflammation of the gallbladder, infection in the bile ducts, or acute pancreatitis. Pancreatitis from gallstones causes severe upper abdominal pain that often radiates to the back, along with nausea, vomiting, fever, and a rapid heartbeat. This is a medical emergency. If you have gallstone pain that becomes constant rather than coming in waves, is so severe you can’t find a comfortable position, or is accompanied by fever, yellowing of your skin or eyes, or persistent vomiting, you need emergency care. These signs mean a stone is causing a blockage that your body cannot resolve on its own.