Most gallstones that cause symptoms cannot be safely “passed” the way you’d pass a kidney stone. The common bile duct, the tube a gallstone must travel through to reach your intestine, averages only about 6.7 mm in diameter. Stones smaller than 5 mm sometimes slip through on their own, but larger stones often get stuck, causing intense pain or dangerous blockages. Understanding what’s actually happening inside your body helps you figure out whether you’re waiting out a passing stone or dealing with something that needs medical attention.
Why Gallstones Are Harder to Pass Than You Think
Gallstones form inside the gallbladder, a small pouch tucked under your liver. To leave your body naturally, a stone has to squeeze through the cystic duct (which connects the gallbladder to the bile system) and then through the common bile duct into your small intestine. The common bile duct is narrow, averaging under 7 mm across in most adults, and it widens only slightly with age. People over 50 may have a duct closer to 7 or 8 mm, but that still leaves very little room.
Stones under 5 mm have the best chance of passing without intervention. Stones between 5 and 10 mm sometimes pass but carry a higher risk of getting lodged. Stones larger than 10 mm rarely make it through on their own, and a stuck stone can block bile flow entirely, leading to infection, jaundice, or pancreatitis.
What a Passing Stone Feels Like
When a gallstone moves into a duct, you’ll typically feel a steady, gripping pain in the upper right abdomen near the rib cage. This is called biliary colic. The pain can be severe and may radiate to the upper back or behind the breastbone. Nausea and vomiting are common. Episodes usually last 30 minutes to several hours, then gradually ease as the stone either passes through into the intestine or falls back into the gallbladder.
Biliary colic tends to come and go. If your pain is constant, lasts more than a few hours, and gets worse when you breathe in, or if you develop a fever, chills, yellowing of the skin or eyes, dark urine, or pale stools, the situation has likely progressed beyond a simple passing stone. Constant pain with fever suggests the gallbladder itself has become inflamed. Jaundice or changes in urine and stool color mean a stone is blocking the common bile duct. Both of these are emergencies that need treatment within hours.
Managing Pain While You Wait
If you’re having a biliary colic episode and your doctor has confirmed it’s not an emergency, pain management is the main goal while the stone either passes or settles back down. Anti-inflammatory pain relievers can help take the edge off. Applying a heating pad to your upper right abdomen may also provide some comfort.
During an episode, avoid eating. Food triggers the gallbladder to contract and squeeze bile into the digestive tract, which can push the stone further into a duct and intensify the pain. Once the pain subsides, stick to low-fat meals for the next few days. Fatty foods cause the strongest gallbladder contractions.
Certain pain medications used in hospitals for biliary colic work by relaxing the muscles around the ducts, giving the stone more room. Some opioid-type painkillers are avoided because they can tighten the valve where the bile duct meets the intestine, making things worse. This is one reason managing a gallstone episode at home with whatever’s in your medicine cabinet has limits.
The Olive Oil “Flush” Doesn’t Work
You’ve probably come across claims that drinking large amounts of olive oil and lemon juice can flush gallstones out. People who try this often report passing green, waxy lumps in their stool and assume they’ve expelled their stones. Lab analysis tells a different story. A study published in The Lancet examined these “stones” and found they contained no cholesterol, no bilirubin, and no calcium, the actual components of real gallstones. They melted into an oily green liquid at body temperature.
What’s actually happening is a chemical reaction. Olive oil gets partially broken down by stomach enzymes, and the resulting fatty acids mix with potassium from the lemon juice to form soap-like balls. They’re essentially lumps of saponified fat, not gallstones. Meanwhile, any real gallstones remain exactly where they were. Worse, the large volume of fat consumed during a flush triggers powerful gallbladder contractions, which could push a real stone into a duct and cause an emergency.
Dissolving Stones With Medication
For people who can’t or don’t want to have surgery, a bile acid medication called ursodiol can slowly dissolve cholesterol gallstones. It works by changing the chemical balance of your bile so it can break down the cholesterol in existing stones. This only works on cholesterol stones, not on the pigment stones that make up about 20% of cases.
Success depends heavily on stone size. Stones under 5 mm dissolve in about 70% of patients. Stones under 10 mm dissolve in roughly half. For stones larger than 10 mm, the success rate drops to around 29%. A meta-analysis of all randomized trials found an overall dissolution rate of 37%, so it works for some people but not most. Treatment takes months to years, and you’ll need repeat ultrasounds to confirm the stones are actually shrinking. If there’s no progress after six months, or only partial dissolution after two years, doctors typically recommend stopping.
Even when dissolution works, stones come back in a significant number of cases because the underlying chemistry of the bile hasn’t permanently changed.
When Doctors Need to Remove a Stuck Stone
If a stone gets lodged in the common bile duct, it usually won’t pass on its own and needs to be removed. The most common procedure for this is called ERCP. A thin, flexible scope is guided through your mouth and stomach into the opening where the bile duct empties into the small intestine. The doctor can then widen the opening and pull the stone out, or place a small stent to keep the duct open.
ERCP is typically done under sedation, and most people go home the same day or the next morning. It’s specifically for stones stuck in the ducts, not for stones still sitting in the gallbladder.
Another option, shock wave lithotripsy, uses targeted sound waves to break stones into smaller pieces that can pass more easily. It’s used more commonly for kidney stones and pancreatic duct stones, and it has limitations for gallstones. Stones in very narrow ducts may not pass even after being broken up, and certain stone compositions don’t fragment well. It’s also not an option if you’re pregnant, take blood thinners, or need urgent, guaranteed clearance.
Gallbladder Removal: The Definitive Fix
If you’re having repeated episodes of biliary colic, or if a stone has caused complications like inflammation or duct blockage, most doctors will recommend removing the gallbladder entirely. This is one of the most commonly performed surgeries worldwide, and it’s done laparoscopically through a few small incisions in the abdomen.
Recovery is faster than many people expect. Most patients go home the same day. Returning to work typically takes one to two weeks. Your body doesn’t need a gallbladder to digest food. Without it, bile drips continuously from the liver into the intestine rather than being stored and released in bursts. Some people notice looser stools or mild digestive changes for a few weeks after surgery, but these usually settle down.
The reason surgery is so commonly recommended is simple math. Once you’ve had one symptomatic episode, there’s a high likelihood of more. And each episode carries a small but real risk of a stone getting stuck in a dangerous spot. Removing the gallbladder eliminates that risk permanently, while dissolution therapy and watchful waiting leave it in place.