Cholelithiasis is the medical term for gallstones. It refers to hard deposits that form inside the gallbladder, a small organ beneath your liver that stores bile. Gallstones affect roughly 5 to 6% of men and 8 to 9% of women in the United States and Europe, making them one of the most common digestive conditions.
How Gallstones Form
Your liver produces bile, a digestive fluid that helps break down fats. The gallbladder stores this bile between meals, then squeezes it into your small intestine when you eat. Gallstones form when certain substances in bile, most often cholesterol, become too concentrated and harden into solid pieces. These can be as small as a grain of sand or as large as a golf ball, and you can develop a single stone or dozens at once.
About 73% of gallstones are cholesterol stones, made up primarily of hardened cholesterol (averaging 77% of their dry weight). The remaining stones are pigment stones, which form from a bile pigment called bilirubin. Pigment stones tend to be smaller and darker. They’re more common in people with certain blood disorders where red blood cells break down rapidly, producing excess bilirubin.
Who Is Most at Risk
Gallstones are more common in women, people over 40, and those with a family history of the condition. Obesity is a major risk factor because it increases cholesterol levels in bile. Hispanic ethnicity also carries higher risk. These patterns hold true even in children, where rising obesity rates have made gallstones increasingly common in younger age groups.
Rapid weight loss can also trigger gallstone formation. When you lose weight quickly, the liver secretes extra cholesterol into bile, and the gallbladder may not empty as efficiently. Pregnancy raises the risk for similar reasons: hormonal changes slow gallbladder emptying and increase cholesterol saturation in bile. Certain genetic conditions that cause chronic breakdown of red blood cells, such as sickle cell disease, predispose people specifically to pigment stones.
What Gallstone Pain Feels Like
Many people with gallstones never experience symptoms. The stones sit quietly in the gallbladder and are often discovered incidentally during imaging for something else. These “silent” gallstones typically don’t require treatment.
When a gallstone does cause problems, the hallmark symptom is a steady, building pain in the upper right abdomen, just under the ribcage. This happens when a stone temporarily blocks the opening of the gallbladder during a contraction. The pain, called biliary colic, builds to a peak and then slowly fades, with episodes lasting anywhere from a few minutes to several hours. It commonly radiates to the right shoulder, the right arm, or between the shoulder blades.
Fatty or heavy meals are a classic trigger. Your small intestine detects the fat content in a meal and signals the gallbladder to contract harder to release more bile. A bigger contraction against a stone lodged in the opening means more intense pain. Nausea and vomiting often accompany an attack.
Complications Worth Knowing About
The most common complication is cholecystitis, which is inflammation of the gallbladder itself. This happens when a stone stays lodged in the gallbladder’s outlet for an extended period, trapping bile inside. The gallbladder becomes swollen, inflamed, and sometimes infected. Unlike biliary colic, the pain from cholecystitis doesn’t fade on its own and is often accompanied by fever. Without treatment, about 10% of cholecystitis cases can lead to a perforated gallbladder, which carries a mortality rate of up to 16%.
Stones can also slip out of the gallbladder and travel into the bile ducts, the tubes that carry bile to the intestine. A stone stuck in the common bile duct can cause jaundice (yellowing of the skin and eyes), pale stools, and a serious infection of the bile duct system. If a stone blocks the duct where the pancreas drains, it can trigger gallstone pancreatitis, a painful and potentially dangerous inflammation of the pancreas. In rare cases, a large stone erodes through the gallbladder wall into the small intestine and causes a bowel obstruction.
How Gallstones Are Diagnosed
Abdominal ultrasound is the standard first test. It’s noninvasive, widely available, and has a sensitivity of 84 to 97% for detecting gallstones. The test uses sound waves to create images of the gallbladder, where stones show up as bright spots with shadows behind them. If your doctor suspects a stone has moved into the bile ducts, additional imaging or specialized scans may be needed to find it.
Treatment Options
Silent gallstones that cause no symptoms are generally left alone. Once gallstones start causing repeated pain or complications, the standard treatment is surgical removal of the gallbladder. This is the only cure for symptomatic gallstones. Most people have this done laparoscopically, through a few small incisions, and go home the same day or the next. You can live normally without a gallbladder. Bile simply flows directly from the liver into the small intestine instead of being stored first.
For people who can’t safely undergo surgery due to other serious illnesses, there are alternatives. Oral medications can slowly dissolve small cholesterol stones, but the process takes 6 to 12 months and gallstones frequently return within five years. In certain high-risk patients, stones can be addressed through drainage procedures done through the skin or through an endoscopic stent placed into the gallbladder. These are temporizing measures rather than permanent fixes.
One specific situation that pushes toward surgery even without typical symptoms is a porcelain gallbladder, where the gallbladder wall becomes calcified over time due to chronic stone irritation. This condition carries an increased risk of gallbladder cancer, so removal is recommended regardless of symptoms.