Gallstones - Treatment 

Treating gallstones 

Gallstones

Gallstones are the most common cause of emergency hospital admission for people with abdominal pain. About 8% of the adult population has gallstones and 50,000 people a year have an operation to remove their gallbladder.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Diet and gallstones

In the past, people with gallstones who were not suitable for surgery were sometimes advised to adopt a very low fat diet to stop the gallstones growing.

However, recent evidence suggests this is not helpful because rapid weight loss resulting from a very low fat diet can actually cause gallstones to grow.

Therefore, if surgery is not recommended or you want to avoid having an operation, it is advisable to adopt a healthy and balanced diet based on the 'eatwell plate'. This involves eating a variety of foods – including moderate amounts of fat – and having regular meals.

A healthy diet will not cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones.

Read more about healthy eating.

Your treatment plan will depend on how the symptoms are affecting your daily life.

If you don't have any symptoms, a policy of ‘active monitoring’ is often recommended. This means you will receive no immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment will depend on how the pain affects your daily activities. If the episodes are mild and infrequent, you may be prescribed painkillers to control further episodes and given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and occur frequently, gallbladder removal surgery will usually be recommended. The gallbladder is not an essential organ and most people notice little difference without it.

Keyhole surgery

In most cases, keyhole surgery will be used to remove your gallbladder if surgery is recommended. This is known as a laparoscopic cholecystectomy.

During a laparoscopic cholecystectomy, three or four small cuts (each about 1cm or less) are made in your abdomen. One cut will be by the belly button and the others will be on the right side of your abdomen.

Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.

laparoscope (a long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor. Your surgeon will then remove your gallbladder using special surgical instruments.

Sometimes, if it's thought there may be gallstones in the bile duct, an X-ray of the bile duct is also taken during the operation. If gallstones are found, they can sometimes be removed during keyhole surgery. If the operation cannot be done this way or an unexpected complication occurs, it may have to be converted to open surgery (see below).

After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.

Laparoscopic cholecystectomies are usually performed under a general anaesthetic, which means you will asleep during the procedure and won't feel any pain while it's carried out. The operation takes 60-90 minutes and you can usually go home the same day. Full recovery typically takes around 10 days.

Single-incision keyhole surgery

Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means you will only have one barely visible scar.

However, single-incision laparoscopic cholecystectomies haven’t been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training.

The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy.

Open surgery

In some circumstances, a laparoscopic cholecystectomy may not be recommended. This may be due to technical reasons, safety concerns or if there is a stone in the bile duct that cannot be removed another way.

A laparoscopic cholecystectomy may not be recommended if you:

  • are in the third trimester (the last three months) of pregnancy
  • are obese – extremely overweight with a body mass index (BMI) of 30 or above
  • you have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10-15cm (4-6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed. This is done under general anaesthetic, so you will be asleep while it is carried out and won't feel any pain.

Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to five days and it typically takes six weeks to fully recover.

Read more about recovering from gallbladder surgery.

Endoscopic retrograde cholangio-pancreatography (ERCP)

An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. However, the gallbladder is not removed during this procedure so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (a long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

However, during ERCP the opening of the bile duct is widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body.

Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

An ERCP is usually carried out under sedation, which means you will be awake throughout the procedure but will not experience any pain.

The ERCP procedure lasts about 30 minutes on average, but it can take anywhere from 15 minutes to over an hour. You may need to stay overnight in hospital after the procedure so you can be monitored.

Medication to dissolve gallstones

If your gallstones are small and don't contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

However, these are not prescribed very often because they are rarely very effective, they need to be taken for a long time (up to two years) and gallstones can recur once treatment is stopped.

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

The use of ursodeoxycholic acid is not usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if it is thought that you are at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

 



Page last reviewed: 18/11/2013

Next review due: 18/11/2015

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Comments

The 15 comments posted are personal views. Any information they give has not been checked and may not be accurate.

SFree said on 18 June 2014

I had my gallbladder removed 9 years ago but 6mths ago I collapsed with a similar pain to what I had before. I was admitted into hospital and kept in overnight for tests including ecg's. Nothing was found and I was sent home. I had several more attacks before receiving an appointment for an ultrasound scan, again nothing was found. The attacks have recently become almost daily so yesterday I paid for a private MRCP scan to be performed. Guess what, I have a 1cm stone in my common bile duct. Whether its a new stone on one that was not found 9yrs ago I have no idea. All I know is it should have been found months ago. I now have to wait to see what is going to be done about it and how long I will have to wait. I prey it will not be to long as I cannot cope with daily attacks lasting up to 8hrs (usually at night) and normally ending up with me passing out and collapsing on the floor when my blood pressure drops down to 65/38. If you suspect you have a rogue stone in a bile duct I highly recommend getting an mrcp scan done as soon as you can to find the culprit.

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Hugo Z Hackenbush said on 10 May 2014

My previous comments are dated 13 July 2013.

I feel fairly safe in reporting the results so far. I started taking peppermint oil capsules ( from Healthspan) - 2 with breakfast and 2 with the evening meal. After about 6 months I dropped it to one capsule (100 mg) with each meal. I also started drinking twice as much water as I would normally do, but that didn't last long before I got out of the habit.

Within a very short time - 3-4 weeks - I went from an average of one painful bout at night per week to zero. Then, perhaps, 2-3 months after starting this regime, I had one bout, which wasn't quite like the usual bout of pain and, since then, absolutely nothing, which is why I dropped the dose down to 2 capsules a day
Instead of 4. I'd like to think that single bout might have been the passing of the stone, but without ultrasound that's just speculation.

It's now 10 months since I started and I feel confident enough to say it has worked for me, and I hope it would work for others.

When I returned to the hospital in Jan 2014 for the six month 'check', the surgeon was not in the least interested in my no longer having pain and signed my case shut.

I shall continue to take one 100mg capsule in the morning and one in the evening indefinitely and, should I ever need ultrasound again, I shall ask the operator to have a quick shufti at the gallbladder.

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abbygirl said on 15 April 2014

My 76 year old sister, who was otherwise in very good health passed away 9 months ago from gallstones that went to the bile duct and left her pancreas perforated and bile leaked and she became badly infected. She went by ambulance to emergency and because her blood pressure was so low and the doctors were hoping her blood pressure would rise, which it did not, they had to go ahead with the operation, and she went into a coma and died on the operating table. I don't understand why doctors are not taking gallstones as a serious problem and operating the way they used to. When her and my niece went to the specialist, he said that they don't operate on gallstones anymore unless you have a severe attack. Please explain this.

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Brook53 said on 25 March 2014

I had an ultrasound to see if I had gallstones none were found but I am still getting pain in upper chest after eating low fat ffood,there was suggestions of Billiary Colic do I have to live with this,the pain is terrible.
Does any one have any remedies.

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Hugo Z Hackenbush said on 13 July 2013

I've got an 8mm stone and am most reluctant to have the bladder removed; it just seems the wrong way to fix things: you don't remove part of yor car's engine if the fuel injector is partially blocked. I told the surgeon that by managing the foods I eat - avoiding ones that bring on the pain (fried or fatty stuff) - and not eating late in the evening, I can prevent recurrence of the pain. I have another appointment in 6 months when we will review things.

Meanwhile, I intend to boost my water intake (I know I don't drink enough), follow advice on the Internet such as foods to avoid and those to eat, and I'm also going to take peppermint oil capsules ( from Healthspan), after reading that Rowachol can sometimes help in reducing stone size and may also stop further stones (but I can't get it without a prescription, and it appears to be largely peppermint oil).

I have had confidence in my GPs up to now, but it was a disappointment that, on my describing my fairly classic symptoms, they did not immediately realise the cause. It took an ultrasound and a consultant to diagnose the problem. Perhaps they just don't have the luxury of time to think. Anyway, I realise that I have to take control and do the research whilst remembering that, wonderful as it is, the Internet has a lot of misinformation on it and some quackery, too.

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User744746 said on 30 January 2013

I have been living with a pain in my right side since september and after 4 hospital trips and 2 CT scans they have found sludge in my gallbladder. i am currently waiting for an ultra sound, i was wondering how long i will have to wait for this it has allready been 6 days and i have not had a letter yet or anyone ring me. i am in allot of discomfort and have had very little sleep i just want to get to the bottem of this sooner rather than later. if anyone else has had to wait for one for suspected gallstones i would be interested to know about your experience.

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turnertr said on 21 December 2012

I suffered from abdominal pains while at CentreParcs and assumed it was something I'd eaten. I was whisked off to the local A&E, given Morphine, and sent back again. (No immediate reccurance - so nothing to do with CentreParcs!). I had two further night-time attacks, each requiring morphine, over about two years. On the 3rd occasion, I was near my local private hospital which I new to be OK'ed by BUPA for gastro stuff, so I called and asked for an appointment. 45 minutes later, I am with the consultant being given a good look at and description of the possibilities (which didn't include gall stones at this stage). I was lined up the next week (after drinking the bowel preparation stuff and feeling like I was going to turn inside out - really!) for an endoscopy, the-other-endoscopy (!), and an ultrasound - which I happened to have first. Bingo - a whole group of stones showed up in the gall bladder. The next week I met the surgeon who, for the first time, used the expression of "feeling like you have a band of steel around your upper abdomen, with the pain radiating from the back to the front" Exactly! Spot on! A week later, keyhole surgery became letter-box surgery when my gall bladder came over all shy and wouldn't come out to be excised and had caused some liver scarring. It meant an overnight stay but that was no problem. It was great to think I would never get the pain again - and, of course, I never have. It hasn't affected me in the slightest as far as I am aware. That the first folks involved didn't spot what it was from my own "pain, radiating from the back" description was, of course, a bit galling... Ha, ha! Tim T.

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pinkcarlady said on 06 December 2012

I'm a bit confused as to the treatment, my g p said that the surgeon would most likely remove the gallbladder but when I asked her about the ultrasound treatment she said that it was fine for kidney stones, but with gallstones they breakup and just form a "sludge" in the bottom of the gallbladder. Anyone had ultrasound treatment?

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vicky_revell said on 17 July 2012

So far I have had 1 attack caused by gallstones and it was agony! I have had an ultrasound and I have 3 gallstones- my doctor has told me to monitor my health and if I have another attack or am not happy then I should go back.
I knew it would take ages to see a doctor and get a scan, so I decided to do some ressearch and see how I could help myself. It would seem that a high fat diet is the worst thing for people woth gallbladder problems, so I have completely changed the way I eat!

I have stopped eating gluten, wheat, eggs, milk, chocolate, biscuits and I no longer have caffeine, so no tea, coffee or fizzy drinks.
Being a vegetarian, I am still eating cheese- but I am eating much smaller quantities and am sticking to low/half fat were possible.
I now eat lots of salad, potatoes, rice/maize/corn pasta and some gluten free treats like vanilla wafers, crispbreads, fruit bars etc. I try to avoid anything that is higher than 5% sat fat.

It hasn't been easy, but I feel so much better. The only downside is that I have to be super organised and can no longer eat on the run! But it is a small price to pay, considering how ill I have been feeling.

Obviously, everyone is different but you can help yourself by looking at your diet and cutting out the things that are known to cause attacks e.g. one of the worst foods for us is onions?!
I used it as a rough guide and mostly, the advice is sound.

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LITTLEREDRIDINGHOOD said on 02 July 2012

continued....i begged them to remove my gallbladder, they couldnt do it until about 12 weeks after having given birth as they said my uterus was too high and some damage to it may occur as a result of the cholecystectomy...however one morning i was discharged at 5am after another 2am attack... i felt very very poorly, went for a walk and some lunch as i felt like i was literally dying...i fell asleep and woke at 7pm screaming, i got taken back in to a&e by ambulance, already dosed up on the pethidine which had become uneffective to me...my blood tests showed a slight infection in my blood....they kept me in overnight for observation...the consultant who said he didnt think i had gallstone problems came in at 8am and said that they would need to remove my gallbladder in 10 minutes....it had got that serious....the bile had been leaking out in to my system and he said that 24 hours later id have gotten septecimia or such like....so i was very very poorly, i feel that if it had not been for my nan telling me what she thought my symptoms were and had i not been pressing for answers i may not have been here today...these days i have side effects of having no gall bladder such as ibs, i can now no longer tolerate much dairy and iv put on a slight bit of weight, literally only a few pounds....but it is definately a lot better than suffering gallbladder disease/pancreatitus or even just biliary colic.... i can say that it is worse than childbirth and i have had 3 children, I am now almost 28, im of a medium build and 5'4 so not particularly overweight or anything.....at first when my attacks subsided i felt like a fraud as i felt fine and couldnt explain what it was...but please if you think you have gallstones, ask for an ultrasound...mine did not show up on xray..it has to be ultrasound.... i hope my comments can be of help to someone! x

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LITTLEREDRIDINGHOOD said on 02 July 2012

Hi, I had severe chest/upper abdo pain right round my ribs and through to my back along with nausea, v & d starting at 32 weeks pregnant....if i think back id had an "attack" about a year before but this was accentuated during pregnancy, from 32 weeks on i started getting an attack a week and by 36 weeks i was visiting a&e approx 2-3 times per week, my grandmother diagnosed my gallstones....docs said it was: baby in wrong position, heartburn, panic attack, pulmonary embolism, anxiety.. I kept saying my nan thinks i have gallstones and that id googled the symptoms and all mine matched, bar 1, the shoulder pain. they said it couldnt be as i was too young... I was 26 years old after suffering for weeks on end I demanded an ultrasound from my gp...she reluctantly booked me in and surprise surprise, there they were, lots and lots of little gall stones floating around... I cried with relief as i knew what it was.... During an attack paracetomol didnt work, neither did ibuprofen, i was prescribed pethidine tablets to take as i was pregnant and it was the strongest stuff i could get without being taken in to hospital....however i only visited a&e when the pethidine wasnt enough which was quite frequently...i was on morphine 2-3 times per week whilst pregnant because I was in soooooo much agony, the only "comfortable" position, which wasnt actually comfortable but more, bearable, was on my knees on the floor and arms on sofa, head down (my bump was in way or id have been curled up in to a ball) i was advised no more than 5 grams of fat per 100 grams which meant my diet was pretty limited.... i was always so hungry, i missed out on the first 6 weeks of my little girls life as i was so so ill and in hospital on morphine at least 3 times a week for hours and hours at a time... i always demanded to be let home to see her as soon as possible after the morphine....i also begged them to remove my gall bladder as i was in so much pain...to be cont...

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Nightstar1 said on 11 June 2012

I seem to have biliary colic and am waiting for my keyhole surgery date. Just wanted to share my experience in case it helps anyone who is having a similar experience. I've kept a record of how the pain feels and what seems to help.
The pain feels like a crushing pain, like my insides being strangled, most of the time centred around my breast bone and when it's bad, spreading to my abdomen and when it's really bad, even to my back.
Stretching my back and sides when it's uncomfortable seems to help. When it's really bad I take paracetamol which seems to be the only thing that always works after a while, mostly almost instantly. Heartburn tablets seem to actually make it worse. When I'm waiting for the paracetamol to kick in, I lie down and keep very still to stop freaking out as stress definitely either triggers it or makes it worse. Trying to talk takes effort and hurts as it seems to need deep breaths to speak. I try to find a balance between taking deep breaths which hurts and short shallow breaths which makes me panic more. Taking long calm breaths but trying not to breathe too deeply eventually seems to calm me down and relax the muscles enough to stop the spasm and "let go of its tight grip".
The relief can feel sudden or slowly loosening. Usually the medium pain lasts about half an hour and comes and goes suddenly and randomly. The really bad pain where I need to lie down lasts up to an hour or two. Hope this helps.

To summarise:
Method for relief: (that's helped for me)
1. Walk around.
2. Stretch back and sides. Hold arms above head, breath in and hold breath.
3. Take 1 or 2 paracetamol if it gets bad.
4. If it gets worse lie down and keep very still.
5. Slow shallow breaths, not deep or fast ones to keep balance between pain and panic.
6. Wait 30 mins - 2 hours, keep very still to relax, try to fall asleep.

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MRGraham said on 23 April 2012

I appreciate this is a month after you posted your question but if your still struggling with diet for your daughter, Chicken and rice i find is the safest meal for me. I tend to buy the uncle bens microwave flavoured rice for abit of flavour, jacket potatoe, Hienz Big soups are good as well as they are like a proper meal minus the fat, beans on toast. Depending on how intollerant she is to fat, for snacky type stuff walkers baked crisps (2.4g fat per bag) Go ahead bars, wine gums.
My worst triggers are eggs, cheese and yoghurts.

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User658432 said on 21 March 2012

my daughter 25 has inflamed gallbladder was admitted they have said it sludgy and gravely and liver function not good. They want to wait as 11 days ago she had a c section and they had to removesome muscle and part of womb because of previous c section. They said this prob worse than bigger stones they not sure if she has bigger stone loose. Contradictory advise on diet she been told no oily fish and no fat, need help on food to give her. She had gestational diabetes with both pregnancies and heartburn. When younger used to get bilious attacks. Need help with diet please

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jwp said on 26 May 2011

I was diagnosed with having gallstones and arrangements made for removal of galbladder. I am unhappy about having a general anaesthic as on the two previous times I have had a general anaesthicihave I have had a bad re-action. Now I read about the alternative Endoscopic retrograde cholangiopancreatolography (ERCP). Why is this not more widely suggested? Why is surgery the first ( and in many cases the only treatment) recommended? i would much rather have an Endoscopic retrograde cholangiopancreatolography (ERCP). I think that a choice should be given, surgery or ECRP

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Having an operation

If your GP has suggested you may need surgery, this guide is for you

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