Gallstones Symptoms: Signs, Pain, and When to Act

What are gallstones, and who gets them?

Gallstones are hardened deposits that form in the gallbladder — a small, pear-shaped pouch beneath the liver that stores bile. Most are made primarily of cholesterol (roughly 75% of gallstones in Western populations); a smaller proportion are pigment stones made from bilirubin.

Gallstones affect approximately 10–15% of U.S. adults — about 25 million people. Several factors raise the risk 1Ref 1National Institute of Diabetes and Digestive and Kidney Diseases (2023).Definition & Facts for Gallstones.Gallstone prevalence (~10–15% of US adults), cholesterol versus pigment stone types, risk factors including sex and obesity, and ultrasound as the first-line diagnostic test2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Gallstones.Biliary colic symptoms and triggers, the spectrum of gallstone complications (cholecystitis, choledocholithiasis, cholangitis, pancreatitis), and diagnostic approach:

• Female sex, particularly with multiple pregnancies
• Obesity or rapid weight loss
• Age (risk increases from middle age onward)
• A diet high in refined carbohydrates and low in fiber
• Family history of gallstones
• Certain medical conditions (type 2 diabetes, Crohn's disease, blood disorders)
• Some medications, including certain cholesterol drugs and hormone therapy

What does a gallstone attack feel like?

The medical term for a gallstone attack is biliary colic. It happens when a stone temporarily blocks the cystic duct (the outlet of the gallbladder) as the gallbladder contracts — most often triggered by eating.

Typical features of biliary colic:

• Location: Upper right abdomen or the center (epigastric) area; sometimes felt in the right shoulder blade or upper back
• Character: Steady or crampy, intense, building to a peak over 15–30 minutes
• Duration: Usually 30 minutes to a few hours, then eases as the stone moves back or passes
• Triggers: Fatty or rich meals, but can occur at any time, including at night
• Associated symptoms: Nausea, vomiting, bloating, and belching

Not every upper abdominal pain is a gallstone — acid reflux, ulcers, and muscle strain feel similar. An ultrasound is the most common first test to confirm gallstones 1Ref 1National Institute of Diabetes and Digestive and Kidney Diseases (2023).Definition & Facts for Gallstones.Gallstone prevalence (~10–15% of US adults), cholesterol versus pigment stone types, risk factors including sex and obesity, and ultrasound as the first-line diagnostic test.

Can gallstones cause symptoms that feel like heartburn or indigestion?

Yes, and this is a common source of confusion. Some people with gallstones describe a sensation of bloating, fullness, or discomfort after meals rather than sharp pain. These vague digestive complaints can overlap with acid reflux (GERD), irritable bowel syndrome, and other conditions.

A key distinguishing feature of gallstone pain is its location (upper right side or center rather than lower abdomen) and its relation to fatty meals. However, only a clinician with imaging can tell you definitively what is causing your symptoms 1Ref 1National Institute of Diabetes and Digestive and Kidney Diseases (2023).Definition & Facts for Gallstones.Gallstone prevalence (~10–15% of US adults), cholesterol versus pigment stone types, risk factors including sex and obesity, and ultrasound as the first-line diagnostic test2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Gallstones.Biliary colic symptoms and triggers, the spectrum of gallstone complications (cholecystitis, choledocholithiasis, cholangitis, pancreatitis), and diagnostic approach.

When do gallstones become an emergency?

Most gallstone attacks settle on their own, but several complications require prompt or emergency care:

• Acute cholecystitis: If the gallbladder becomes inflamed and the pain does not ease within 4–6 hours, worsens, or is accompanied by fever, this is an emergency requiring hospital evaluation
• Choledocholithiasis: A stone that passes into the common bile duct can cause jaundice (yellowing of skin or eyes), dark urine, and pale stools
• Gallstone pancreatitis: Stone migration triggering pancreatic inflammation causes severe pain radiating to the back
• Cholangitis: Infected bile duct — fever, jaundice, and severe abdominal pain together (Charcot's triad) is a medical emergency

These complications need emergency evaluation 1Ref 1National Institute of Diabetes and Digestive and Kidney Diseases (2023).Definition & Facts for Gallstones.Gallstone prevalence (~10–15% of US adults), cholesterol versus pigment stone types, risk factors including sex and obesity, and ultrasound as the first-line diagnostic test2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Gallstones.Biliary colic symptoms and triggers, the spectrum of gallstone complications (cholecystitis, choledocholithiasis, cholangitis, pancreatitis), and diagnostic approach.

How are gallstones diagnosed?

Your clinician will likely recommend:

• Abdominal ultrasound: The first-line imaging test. It is safe, non-invasive, and highly accurate at detecting gallstones 1Ref 1National Institute of Diabetes and Digestive and Kidney Diseases (2023).Definition & Facts for Gallstones.Gallstone prevalence (~10–15% of US adults), cholesterol versus pigment stone types, risk factors including sex and obesity, and ultrasound as the first-line diagnostic test
• Blood tests: Liver enzymes, bilirubin, and inflammatory markers help assess whether complications are present
• Further imaging (CT or MRCP): Used when the ultrasound is inconclusive or when ductal stones are suspected 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Gallstones.Biliary colic symptoms and triggers, the spectrum of gallstone complications (cholecystitis, choledocholithiasis, cholangitis, pancreatitis), and diagnostic approach

A gastroenterologist is the right specialist to evaluate gallstone symptoms, interpret imaging, and discuss whether watchful waiting or cholecystectomy (gallbladder removal) is the right next step. Gale can help you find a clinician and prepare for that appointment.