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Common
Red flags
4
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Biliary colic is the name for the pain caused by gallstones when they temporarily block the duct that drains the gallbladder. The gallbladder squeezes against the blockage, and this causes pain that builds up and then fades. Many people have gallstones without ever feeling anything; biliary colic is what happens when stones start to cause symptoms. It is different from acute cholecystitis, in which the gallbladder becomes inflamed and the pain does not settle.
How common is it?
Gallstones are common in adults, and only a minority of people who have them develop pain. Those who have had one attack are likely to have more over time.
Why does it happen?
Gallstones form when substances in bile, mainly cholesterol or bilirubin (a yellow pigment), clump into hard particles. After a meal, especially one containing fat, the gallbladder contracts. If a stone is pushed against the outlet, pain results. Risk factors include being female, pregnancy, overweight and obesity, rapid weight loss, older age, a family history of gallstones and some medical conditions.
Symptoms
- Pain in the upper right or upper middle belly that builds quickly and stays steady, often for 30 minutes to a few hours
- Pain that can spread to the back or the right shoulder blade
- Often starts after a meal, especially a fatty one, or at night
- Nausea or vomiting during the attack
- Sweating or restlessness; many people cannot find a comfortable position
- Completely well between attacks
Red flags — seek urgent medical care
Pain lasting more than about 4 to 6 hours, or pain with fever or chills
May mean the gallbladder is inflamed or infected. Go to the emergency department.
Yellow skin or eyes, dark urine, pale stools or itching
A stone may have moved into the main bile duct. This needs urgent assessment.
Severe pain going through to the back with repeated vomiting
Could be gallstone pancreatitis (inflammation of the pancreas). Seek emergency care.
Chest pain, breathlessness or sweating with the pain
Upper belly pain can sometimes come from the heart. If in doubt, call emergency services.
How is it diagnosed?
The pattern of pain is very characteristic, and your doctor will ask about it in detail. An ultrasound of the abdomen is the main test and shows gallstones well. Blood tests (including liver tests) help check that a stone is not causing a blockage, infection or pancreatitis. Occasionally an MRI of the bile ducts or an endoscopic ultrasound is used to look for small stones or stones in the duct.
Outlook — what to expect
Biliary colic tends to return. Removing the gallbladder (cholecystectomy) is the most reliable way to prevent further attacks and complications, and most people do very well afterwards. Whether and when to operate is decided together with your surgeon.
Treatment
Habits & Lifestyle
Lifestyle steps may reduce triggers and support a healthy weight, but they do not make existing stones disappear.
- Aim for gradual weight loss if you are overweight; avoid crash diets, which can cause stones
- Stay physically active as advised by your doctor
- Do not skip meals for long periods and then eat very large meals
- Keep a note of when attacks happen and what you ate, and show it to your doctor
Diet
Many people notice that large or fatty meals trigger attacks.
- Choose smaller, lighter meals and limit deep-fried and very fatty foods if they trigger pain
- Eat more vegetables, fruit, whole grains and legumes
- Healthy fats such as olive oil and nuts in moderate amounts are generally fine unless they bring on pain
- There is no proven diet that dissolves gallstones
Medications
Medicines can ease pain, but they cannot reliably prevent attacks. Your doctor decides what is suitable.
- Simple pain relief or anti-inflammatory medicines may be advised for attacks; check first with your doctor if you have kidney, stomach or bleeding problems
- Medicines that dissolve stones (bile acid tablets) work slowly, only on some small cholesterol stones, and stones often return when stopped; they are used only for selected people
- Do not use herbal "gallbladder flushes" or large amounts of oil; they are not proven and can cause harm
Procedures & Surgery
Surgery is the standard treatment for stones that cause symptoms.
- Laparoscopic cholecystectomy (keyhole gallbladder removal) is usually done as a day case or with a short stay
- Surgery is usually advised after attacks start because they tend to recur
- If a stone is in the main bile duct, ERCP (a scope procedure) may be used to remove it
- If you are not fit for surgery, your doctor will discuss other options and how to recognise complications
Living with the condition
- Know your emergency signs: pain that does not settle, fever, or yellow skin.
- If you are waiting for surgery, keep your meals small and low in fat to reduce attacks.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Do I need surgery, and how long can I safely wait?
- Could my pain be from something other than gallstones?
- Which pain medicine is safe for me during an attack?
- Will I need to change my diet after gallbladder removal?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide