When you feel a sharp, steady pain under your right rib cage that lasts for hours and doesn’t go away with gas or vomiting, it’s not just indigestion. It could be gallstones - and if this happens more than once, it’s time to pay attention. About 1 in 10 adults in developed countries has gallstones, but most never know it. The real problem starts when those stones block the flow of bile. That’s when biliary colic turns into cholecystitis, and surgery stops being an option - and becomes a necessity.
What Exactly Is Biliary Colic?
Biliary colic isn’t an infection. It’s a warning sign. It happens when a gallstone gets stuck in the cystic duct - the tube that drains bile from your gallbladder. The muscle in the gallbladder contracts hard trying to push bile through, but the stone blocks it. That’s when the pain hits.
The pain is intense, localized to the upper right side of your abdomen or just below your breastbone. It doesn’t come in waves like cramps. It’s steady, builds up within an hour, and lasts 1 to 5 hours. You can’t relieve it by moving, burping, or having a bowel movement. Many people mistake it for heartburn or a stomach bug. But if you’ve had it once, there’s a 90% chance you’ll have it again within 10 years. Two-thirds will get it back within two years.
Most gallstones are made of cholesterol - about 80% in Western countries. The rest are pigment stones, formed from excess bilirubin. They don’t form because of diet alone. It’s about how your body processes bile. If your gallbladder doesn’t empty often enough, cholesterol crystals build up. Obesity, rapid weight loss, pregnancy, and certain medications all raise your risk.
When Biliary Colic Turns Into Cholecystitis
If the stone stays stuck for more than a few hours, your gallbladder starts to swell and get inflamed. That’s acute cholecystitis. It’s no longer just pain - it’s infection waiting to happen.
Symptoms get worse: fever, nausea, vomiting, and tenderness when you press on your right side. The pain doesn’t fade - it lingers for days. Blood tests show elevated white blood cells and liver enzymes. An ultrasound will reveal a thickened gallbladder wall and maybe even fluid around it.
One in five people who have biliary colic will develop cholecystitis. And if left untreated, it can lead to a ruptured gallbladder, sepsis, or stones moving into the common bile duct - causing jaundice or pancreatitis. The NHS reports that 20-30% of people with untreated symptomatic gallstones end up in the emergency room within five years.
That’s why timing matters. The Society of American Gastrointestinal and Endoscopic Surgeons says cholecystectomy should happen within 72 hours of diagnosing acute cholecystitis. Waiting longer increases the chance your surgery will need to be done the old-fashioned way - with a large incision - instead of the minimally invasive option.
Why Laparoscopic Cholecystectomy Is the Gold Standard
For most people with recurring gallstone symptoms, removing the gallbladder is the only reliable fix. And the standard procedure today is laparoscopic cholecystectomy.
This isn’t open surgery with a big cut. It’s done through four tiny incisions. A camera and thin instruments go in, the gallbladder is carefully detached, and removed. The average operation takes 45 to 60 minutes. Most patients go home the same day or the next morning.
Compared to open surgery, recovery is dramatically faster: 7 days versus 30. Hospital stays drop from nearly 5 days to just over 1. Pain is much less. Scarring is minimal. And success rates? Around 95% of patients report major improvement in quality of life.
It’s not without risks. About 5-10% of cases need to be switched to open surgery because of severe scarring, anatomy problems, or uncontrolled bleeding. But in experienced hands, serious complications - like bile duct injury - happen in less than 2% of cases.
Patients under 75 with no major health issues have a 30-day mortality rate below 0.1%. That number jumps to 2.8% for those over 75 with three or more chronic conditions. That’s why doctors don’t rush surgery for frail elderly patients unless absolutely necessary.
What About Non-Surgical Options?
Some people hear "surgery" and panic. They look for alternatives. There are options - but they’re not replacements.
Ursodeoxycholic acid (UDCA) can dissolve small cholesterol stones. But it only works in 30-50% of cases, and it takes 6 to 24 months. Even if it works, half the stones come back within five years. It’s mostly used for people who can’t have surgery - not as a first choice.
Shock-wave lithotripsy breaks stones apart with sound waves, then uses medication to dissolve the fragments. It had promise in the 90s, but recurrence rates were too high. Today, it’s rarely used.
Endoscopic ultrasound-guided drainage is new. The FDA approved it in 2023. It’s for high-risk patients who can’t tolerate surgery. A tiny tube is placed into the gallbladder to drain it, buying time. It’s not a cure - it’s a bridge. One study showed 85% success in stabilizing patients who were too sick for surgery.
There’s no magic pill. Diet changes won’t make gallstones disappear. Low-fat diets help reduce attacks, but they don’t stop stones from forming. Supplements, herbal remedies, and gallbladder flushes? No scientific backing. Don’t waste time or money on them.
What Happens After Surgery?
People worry about living without a gallbladder. The truth? Most don’t notice a difference.
The liver still makes bile. Without the gallbladder to store it, bile flows directly into the small intestine. Some people get looser stools for a few weeks - especially after fatty meals. That usually settles down. About 12% report ongoing diarrhea. A small number - around 6% - develop post-cholecystectomy syndrome: persistent pain, bloating, or nausea. That’s often because something else is wrong - like bile duct stones, Sphincter of Oddi dysfunction, or even undiagnosed IBS.
Recovery is quick. Most get up and walk within 4 hours. Start sipping water and clear liquids within 6 hours. Solid food by the next day. Return to light work in a week. Heavy lifting? Wait 4 to 6 weeks.
One patient from Cleveland Clinic had 17 episodes of biliary colic over 18 months. After surgery, her pain vanished. Within 10 days, she was back to hiking. Two weeks later, she was back at work. That’s the norm, not the exception.
Who Should Consider Surgery - And Who Should Wait?
Not everyone with gallstones needs surgery. But if you’ve had biliary colic, and you’re under 75 with no major heart or lung disease, the answer is almost always yes.
Here’s the rule of thumb:
- Have had one or more attacks? → Surgery is strongly recommended.
- Have diabetes or heart disease? → Talk to your doctor. Risk is higher, but so is the danger of waiting.
- Over 75 with multiple chronic illnesses? → Conservative management may be safer. Monitor closely.
- Have stones but zero symptoms? → Leave them alone. Only 1-3% develop symptoms each year.
Women are 2 to 3 times more likely to get gallstones than men. Hispanic populations have a 45% higher risk than non-Hispanic whites. Obesity is the biggest driver. The global market for gallstone treatments is growing - not because more people are getting sick, but because more people are getting diagnosed and treated.
What Patients Say - Real Stories
A Healthline survey of over 1,200 people found that 78% chose surgery after three or more episodes. Sixty-five percent said severe pain that sent them to the ER was the deciding factor.
On Reddit, 82% of those who had laparoscopic surgery said their quality of life improved within two weeks. The complaints? Diagnostic delays - 41% saw three or more doctors before getting an ultrasound. And 29% said their pain wasn’t managed well during the attack. That’s the hidden problem: doctors miss it. Pain is dismissed as indigestion. Ultrasounds aren’t ordered fast enough.
One man in his 50s waited six months because his GP said it was "just gas." He ended up in the ER with cholecystitis. His surgery was delayed. He needed an open procedure. Recovery took two months. He told his story to warn others: "If your pain is sharp, steady, and doesn’t go away - get an ultrasound. Don’t wait."
Can gallstones go away on their own?
No. Once gallstones form, they don’t dissolve on their own. Some people never have symptoms, so they live with them. But if they cause pain or inflammation, they won’t disappear without treatment. Medications like ursodeoxycholic acid can dissolve small cholesterol stones in some cases, but this takes months and has a high recurrence rate. Surgery remains the only permanent solution.
Is laparoscopic surgery better than open surgery for gallstones?
Yes, for most people. Laparoscopic cholecystectomy uses small incisions, has less pain, shorter hospital stays (1-2 days vs. 4-7 days), and faster recovery (1 week vs. 4-6 weeks). It’s the standard today, used in over 90% of cases in the U.S. Open surgery is only needed if there’s severe inflammation, scarring, or complications during the laparoscopic procedure.
What are the risks of gallbladder removal?
Serious complications are rare - under 2% in experienced hands. The most common risks include bleeding, infection, and injury to the bile duct (which happens in less than 1% of cases). Some people have looser stools after surgery, especially after fatty meals, but this usually improves over time. A small number develop post-cholecystectomy syndrome, which may require further testing to rule out other issues like bile duct stones or IBS.
Can I prevent gallstones with diet?
Diet alone can’t prevent gallstones, but it can reduce the chance of attacks. Avoiding rapid weight loss, eating regular meals, and limiting high-fat, high-sugar foods helps. Obesity and diabetes are major risk factors, so maintaining a healthy weight and managing blood sugar are key. No specific food causes gallstones, but skipping meals or crash dieting increases risk.
Why do some people still have pain after gallbladder removal?
Pain after surgery doesn’t always mean the operation failed. About 6-12% of people report ongoing symptoms. This could be due to bile duct stones that weren’t removed, Sphincter of Oddi dysfunction, irritable bowel syndrome, or even acid reflux. In rare cases, a stone may have been left behind. If pain persists, further tests - like an MRI of the bile ducts or an endoscopic ultrasound - are needed to find the real cause.
When you’re in pain, waiting for answers is the hardest part. But once you have a diagnosis, the path forward is clear. Gallstones aren’t a mystery anymore. We know what causes them. We know how to treat them. And for most people, the solution is simple: remove the source. Not because it’s drastic - but because it works.
PAUL MCQUEEN
February 7, 2026 AT 19:49Ugh, I swear every time I go to the doctor with abdominal pain they just hand me Tums and call it a day. Had two episodes last year - thought it was food poisoning. Turns out? Gallstones. Took six weeks to get an ultrasound. By then, I was in cholecystitis mode. Surgery was a breeze, but the system? Total joke.
Don’t wait like I did. If it’s steady pain under the ribs? Get scanned. No excuses.