How I decide whether a stone explains the pain
The way the pain behaves is more useful than whether it occurs after eating. Gallstones, reflux and other digestive conditions can all cause symptoms after meals. Separate episodes of substantial pain in the upper right or middle of the abdomen fit gallstone pain better than daily bloating, fullness or burning alone.
Before recommending a surgical opinion, I compare that pattern with your scan and blood results and consider other causes. Removing the gallbladder can help typical gallstone attacks, but will not reliably treat symptoms from reflux or irritable bowel syndrome. Fever, jaundice or pain that does not settle needs urgent assessment.
Guidance behind this advice
The position of a stone changes the problem
In the gallbladder
A stone confined to the gallbladder may cause no symptoms. A chance finding does not automatically require an operation.
In the gallbladder
A stone confined to the gallbladder may cause no symptoms. A chance finding does not automatically require an operation.
At the outlet
A stone blocking the gallbladder outlet can cause an attack of pain. Persistent blockage can cause gallbladder inflammation (cholecystitis).
In the bile duct
A duct stone may block bile drainage, cause jaundice or lead to infection. A stone near the shared drainage area can also trigger pancreatitis. Severe pain, fever or jaundice needs urgent assessment.
Simplified illustrations, not to scale. These show an example, not your own anatomy or test result.
Read every diagram explanation
In the gallbladder
A stone confined to the gallbladder may cause no symptoms. A chance finding does not automatically require an operation.
At the outlet
A stone blocking the gallbladder outlet can cause an attack of pain. Persistent blockage can cause gallbladder inflammation (cholecystitis).
In the bile duct
A duct stone may block bile drainage, cause jaundice or lead to infection. A stone near the shared drainage area can also trigger pancreatitis. Severe pain, fever or jaundice needs urgent assessment.
Where do gallstones form?
The liver makes bile, a fluid that helps digest fat. The gallbladder is a small storage pouch underneath the liver, on the right side of your upper abdomen. It releases bile through small drainage tubes called bile ducts into the duodenum, the first part of the small bowel.
Gallstones form when substances in bile collect into solid pieces. A stone can remain inside the gallbladder, block its outlet or move into the main bile duct. These positions can cause different problems.
What does gallstone pain feel like?
Typical gallstone pain, called biliary colic, is a substantial pain in the upper right or middle of the abdomen. It can spread to the back or right shoulder and may cause nausea or vomiting. Despite the name, the pain can be steady. It may follow a meal, although meals do not trigger every attack.
Bloating, heartburn or vague discomfort alone are less specific. Gallstones seen on a scan may be incidental. I consider other causes before recommending treatment because removing the gallbladder will not reliably resolve symptoms caused by another condition.
Warning signs that need urgent assessment
Persistent blockage of the gallbladder outlet can cause inflammation called cholecystitis, often with continuing pain and tenderness. A stone in the common bile duct can obstruct drainage and cause jaundice (yellow eyes or skin), dark urine or pale poo. Infection in a blocked bile duct is called cholangitis and needs urgent treatment.
A stone near where the bile and pancreatic ducts drain into the bowel can also trigger pancreatitis, or inflammation of the pancreas. Severe or continuing pain, fever or jaundice needs urgent assessment. Do not wait for a routine appointment to see whether these symptoms settle.
Which tests might I need?
An ultrasound and blood tests are usually the starting point. I choose any further investigation according to whether I suspect a stone in the gallbladder, a blocked bile duct or another cause of pain.
| Option | What it can show |
|---|---|
| Ultrasound | Gallstones in the gallbladder and widening of the bile ducts. |
| Blood tests | Signs of inflammation, impaired bile drainage or pancreatic inflammation. |
| MRCP or endoscopic ultrasound | A closer assessment when a bile-duct stone is suspected. Not everyone needs these tests. |
| Gastroscopy | The lining of the food pipe, stomach and duodenum. It does not inspect inside the gallbladder or bile ducts. |
What treatment is available?
Gallstones found incidentally, without symptoms or complications, usually do not need treatment. If your symptoms fit gallstone attacks, I can arrange a surgical opinion to discuss removing the gallbladder. An operation is not always required or appropriate; the decision depends on your symptoms, scan findings and health.
ERCP is a specialist endoscopy procedure used to treat bile duct problems, including removing duct stones or helping blocked bile drain. The endoscope reaches the duodenum; small instruments pass through it into the duct opening. ERCP does not remove the gallbladder. Some people need both duct treatment and gallbladder surgery.
If gallstone pain becomes recurrent or affects your daily life, surgery may be recommended because removing the gallbladder prevents further attacks and some complications.
The usual operation is a laparoscopic cholecystectomy, using several small cuts and a camera. An open operation, with a larger cut, is sometimes planned or needed if the gallbladder is severely inflamed, scarred or difficult to remove safely.
You do not need a gallbladder to digest food, because bile continues to flow from the liver into the bowel. Even so, removal is a real operation. Infection, bleeding, bile leakage, injury to the bile duct, blood clots and temporary changes in bowel habit are possible, although serious complications are uncommon.
Many people go home the same day or after one night and return to lighter activities within one to two weeks after keyhole surgery; recovery after open surgery usually takes longer. Your surgeon will give you advice based on the operation and your health.
I can explain why a surgical opinion may be useful and help arrange the referral. The surgeon will discuss whether an operation is right for you, the expected recovery and the specific risks. My work is mainly with procedures inside the digestive tract; gallbladder removal is an operation through the abdominal wall and is performed by a surgeon.
While waiting for assessment, smaller meals or avoiding foods that reliably trigger pain may help. A food diary can be useful, but there is no need for an extreme fat-free diet. Diet does not reliably remove existing stones. I will advise on pain relief and the next step for your situation.
When to get urgent help
Seek urgent medical assessment for severe or continuing upper abdominal pain, fever or shaking chills, yellow eyes or skin, or repeated vomiting. Fever with jaundice or feeling very unwell needs immediate help.
Call 111 if you collapse, become confused, feel faint with severe illness or cannot travel safely.
Three things to remember
- Gallstones found by chance often need no treatment if they remain in the gallbladder and cause no symptoms.
- Typical attacks, continuing pain and bile duct stones need different assessments.
- Gallbladder surgery removes the gallbladder. ERCP treats duct stones and does not remove the gallbladder.
Related information
Sources and further reading
English clinical master checked 15 October 2026.