Overview

Biliary colic is a dull pain in the middle to upper right area of the abdomen. It occurs when a gallstone blocks the bile duct, the tube that normally drains bile from the gallbladder to the small intestine. The pain goes away if the stone passes into the small intestine and unblocks the duct. The usual treatment for chronic gallstones with pain is removal of the gallbladder. This organ is not essential to digestive health.

Cause

Biliary colic happens when the gallbladder contracts and causes a gallstone to temporarily block the duct that drains the gallbladder. Gallstones are hard masses that form in the gallbladder. They can be small and numerous, or large and few. Gallstones form due to chemical imbalances in bile or infrequent or incomplete emptying of the gallbladder.

Increased pressure in the gallbladder causes the pain and discomfort associated with biliary colic.

What is bile?

Bile and digestive enzymes are carried by the bile ducts from the liver, gallbladder, and pancreas to the small intestine. The bile carries away wastes from the liver and helps digest fats. A portion of the bile is stored in the gallbladder. Eating a meal makes the gallbladder contract, or squeeze inward. This empties the gallbladder’s contents into the small intestine.

Symptoms

A person with biliary colic typically feels pain in the middle to right upper abdomen. The pain can feel sharp, crampy, or like a constant dull ache. Colic often occurs in the evening, especially after eating a heavy meal. Some people feel it after bedtime.

The worst pain of biliary colic commonly lasts for 30 minutes to an hour, but may continue at a lower intensity for several more hours. The pain stops when the gallstone breaks free of the bile duct and passes into the intestine.

Biliary colic vs. cholecystitis

Cholecystitis is an inflammation of the gallbladder. It requires immediate medical care. Similar to biliary colic, gallstones are a common cause of cholecystitis. Cholecystitis is a possible complication of biliary colic. Its symptoms are more severe than those associated with biliary colic, and they last longer.

Symptoms of cholecystitis may include:

  • prolonged abdominal pain that doesn’t get better
  • fever or chills
  • nausea and vomiting
  • yellowish tinge to the skin and eyes, which is known as jaundice
  • tea-colored urine and pale stools

Risk factors

Some people are more likely to have gallstones than others based on different factors.

  • Gender: Women are more likely to develop gallstones than men. This is because estrogen, the female sex hormone, can make gallstones more likely to form.
  • Heredity: A family history of gallstones increases the risk of gallbladder problems.
  • Age: Gallstones are more common in people older than 40.
  • Ethnicity: Native Americans and Mexican-Americans are more prone to gallstones than other groups.
  • Body weight: Overweight or obese people may have more cholesterol in their bile, which helps stones form. Rapid weight loss and fasting also raises the amount of cholesterol in the bile.

Diet and biliary colic

Dietary factors can make gallstones more likely to form, although not all gallstones lead to biliary colic.

Some research suggests that diets high in calories and processed carbohydrates such as white bread and sweets may raise the risk of gallstones. Crohn’s disease and insulin resistance are also linked to gallbladder problems.

Read more: Crohn’s disease and gallbladder disease »

Health risks

Prolonged blockages of the bile ducts can lead to serious complications, such as damage and infection in the gallbladder, bile ducts, or liver. One serious complication is swelling or inflammation in the gallbladder. That is called cholecystitis.

Also, a gallstone that blocks the duct from the pancreas to the intestine can cause inflammation of the pancreas, called gallstone pancreatitis. Gallstone pancreatitis is potentially life-threatening.

How it’s diagnosed

You may be referred to a gastroenterologist if you have biliary colic. Gallstones are diagnosed using medical history, laboratory tests, and medical imaging.

The standard imaging test is an ultrasound. Your doctor will pass a special wand across your belly. It bounces sound waves off the inner organs and can reveal the presence of gallstones. In some cases, your doctor may order computed tomography (a CT scan), magnetic resonance imaging (MRI), or other diagnostic tests.

Treatment

The usual treatment for gallstones is surgery to remove the gallbladder. This is known as a cholecystectomy. Laparoscopic surgery, or keyhole surgery, is the most common way to perform a cholecystectomy. It’s often performed as an outpatient procedure. In some cases, open surgery may be required. The surgeon makes an incision in the abdominal area. For this procedure, a hospital stay is required during recovery.

If you can’t have surgery, your doctor can try other procedures to dissolve or break up the gallstones. In such cases, the gallstones may come back within a few years.

Outlook

Many people with gallstones don’t experience biliary colic. In such cases, the underlying gallbladder problem is silent, meaning it does not cause noticeable problems. Chronic gallstones can be cured with surgery. Your gallbladder isn’t essential to your digestive health, so it can be removed. Once the gallbladder is removed, bile flows directly from the liver to the intestine, and causes no health problems.