Gallstones: Symptoms, Causes, Treatment, and When a Gallbladder Attack Is an Emergency

Written by Dr. Casey Dean, DO, Board-Certified Family Medicine Physician | Medically reviewed by Dr. Kathryn Kline, MD | Trinity Family Medicine

Last medically reviewed: September 2026

About the author: Dr. Casey Dean is a board-certified family medicine physician (ABFM) who evaluates abdominal pain, metabolic conditions, and gallbladder-related symptoms for patients across Texas through primary care and telehealth.

If you've felt a deep, gripping pain in the upper-right part of your belly an hour or two after a rich meal, gallstones are one of the first things a doctor will think about. Gallstones — the medical term is cholelithiasis — are hardened deposits that form in your gallbladder, and they are remarkably common. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), gallstones affect roughly 10 to 15 percent of U.S. adults — nearly 25 million people. The good news is that most people who have them never feel a thing. This guide explains the real symptoms of a gallbladder attack, what raises your risk, how gallstones are diagnosed and treated, and — most important — the warning signs that turn a manageable problem into a medical emergency.

Quick Summary: Key Facts at a Glance

Emergency warning: Do not wait at home if gallbladder pain persists for several hours or worsens, or comes with fever, chills, yellowing of the skin or eyes, dark urine, pale stools, or persistent vomiting. These can signal infection (cholecystitis or cholangitis) or pancreatitis. Go to the emergency room or call 911 — untreated bile-duct infection can become life-threatening.

What Are Gallstones?

Gallstones are pebble-like deposits that form inside the gallbladder, the small pouch under your liver that stores bile. Bile is a digestive fluid, and when it holds too much cholesterol or bilirubin, those substances can crystallize and harden into stones ranging from a grain of sand to a golf ball. When people say "gallbladder attack," the clinical term is biliary colic — pain caused when a stone temporarily blocks the duct that drains the gallbladder. When a stone lodges in a duct and causes inflammation or infection, that becomes acute cholecystitis (an inflamed gallbladder) or, if it blocks the main bile duct, choledocholithiasis and cholangitis (a bile-duct infection).

Most gallstones are made mainly of cholesterol. Researchers believe the process starts when the balance of cholesterol, bile salts, and bilirubin in bile shifts, though several factors contribute rather than one single cause.

What Are the Symptoms of a Gallbladder Attack?

The hallmark symptom is a steady, moderate-to-severe pain in the upper-right or upper-middle abdomen that often begins after a fatty or heavy meal. According to the 2024 American Academy of Family Physicians (AAFP) review, biliary colic pain is characteristically steady rather than crampy. It sits in the upper-middle or upper-right belly and typically lasts one to five hours before gradually subsiding. The pain can radiate to the right shoulder blade or the middle of the back, and it is often accompanied by nausea or vomiting.

Importantly, bloating, gas, and vague indigestion are not specific for gallstones and are less typical of biliary colic — so those symptoms alone rarely point to your gallbladder. Other conditions can mimic a gallbladder attack, including acid reflux and GERD, peptic ulcers, a heart attack, and pancreatitis, which is why a clinical evaluation matters rather than self-diagnosis.

Most people with gallstones never develop symptoms at all. NIDDK notes that most gallstones are "silent," the AAFP review reports that nearly 80 percent are found incidentally, and asymptomatic gallstones progress to symptoms at only about 2 percent per year.

What Causes Gallstones and Who Is at Risk?

Gallstones form when bile becomes oversaturated with cholesterol, and certain groups are more prone to it. For decades, clinicians taught the memorable "five F's" — female, forty (older age), fat (excess weight), fertile (pregnancy), and family history — and while that phrase is now considered dated and overly simplistic, the underlying risk factors hold up. Women are more than twice as likely as men to develop gallstones, largely because estrogen raises cholesterol in bile and slows gallbladder emptying, according to the Cleveland Clinic. U.S. gallstone prevalence has been rising, roughly doubling between 1988 and 2020, a trend researchers link to increasing rates of obesity and metabolic disease.

One modern risk factor deserves special attention: rapid weight loss. Losing weight quickly — including from very low-calorie diets, bariatric surgery, or GLP-1 medications like semaglutide and tirzepatide — is associated with a higher risk of gallstones, and researchers believe rapid loss raises the cholesterol saturation of bile while these drugs also slow gallbladder emptying. The FDA label for semaglutide reports gallstones (cholelithiasis) in about 1.5 percent of patients on the 0.5 mg dose in placebo-controlled trials, versus none reported on placebo.

Dr. Dean's clinical perspective: When starting a patient on a GLP-1 for weight loss, two things are worth tracking: the pace of weight loss and any new right-upper-belly pain. The same rapid loss that improves metabolic health can also nudge the gallbladder toward stones. It is a manageable trade-off, not a reason to avoid effective treatment, but it is worth watching. If you're considering these medications, our telehealth weight loss and GLP-1 options in Texas explains how monitored care fits in. Gallstones also travel in the same metabolic company as fatty liver disease (MASLD).

When Is a Gallbladder Attack an Emergency? (Red-Flag Comparison)

A simple gallbladder attack is painful but self-limited; the danger is when a stone causes infection or blocks the pancreas. The table below shows how uncomplicated biliary colic differs from the complications that need emergency care.

What this means in plain English: If your pain fades within a few hours and you have no fever or yellowing, you likely had a biliary colic attack and should follow up with a doctor. If the pain persists for several hours, keeps worsening, or comes with fever, chills, jaundice, dark urine, pale stools, or repeated vomiting, treat it as an emergency rather than waiting for it to pass. Acute cholangitis in particular is dangerous — it can progress to sepsis and is fatal if untreated.

Do You Need Testing to Diagnose Gallstones?

Yes — the key test is an abdominal ultrasound, and it is usually all that's needed. According to the 2024 AAFP review, ultrasonography is the first-line imaging test for suspected gallstones and acute cholecystitis, with sensitivity and specificity greater than 95 percent for detecting stones. It is quick, painless, and uses no radiation. Your clinician may also order blood tests (liver enzymes, bilirubin, and sometimes lipase) if a blocked duct, infection, or pancreatitis is suspected. Routine testing is not recommended for people without symptoms, since silent gallstones generally don't need treatment.

How Are Gallstones Treated?

For people with repeated gallbladder attacks, the standard treatment is surgical removal of the gallbladder, called laparoscopic cholecystectomy — and you can live a normal life without a gallbladder. The 2024 AAFP review names laparoscopic cholecystectomy as the treatment of choice for most patients with symptomatic gallstones or acute cholecystitis. During an attack, pain is controlled with medication. A 2016 Cochrane review found that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or ketorolac relieve biliary pain better than placebo and about as well as opioids, so NSAIDs are often preferred. Every medication has trade-offs — NSAIDs can irritate the stomach and affect the kidneys — so a clinician should review your options before you rely on them.

Medications that dissolve stones (ursodeoxycholic acid) exist but work slowly and only for certain small cholesterol stones. The AAFP notes they should not be used routinely and are reserved as a nonsurgical alternative for select patients who cannot have surgery. A common question after surgery is whether digestion changes. A minority of people develop looser stools afterward: a systematic review cited by the AAFP found about 13 percent experience post-cholecystectomy diarrhea, which is usually manageable.

For asymptomatic gallstones, the AAFP recommends watchful waiting rather than surgery, because the yearly risk of developing symptoms is low.

Can You Treat Gallstones During Pregnancy?

Yes — gallstones can be safely evaluated and, when necessary, treated during pregnancy. Pregnancy itself raises gallstone risk because higher estrogen levels change bile composition and slow gallbladder emptying. If you develop symptoms while pregnant, tell your obstetric clinician promptly. Ultrasound is safe in pregnancy and is the preferred test. Simple attacks are often managed conservatively, but medically necessary surgery should not be delayed simply because of the trimester — laparoscopic cholecystectomy can be performed safely during pregnancy, with timing decided by your obstetric and surgical teams. Some pain medications, including NSAIDs, are limited or avoided in later pregnancy, so treatment should always be individualized. Confirm any medication with your obstetric provider before taking it.

When to See Your Doctor

See a doctor for any recurring pain in the upper-right or upper-middle abdomen, especially if it follows meals, so the cause can be identified and other conditions ruled out. A clinician can review your symptoms and risk factors, arrange an abdominal ultrasound, check bloodwork if needed, and help you decide between watchful waiting and a surgical referral.

A telehealth clinician can assess whether your symptoms are consistent with gallstones, order the right imaging and labs, and refer you for surgical evaluation when appropriate. Gallbladder infection, jaundice, or unrelenting pain always requires in-person emergency care instead. Trinity Family Medicine offers physician-led telehealth across Texas starting at $49.99, with the same doctor each time. You can book online or call 817-932-4022. (Curious how a visit compares to urgent care or the ER? See our Texas doctor visit cost guide without insurance.)

Frequently Asked Questions About Gallstones

The Bottom Line

Gallstones are extremely common, and for most people they stay silent and generally need no treatment. The situation to respect is a gallbladder attack that comes with fever, chills, jaundice, or pain that won't ease — those are signs of infection or blockage that need emergency care. If you have recurring upper-right belly pain after meals, a telehealth visit can help identify the cause, arrange an ultrasound, and connect you with the right treatment before a manageable problem becomes a dangerous one.

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