What are gallstones

Cholelithiasis or gallstones are hardened deposits of digestive fluid, usually made of cholesterol, that can form in your gallbladder ¹. Your gallbladder is a small pear-shaped organ located just beneath the liver, on the right side of your abdomen. The gallbladder holds a digestive fluid known as bile that is released into your small intestine. In the United States, 6% of men and 9% of women have gallstones, most of which are asymptomatic ¹. The highest prevalence of gallstones arises in Native American populations. Gallstones are not as common in Africa or Asia. The epidemic of obesity has likely magnified the rise of gallstones.

Despite how prevalent gallstones may be, more than 80% of people remain asymptomatic ¹. In patients with asymptomatic gallstones discovered incidentally, the likelihood of developing symptoms or complications is 1% to 2% per year. Those who started to develop symptoms may continue to have major complications (cholecystitis, choledocholithiasis, gallstone pancreatitis, cholangitis) occur at a rate of 0.1% to 0.3% yearly. Asymptomatic gallbladder stones found in a normal gallbladder and normal biliary tree do not need treatment unless they develop symptoms. However, approximately 20% of these asymptomatic gallstones will develop symptoms over 15 years of follow-up. These gallstones may go on further to develop complications such as cholecystitis, cholangitis, choledocholithiasis, gallstone pancreatitis, and rarely cholangiocarcinoma ¹.

Types of gallstones that can form in the gallbladder include:

• Cholesterol gallstones. The most common type of gallstone (80%-98% of gallstones), called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
• Pigment gallstones (2%-20% of gallstones). These dark brown or black stones form when your bile contains too much bilirubin.

These chemical imbalances cause tiny crystals to develop in the bile.

These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble.

Sometimes only 1 stone will form, but there are often several at the same time.

Each gallstone has a unique set of risk factors. Some risk factors for the development of cholesterol gallstones are obesity, age, female gender, pregnancy, genetics, total parenteral nutrition, rapid weight loss, and certain medications.

Approximately 2% of all gallstones are black and brown pigment stones. These can be found in individuals with high hemoglobin turnover. The pigment consists of mostly bilirubin. Patients with cirrhosis, ileal diseases, sickle cell anemia, and cystic fibrosis are at risk of developing black pigment stones. Brown pigments are mainly found in Southeast Asian population and are not common in the United States. Risk factors for brown pigment stones are intraductal stasis and chronic colonization of bile with bacteria.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

Cholesterol gallstones are formed mainly due to over secretion of cholesterol by liver cells and hypomotility or impaired emptying of the gallbladder. In pigmented gallstones, conditions with high heme turnover, bilirubin may be present in bile at higher than normal concentrations. Bilirubin may then crystallize and eventually form stones.

Symptoms and complications of gallstones result when stones obstruct the cystic duct, bile ducts or both. Temporary obstruction of the cystic duct (as when a stone lodges in cystic duct before the duct dilates and the stone returns to gallbladder) results in intense abdominal pain commonly known as biliary colic, but is usually short-lived, usually lasts 1 to 5 hours, although it can sometimes last just a few minutes. When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis.

More persistent obstruction of cystic duct (as when a large gallstone gets permanently lodged in the neck of the gallbladder) can lead to acute cholecystitis (inflammation of the gallbladder). Acute cholecystitis can cause persistent pain, jaundice and a fever.

Sometimes a gallstone may get pass through the cystic duct and get lodged and impacted the common bile duct, and causes obstruction and jaundice. This complication is known as choledocholithiasis.

If gallstones pass through the cystic duct, common bile duct and get dislodged at the ampulla of the distal portion of the bile duct, acute gallstone pancreatitis may result from backing up of fluid and increase pressure in pancreatic ducts and in situ activation of pancreatic enzymes. Occasionally, large gallstones do perforate the gallbladder wall and create a fistula between the gallbladder and small or large bowel, producing bowel obstruction or ileus.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms typically don’t need treatment.

The gallbladder

The gallbladder is a small, pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver into the gallbladder through a series of channels known as bile ducts.

The bile is stored in the gallbladder and, over time, becomes more concentrated, which makes it better at digesting fats.

The gallbladder releases bile into the digestive system when it’s needed.

Figure 1. Gallbladder location

Figure 2. Gallbladder anatomy

Figure 3. The common bile duct is closely associated with the pancreatic duct and the duodenum

What is choledocholithiasis?

Choledocholithiasis is the presence of at least one gallstone in the common bile duct. The gallstone may be made up of bile pigments or calcium and cholesterol salts. About 1 in 7 people with gallstones will develop stones in the common bile duct. The common bile duct is a small tube that carries bile from the gallbladder to the duodenum. Obstruction of the common bile duct may also lead to obstruction of the pancreatic duct because these ducts are usually connected. If the pancreatic duct is also obstructed, pancreatitis will likely develop.

Risk factors for choledocholithiasis include a history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder removed.

Figure 4. Choledocholithiasis

Choledocholithiasis symptoms

Often, there are no symptoms unless the stone blocks the common bile duct. Symptoms may include:

• Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant or cramping. It can feel sharp or dull.
• Fever
• Yellowing of skin and whites of the eyes (jaundice)
• Loss of appetite
• Nausea and vomiting
• Clay-colored stools

Choledocholithiasis possible complications

Complications may include:

• Biliary cirrhosis
• Cholangitis
• Pancreatitis

Tests that show the location of gallstones in the bile duct include the following:

• Abdominal CT scan
• Abdominal ultrasound
• Endoscopic retrograde cholangiography (ERCP)
• Endoscopic ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

Your health care provider may order the following blood tests:

• Bilirubin
• Complete blood count (CBC)
• Liver function tests
• Pancreatic enzymes

Choledocholithiasis treatment

The goal of treatment is to relieve the blockage.

Treatment may involve:

• Surgery to remove the gallbladder and stones
• Endoscopic retrograde cholangiography (ERCP) and a procedure called a sphincterotomy, which makes a surgical cut into the muscle in the common bile duct to allow stones to pass or be removed

Choledocholithiasis prognosis

Blockage and infection caused by stones in the biliary tract can be life threatening. Most of the time, the outcome is good if the problem is detected and treated early.

What causes gallstones

Experts don’t know what causes gallstones to form. Doctors think gallstones may result when:

• Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
• Your bile contains too much bilirubin. Bilirubin is a chemical that’s produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
• Your gallbladder doesn’t empty correctly. If your gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.

How do you get gallstones

There are three main pathways in the formation of gallstones:

1. Cholesterol supersaturation: Normally, bile can dissolve the amount of cholesterol excreted by the liver. But if the liver produces more cholesterol than bile can dissolve, the excess cholesterol may precipitate as crystals. Crystals are trapped in gallbladder mucus, producing gallbladder sludge. With time, the crystals may grow to form stones and occlude the ducts which ultimately produce the gallstone disease.
2. Excess bilirubin: Bilirubin, a yellow pigment derived from the breakdown of red blood cells, is secreted into bile by liver cells. Certain hematologic conditions cause the liver to make too much bilirubin through the processing of breakdown of hemoglobin. This excess bilirubin may also cause gallstone formation.
3. Gallbladder hypomotility or impaired contractility: If the gallbladder does not empty effectively, bile may become concentrated and form gallstones.

Depending on the cause, gallstones have different compositions. The three most common types are cholesterol gallstones, black pigment gallstones, and brown pigment gallstones. Ninety percent of gallstones are cholesterol gallstones.

Factors that may increase your risk of gallstones include:

• Being female
• Being age 40 or older
• Being a Native American
• Being a Mexican-American
• Being overweight or obese
• Being sedentary
• Being pregnant
• Eating a high-fat diet
• Eating a high-cholesterol diet
• Eating a low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Losing weight very quickly
• Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
• Having liver disease

Who’s at risk of gallstones

Gallstones are more common if you:

• are female, particularly if you have had children, are taking the combined pill, or are undergoing high-dose oestrogen therapy
• are overweight or obese
• are aged 40 years or older (the older you are, the more likely you are to develop gallstones)
• have a condition that affects the flow of bile (such as cirrhosis, primary sclerosing cholangitis, or obstetric cholestasis)
• have Crohn’s disease or irritable bowel syndrome (IBS)
• have a close family member who’s also had gallstones
• have recently lost weight (from either dieting or weight loss surgery)
• are taking an antibiotic called ceftriaxone

Gallstones prevention

You can reduce your risk of gallstones if you:

• Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
• Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
• Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.

Gallstones diet

From the limited evidence available, changes to your diet and losing weight (if you’re overweight) may help prevent gallstones.

Because cholesterol appears to play a role in the formation of gallstones, it’s advisable to avoid eating too many foods with a high saturated fat content.

Foods high in saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter, ghee and lard
• cream
• hard cheeses
• cakes and biscuits
• food containing coconut or palm oil

A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5 portions a day) and wholegrains.

There’s also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones.

Drinking small amounts of alcohol may also help reduce your risk of gallstones.

But you shouldn’t regularly drink more than 14 units of alcohol a week, as this can lead to liver problems and other health conditions.

Regularly drinking any amount of alcohol can increase the risk to your health.

Losing weight

Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones.

You should control your weight by eating a healthy diet and taking plenty of regular exercise.

But you should avoid low-calorie, rapid weight loss diets. There’s evidence they can disrupt your bile chemistry and increase your risk of developing gallstones.

A more gradual weight loss plan is recommended.

Gallstones signs and symptoms

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:

• Sudden and rapidly intensifying pain in the upper right portion of your abdomen called biliary colic, which is intermittent episodes of constant, sharp, right upper quadrant abdominal pain often associated with nausea and vomiting.
• Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder
• Sweating, nausea or vomiting may accompany biliary colic (gallstones pain)

Gallstone pain may last several minutes to a few hours.

Gallstones pain

Gallstones can cause sudden, severe abdominal pain that usually lasts 1 to 5 hours, although it can sometimes last just a few minutes. Biliary colic (gallstones pain) is usually caused by the gallbladder contracting in response to some form of stimulation, forcing a stone through the gallbladder into the cystic duct opening, leading to increased gallbladder wall tension and pressure which often result in pain known as biliary colic. As the gallbladder relaxes, the stones often fall back into the gallbladder, and the pain subsides within 30 to 90 minutes.

Gallstones pain can be felt:

• in the center of your abdomen (tummy)
• just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is constant and isn’t relieved by going to the toilet, passing wind or being sick.

It’s sometimes triggered by eating fatty foods, but may occur at any time of day and may wake you up during the night.

Biliary colic doesn’t happen often. After an episode of pain, it may be several weeks or months before you have another episode.

Some people also have periods where they sweat excessively and feel sick or vomit.

When gallstones cause episodes of biliary colic, it’s known as uncomplicated gallstone disease.

• Fatty meals are a common trigger for gallbladder contraction. The pain usually starts within an hour after a fatty meal and is often described as intense and dull, and may last from 1 to 5 hours. However, an association with meals is not universal, and in a significant proportion of patients, the pain is nocturnal. The frequency of recurrent episodes is variable, though most patients do not have symptoms on a daily basis.
• A thorough physical exam is useful to distinguish biliary pain due to acute cholecystitis (inflammation of the gallbladder), uncomplicated cholelithiasis or other complications.
• In an uncomplicated biliary colic, the patient is afebrile and has an essentially benign abdominal examination without rebound or guarding.

Acute cholecystitis occurs when persistent gallstone dislodged from the cystic duct causes the gallbladder to become distended and inflamed. The patient may also present with fever, pain in the right upper quadrant and tenderness over the gallbladder (this is known as Murphy’s sign).

When fever, persistent tachycardia (increased or fast heart beat), hypotension (low blood pressure), or jaundice are present, it requires a search for complications of gallstones, including cholecystitis (inflammation of the gallbladder), cholangitis (inflammation of the bile duct and/or liver), pancreatitis (inflammation of the pancreas), or other systemic causes.

Choledocholithiasis is a complication of gallstones when stones obstruct the common bile duct it impedes the flow of bile from the liver to the intestine. Pressure rises resulting in elevation of liver enzymes and jaundice.

Cholangitis is triggered by colonization of bacteria and overgrowth in static bile above an obstructing common duct stone. This produces purulent inflammation of the liver and biliary tree. Charcot’s triad consists of severe right upper quadrant tenderness with fever and jaundice and is classic for cholangitis. Surgical removal of gallstone obstruction with intravenous antibiotics is required to treat this condition.

Other symptoms

Occasionally, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs, such as the pancreas or small bowel.

If this happens, you may develop:

• a high temperature of 100.4 °F (38 °C) or above
• more persistent pain
• a rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhea
• chills or shivering attacks
• confusion
• a loss of appetite

Doctors refer to this more severe condition as complicated gallstone disease.

Gallstones complications

A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system.

Complications of gallstones may include:

Inflammation of the gallbladder (cholecystitis)

A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). If a bile duct becomes permanently blocked, it can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed. The medical term for inflammation of the gallbladder is acute cholecystitis. Acute cholecystitis can cause severe pain and fever.

Acute cholecystitis symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than 5 hours)
• a high temperature (fever) of 100.4 °F (38 °C) or above
• a rapid heartbeat

An estimated 1 in 7 people with acute cholecystitis also experience jaundice.

Acute cholecystitis is usually first treated with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder.

The operation can be more difficult when performed as an emergency, and there’s a higher risk of it being converted to open surgery.

Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don’t always treat these and they may need to be drained.

Occasionally, a severely inflamed gallbladder can tear, leading to inflammation of the inside lining of the abdomen (peritonitis).

If this happens, you may need antibiotics given directly into a vein (intravenous antibiotics), and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

Jaundice

You can get jaundice if a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile.

Symptoms of jaundice include:

• yellowing of the skin and eyes
• dark brown urine
• pale stools
• itching

Sometimes the stone passes from the bile duct on its own. If it doesn’t, the stone needs to be removed.

Blockage of the common bile duct (choledocholithiasis)

Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result.

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, they’re vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis.

Symptoms of acute cholangitis include:

• pain in your upper abdomen that travels towards your shoulder blade
• a high temperature
• jaundice
• chills
• confusion
• itchy skin
• generally feeling unwell

Antibiotics will help treat the infection, but it’s also important to help the bile from the liver to drain with an endoscopic retrograde cholangio-pancreatography (ERCP).

Acute pancreatitis

Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the pancreatic duct (the duct of the pancreas) (see Figure 3 above), causing the pancreas to become inflamed. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

The most common symptom of acute pancreatitis is a sudden severe dull pain in the center of your upper abdomen, around the top of your stomach.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache.

The ache may travel from your abdomen and along your back, and may feel worse after eating.

Leaning forward or curling into a ball may help relieve the pain.

Other symptoms of acute pancreatitis can include:

• feeling sick
• being sick
• diarrhea
• loss of appetite
• a high temperature
• tenderness of the abdomen
• less commonly, jaundice

There’s currently no cure for acute pancreatitis, so treatment focuses on supporting the body’s functions until the inflammation has passed.

This usually involves admission to hospital so you can be given:

• fluids into a vein (intravenous fluids)
• pain relief
• nutritional support
• oxygen through tubes into your nose

With treatment, most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days.

Gallbladder cancer

People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

Having a history of gallstones increases your risk of developing gallbladder cancer. About 4 out of 5 people who have cancer of the gallbladder also have a history of gallstones. But people with a history of gallstones have a less than 1 in 10,000 chance of developing gallbladder cancer.

If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones aren’t causing any symptoms.

The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including:

• abdominal pain
• a high temperature
• jaundice

Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy.

Gallstone ileus

Gallstone ileus is another rare but serious complication of gallstones. It’s where the bowel becomes obstructed by a gallstone.

Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are able to travel through the fistula and can block the bowel.

Symptoms of gallstone ileus include:

• abdominal pain
• being sick
• swelling of the abdomen
• constipation

A bowel obstruction requires immediate medical treatment. If it’s not treated, there’s a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection.

Contact your doctor as soon as possible if you think you have an obstructed bowel.

Surgery is usually needed to remove the gallstone and unblock the bowel. The type of surgery you have will depend on where the obstruction in the bowel is.

Gallstones diagnosis

Tests and procedures used to diagnose gallstones include:

• Tests to create pictures of your gallbladder. Your doctor may recommend an abdominal ultrasound and a computerized tomography (CT) scan to create pictures of your gallbladder. These images can be analyzed to look for signs of gallstones. Ultrasound is the primary modality for diagnosing gallstones. Point-of-care ultrasound has been shown in the hands of trained operators to be as accurate as radiology ultrasound in the detection of gallstones.
• Tests to check your bile ducts for gallstones. A test that uses a special dye to highlight your bile ducts on images may help your doctor determine whether a gallstone is causing a blockage. Tests may include a hepatobiliary iminodiacetic acid (HIDA) scan, magnetic resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.
• Blood tests to look for complications. Blood tests may reveal an infection, jaundice, pancreatitis or other complications caused by gallstones.

Gallstones treatment

Management of gallstones can be divided into two categories: asymptomatic gallstones and symptomatic gallstones.

Asymptomatic gallstones: Most people with gallstones that don’t cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing. Your doctor may recommend you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver (this is known as portal hypertension and is often a complication of alcohol-related liver disease)
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

Gallstones without complications can be treated acutely with oral or parenteral analgesia in emergency department or urgent care center once the diagnosis has been established and alternative diagnoses excluded. Patients should also be offered dietary advice to reduce the chance of recurrent episodes and referred to a general surgeon for elective laparoscopic cholecystectomy. Patients with symptoms and workup consistent with acute cholecystitis will require admission to hospital, surgical consult and intravenous antibiotics. Patients with choledocholithiasis or gallstone pancreatitis will also require admission to hospital, gastrointestinal (GI) consultation and endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP). Patients with acute ascending cholangitis are usually ill-appearing and septic. They often also require aggressive resuscitation and ICU-level care in addition to surgical intervention to drain an infection in the biliary tract.

Treatment options for gallstones include:

• Surgery to remove the gallbladder (cholecystectomy). Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food, but it can cause diarrhea, which is usually temporary.
• Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way and gallstones will likely form again if treatment is stopped. Sometimes medications don’t work. Medications for gallstones aren’t commonly used and are reserved for people who can’t undergo surgery.

How to get rid of gallstones

Medication to dissolve gallstones

If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

But these aren’t prescribed very often because:

• they’re rarely very effective
• they need to be taken for a long time (up to 2 years)
• gallstones can recur once treatment is stopped

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

Ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women.

Sexually active women should either use a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets may occasionally be used to prevent gallstones if it’s thought you’re at risk of developing them.

For example, ursodeoxycholic acid may be prescribed if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

Gallstones diet

In the past, people with gallstones who weren’t suitable for surgery were sometimes advised to adopt a very low-fat diet to stop the gallstones growing.

But recent evidence suggests this isn’t helpful because rapid weight loss resulting from a very low-fat diet can actually cause gallstones to grow.

This means that if surgery isn’t recommended or you want to avoid having an operation, it’s advisable to adopt a healthy, balanced diet.

This involves eating a variety of foods, including moderate amounts of fat, and having regular meals.

A healthy diet won’t cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones.

Gallstones natural treatment

A gallbladder cleanse — also called a gallbladder flush or a liver flush — is an alternative remedy for ridding the body of gallstones. However, no scientific evidence suggests that a gallbladder cleanse helps prevent or treat gallstones or any other disease.

In most cases, a gallbladder cleanse involves eating or drinking a combination of olive oil, herbs and some type of fruit juice over the course of two or more days — during which you may be advised to eat nothing else. There’s no standard formula for gallbladder cleansing regimens and products. Different practitioners follow their own recipes.

Proponents of gallbladder cleansing claim that the treatment helps break up gallstones and stimulates the gallbladder to release them in stool. The large, repeated doses of olive oil in gallbladder cleanse preparations do have a laxative effect. And people who have taken a gallbladder cleanse report finding lumps that look like gallstones in their stool just after the procedure. When analyzed, though, these lumps turn out to be composed of oil, juice and other materials.

Gallbladder cleansing is not without risk. Some people have nausea, vomiting, diarrhea and abdominal pain during the flushing or cleansing period. Individual components of the herbal mixtures used in a gallbladder cleanse may present their own health hazards.

Gallstones that cause no symptoms typically require no treatment. If you have gallstones that require treatment, discuss proven treatment options with your doctor, such as surgical removal, bile salt tablets or sound wave therapy.

Is there a diet after gallbladder removal?

After having their gallbladder removed (cholecystectomy), some people develop frequent loose, watery stools. In most cases, the diarrhea lasts no more than a few weeks to a few months. There isn’t a specific gallbladder removal diet that you should follow if you have this problem, but there are a few things you might consider.

First, it helps to understand why you’re having diarrhea. Diarrhea after gallbladder removal seems to be related to the release of bile directly into the intestines. Normally, the gallbladder collects and concentrates bile, releasing it when you eat to aid the digestion of fat. When the gallbladder is removed, bile is less concentrated and drains more continuously into the intestines, where it can have a laxative effect.

The amount of fat you eat at one time also plays a role. Smaller amounts of fat are easier to digest, while larger amounts can remain undigested and cause gas, bloating and diarrhea.

Although there isn’t a set gallbladder removal diet, the following tips may help minimize problems with diarrhea after you’ve had your gallbladder out:

• Go easy on the fat. Avoid high-fat foods, fried and greasy foods, and fatty sauces and gravies for at least a week after surgery. Instead, choose fat-free or low-fat foods. Low-fat foods are those with no more than 3 grams of fat a serving. Check labels and follow the serving size listed.
• Increase the fiber in your diet. This can help normalize bowel movements. Add soluble fiber, such as oats and barley, to your diet. But be sure to increase the amount of fiber slowly, such as over several weeks, because too much fiber at first can make gas and cramping worse.
• Eat smaller, more-frequent meals. This may ensure a better mix with available bile. A healthy meal should include small amounts of lean protein, such as poultry, fish or fat-free dairy, along with vegetables, fruits and whole grains.

You may also try limiting foods that tend to worsen diarrhea, including:

• Caffeine
• Dairy products
• Very sweet foods

Talk with your doctor if your diarrhea doesn’t gradually go away or becomes more severe, or if you lose weight and become weak. Your doctor may recommend medicines, such as loperamide (Imodium A-D), which slows down intestinal movement, or medications that decrease the laxative effect of bile, such as cholestyramine (Prevalite). Your doctor may also suggest that you take a multivitamin to compensate for malabsorption of fat-soluble vitamins.

1. Tanaja J, Meer JM. Cholelithiasis. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470440