Gallstones are a common cause of pain on the right side of the abdomen, particularly in women. These small, hardened deposits develop in the gallbladder — a small, pear-shaped organ located beneath the liver that stores bile. Bile is a digestive fluid that helps your body break down fats. When bile components become unbalanced, gallstones can form and sometimes lead to discomfort or serious complications.
Although gallstones are common, not everyone who develops them experiences symptoms.
Types of Gallstones
There are two primary types of gallstones, and in some cases, a person may have a combination of both.
1. Cholesterol Gallstones
Cholesterol gallstones are the most common type. They are mainly composed of hardened cholesterol that separates from bile. Normally, bile contains chemicals that dissolve cholesterol, but when there is too much cholesterol in the bile, crystals can form and eventually grow into stones.
These stones are often yellow-green in color and vary in size.
2. Pigment Gallstones
Pigment gallstones are less common and are usually dark brown or black. They are made primarily of bilirubin, a substance produced when red blood cells break down.
People with liver disease (such as cirrhosis), certain blood disorders like hemolytic anemia, or chronic infections may have higher levels of bilirubin, increasing their risk of pigment stone formation.
Size and Number of Gallstones
Gallstones can range dramatically in size — from as tiny as a grain of sand to as large as a golf ball. Some individuals develop only a single stone, while others may have multiple stones at the same time. Larger stones may be more likely to cause blockages, but even small stones can trigger symptoms if they obstruct a bile duct.
Is Right-Sided Abdominal Pain a Symptom?
Many people with gallstones experience no symptoms at all. These are known as silent gallstones and are often discovered incidentally during imaging tests performed for unrelated reasons.
However, when a gallstone blocks a bile duct, it can cause sudden and intense pain known as a gallbladder attack (biliary colic). This pain typically occurs in the upper right abdomen and may last from several minutes to several hours.
Additional symptoms may include:
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Bloating and indigestion, especially after eating fatty foods
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Changes in bowel movements, including diarrhea or pale, clay-colored stools
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Chest discomfort that may be mistaken for heart pain
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Fever and chills (a possible sign of infection)
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Nausea and vomiting
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Pain that spreads to the right shoulder or upper back
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Sharp, cramping, or steady abdominal pain
If jaundice (yellowing of the skin or eyes) develops, it may indicate a bile duct blockage and requires urgent medical attention.
What Causes Gallstones?
Gallstones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. While the exact reason these imbalances occur is not fully understood, several contributing factors have been identified.
Contributing Theories Include:
Gallbladder motility issues:
If the gallbladder does not contract properly and empty bile regularly, bile can become overly concentrated, increasing the likelihood of stone formation.
Obesity:
Higher body weight is associated with increased cholesterol in bile and reduced gallbladder emptying.
Rapid weight loss:
Losing weight quickly — especially through crash diets or surgery — can alter bile chemistry and promote gallstone development.
Hormonal influences, particularly estrogen, may also play a role, which helps explain why gallstones are more common in women.
Risk Factors for Gallstones
Certain individuals are more likely to develop gallstones. You may be at higher risk if you:
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Are female
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Are over 40 years old
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Have a family history of gallstones
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Have liver cirrhosis or hemolytic anemia
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Are overweight or obese
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Have diabetes
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Have experienced rapid weight loss
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Are pregnant or taking hormone therapy
However, having risk factors does not guarantee you will develop gallstones. Likewise, some people with no obvious risk factors may still form them.
How Gallstones Are Diagnosed
If you experience symptoms suggestive of gallstones, a healthcare provider will evaluate your medical history and perform a physical exam. They may press on your abdomen to check for tenderness or swelling.
Diagnostic tests may include:
Abdominal ultrasound:
The most common and effective imaging test. It uses sound waves to detect stones in the gallbladder.
Blood tests:
These check liver function and look for infection or inflammation. Elevated liver enzymes or bilirubin levels may indicate a blocked bile duct.
CT scan:
Provides detailed images of the gallbladder and surrounding organs.
ERCP (Endoscopic Retrograde Cholangiopancreatography):
Uses a flexible tube and dye to visualize and sometimes remove stones in the bile ducts.
HIDA scan:
Involves a radioactive tracer that helps evaluate bile flow.
MRCP (Magnetic Resonance Cholangiopancreatography):
A noninvasive MRI-based scan that produces detailed images of bile ducts.
Treatment Options for Gallstones
Treatment depends on whether symptoms are present and whether complications have developed.
Surgery (Cholecystectomy)
The most common and effective treatment is surgical removal of the gallbladder. This procedure is often performed laparoscopically (minimally invasive) and typically allows for a quick recovery.
Most people can live normally without a gallbladder because bile will continue to flow directly from the liver into the small intestine.
Surgery is generally recommended if:
Medications
If surgery is not possible, medications such as ursodiol (Actigall) or chenodiol (Chenix) may be prescribed to dissolve cholesterol stones.
However:
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They work best on small cholesterol stones
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Treatment can take months or even years
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Stones may return after stopping medication
Preventing Gallstones
Although gallstones cannot always be prevented, healthy lifestyle habits may lower your risk:
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Avoid rapid or extreme weight loss
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Stay well hydrated
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Eat smaller, balanced meals throughout the day
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Limit high-fat and high-cholesterol foods
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Maintain a healthy weight
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Include fiber-rich foods in your diet
Regular physical activity may also support healthy gallbladder function.
Possible Complications
If left untreated, gallstones can lead to serious complications.
Cholangitis:
A bile duct infection causing fever, chills, jaundice, and severe pain. This condition can be life-threatening without treatment.
Cholecystitis:
Inflammation of the gallbladder due to blockage. It may cause intense pain, fever, nausea, and vomiting and can lead to infection or perforation.
Choledocholithiasis:
When stones block the common bile duct, leading to jaundice and digestive issues.
Pancreatitis:
If a gallstone blocks the pancreatic duct, it can cause inflammation of the pancreas — a serious and potentially life-threatening condition requiring immediate care.
Living With Gallstones
Many people with gallstones live normal, healthy lives — especially if their stones remain silent. For those with symptoms, dietary changes and medical monitoring can help manage discomfort and reduce the risk of complications.
If you experience sudden severe abdominal pain, fever, or jaundice, seek medical attention promptly.
Understanding your risk factors and recognizing early symptoms can help you make informed decisions about your health and treatment options.
