Biliary Colic

Gallstones form when substances in bile, mainly cholesterol or bilirubin (a yellow pigment), clump into hard particles. After a meal, especially one containing fat, the gallbladder contracts. If a stone is pushed against the outlet, pain results. Risk factors include being female, pregnancy, overweight and obesity, rapid weight loss, older age, a family history of gallstones and some medical conditions.

Gallstones are common in adults, and only a minority of people who have them develop pain. Those who have had one attack are likely to have more over time.

The pattern of pain is very characteristic, and your doctor will ask about it in detail. An ultrasound of the abdomen is the main test and shows gallstones well. Blood tests (including liver tests) help check that a stone is not causing a blockage, infection or pancreatitis. Occasionally an MRI of the bile ducts or an endoscopic ultrasound is used to look for small stones or stones in the duct.

Lifestyle steps may reduce triggers and support a healthy weight, but they do not make existing stones disappear.

• Aim for gradual weight loss if you are overweight; avoid crash diets, which can cause stones

• Stay physically active as advised by your doctor

• Do not skip meals for long periods and then eat very large meals

• Keep a note of when attacks happen and what you ate, and show it to your doctor

Many people notice that large or fatty meals trigger attacks.

• Choose smaller, lighter meals and limit deep-fried and very fatty foods if they trigger pain

• Eat more vegetables, fruit, whole grains and legumes

• Healthy fats such as olive oil and nuts in moderate amounts are generally fine unless they bring on pain

• There is no proven diet that dissolves gallstones

Medicines can ease pain, but they cannot reliably prevent attacks. Your doctor decides what is suitable.

• Simple pain relief or anti-inflammatory medicines may be advised for attacks; check first with your doctor if you have kidney, stomach or bleeding problems

• Medicines that dissolve stones (bile acid tablets) work slowly, only on some small cholesterol stones, and stones often return when stopped; they are used only for selected people

• Do not use herbal "gallbladder flushes" or large amounts of oil; they are not proven and can cause harm

Surgery is the standard treatment for stones that cause symptoms.

• Laparoscopic cholecystectomy (keyhole gallbladder removal) is usually done as a day case or with a short stay

• Surgery is usually advised after attacks start because they tend to recur

• If a stone is in the main bile duct, ERCP (a scope procedure) may be used to remove it

• If you are not fit for surgery, your doctor will discuss other options and how to recognise complications

Biliary colic tends to return. Removing the gallbladder (cholecystectomy) is the most reliable way to prevent further attacks and complications, and most people do very well afterwards. Whether and when to operate is decided together with your surgeon.

• Do I need surgery, and how long can I safely wait?

• Could my pain be from something other than gallstones?

• Which pain medicine is safe for me during an attack?

• Will I need to change my diet after gallbladder removal?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.