Gallstones are hard, solid deposits that form in the gallbladder, a pear-shaped organ in the upper right abdomen beneath the liver. When you eat, the gallbladder stores bile from the liver and empties it into the upper part of the small intestine (duodenum), helping digest and absorb fats. Gallstones develop when bile has excess cholesterol (fat) or bilirubin (a byproduct of the normal breakdown of red blood cells).

Some gallstones don’t cause symptoms, and many people are unaware they have them. These are “silent” gallstones and don’t require treatment. 

When gallstones block bile flow in the gallbladder or bile ducts, they can cause a gallbladder attack, leading to symptoms like severe abdominal pain, nausea and vomiting, and sweating. While surgery is the most effective option, alternatives like medications and therapies can also improve symptoms. 

Surgical removal of the gallbladder, medically known as a cholecystectomy, is the most common and effective treatment for gallstones. The gallbladder is not essential for your survival. Without it, your liver will continue to produce bile, which will flow directly into the small intestine rather than the gallbladder. 

Depending on the size of gallstones and your overall health, your healthcare provider may perform gallbladder removal surgery using one of two methods: laparoscopic cholecystectomy or open cholecystectomy. 

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the most common surgical procedure for gallbladder removal. It is minimally invasive, and you are under general anesthesia during the procedure so that you will be asleep and pain-free. 

During the surgery, the surgeon makes several small incisions (cuts) in the abdomen and inserts a laparoscope—a thin tube with a light and a camera—through one of the incisions to view the gallbladder. Surgical tools are inserted through the remaining incisions to remove the gallbladder carefully. Most people can go home that day or the following day and usually return to normal activities within a week.

Though a laparoscopic cholecystectomy is generally safe, it does carry potential risks. Complications may include bile leakage, infection, or injury to surrounding organs and tissues, such as the bile ducts, liver, or intestines. Some people develop post-cholecystectomy syndrome (PCS), which includes digestive symptoms such as diarrhea and indigestion. Despite these risks, laparoscopic cholecystectomy has a high success rate and quick recovery for most people. 

Open Cholecystectomy

Open cholecystectomy is a more traditional approach to gallbladder removal. Your healthcare provider may recommend open surgery for a severe infection or inflammation or if you have scarring in the area from a previous abdominal surgery. 

You will be asleep under general anesthesia to ensure you are pain-free during the procedure. The surgeon makes a large incision in the right side of your abdomen, usually below the ribcage, to access and remove the gallbladder. 

Because of the larger incision and extended recovery period, you may need to stay in the hospital for 3-5 days following surgery while healthcare providers monitor your recovery. You should be able to resume normal activities within a month. 

As with any surgery, an open cholecystectomy has potential risks, including infection, bleeding, and injury to nearby organs like the liver, pancreas, and intestines. Some people experience difficulty digesting fats following gallbladder removal and may experience heartburn, indigestion, nausea, and occasional abdominal pain. 

If you have a specific type of gallstone or a serious medical condition that would make surgery too risky, there are effective nonsurgical treatments for gallstones. These treatments can provide a viable alternative to surgery, though recurrent gallstones are possible without complete removal of the gallbladder.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that helps diagnose and treat conditions affecting the bile ducts, pancreas, and gallbladder. Healthcare providers may recommend an ERCP when gallstones become lodged in the common bile duct, blocking bile flow from the gallbladder to the small intestine. 

You will be under sedation or general anesthesia to ensure you stay comfortable throughout the procedure. Your healthcare provider will insert an endoscope—a flexible tube with a camera—through the mouth and throat, passing it through the stomach into the duodenum (the top part of the small intestine). 

They will then inject a dye through the endoscope, which helps X-ray imaging quickly detect gallstones. Once they locate the gallstones, your healthcare provider can pass small instruments through the endoscope to remove gallstones or widen narrowed bile ducts, ensuring proper bile flow. 

You can expect to stay in recovery for 2-6 hours following the procedure to allow the anesthesia or sedative to wear off. You may experience a sore throat, bloating, or nausea for a short time while you recover, and your healthcare provider may ask you to follow a liquid diet for up to 24 hours afterward. 

ERCP is effective and generally safe. However, 5-10% of people develop complications from the procedure, such as infection of the gallbladder or bile ducts, excessive bleeding, perforation (injury) to the bile ducts, pancreas, duodenum, and pancreatitis. 

Oral Dissolution Therapy

Oral dissolution therapy involves taking medication that dissolves cholesterol gallstones. This treatment option is effective for treating small cholesterol stones, so your healthcare provider will only recommend this therapy if you have the right size and type of gallstone. 

Actigall (ursodiol) and Chenix (chenodiol) are oral medications (taken by mouth) that reduce the production of cholesterol in the liver and increase the concentration of bile acids to help dissolve cholesterol in bile.

Oral dissolution therapy requires taking these medications for at least 6-12 months, though it can take up to two years for gallstones to dissolve completely. Even after successful treatment, gallstones often return within five years and require further treatment.

Side effects of oral dissolution therapy include gastrointestinal issues, such as diarrhea, heartburn, nausea, loss of appetite, gas, and abdominal pain. Some people also experience hair loss, headache, dizziness, frequent or painful urination, muscle pain, and cold and flu-like symptoms like a sore throat or runny nose. 

Extracorporeal Shock Wave Lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure that uses high-energy sound waves to break up gallstones in the bile ducts or gallbladder. You will be under sedation or general anesthesia to help you stay comfortable during the procedure. 

Using ultrasound or X-rays to visualize the gallstones, your healthcare provider will direct the shockwaves directly at the gallstones to break them into smaller fragments, which can then pass through the bile ducts. 

This procedure is safe and effective for treating small gallbladder stones but less successful when treating multiple or large stones. However, it is not a common treatment because the risk of gallstones returning is high, so your healthcare provider may only recommend ESWL if you have a solitary stone or if surgery is too risky. 

Healthy lifestyle habits can help reduce the likelihood of developing gallstones or triggering gallbladder attacks. Eating certain foods, increasing physical activity, and managing obesity are common habits your healthcare provider may recommend.

Dietary Changes 

Dietary adjustments can help manage gallstone symptoms and lower the risk of developing future stones. These include the following:

• Increase fiber intake: Consume more fruits, vegetables, legumes, and whole grains to promote healthy digestion
• Incorporate healthy fats: Eat healthy fats, like olive oil, avocados, and fatty fish, to help the gallbladder contract and release bile into the small intestine regularly
• Limit refined sugars and processed foods: Avoid eating diets high in refined sugars and processed foods, as they can increase the likelihood of developing gallstones
• Avoid unhealthy fats: Cut back on unhealthy fats, such as those found in desserts and fried foods, which can raise cholesterol levels in bile

Exercise

Regular physical activity can support your digestive and gallbladder health. A sedentary lifestyle and infrequent exercise increase the risk of developing gallstones. Exercising promotes healthy digestion and reduces the likelihood of cholesterol buildup in the gallbladder. Working out also enhances gallbladder motility, ensuring that bile flows properly and does not stay in the gallbladder.

Aim for at least 30 minutes of moderate-intensity exercise (such as brisk walking, cycling, or swimming) five days a week. Studies show that one hour of daily exercise for those working sedentary jobs (e.g., at a desk) and 30 minutes for those who stand or do heavy manual labor can lower the risk of gallstones by 70%.

Weight Management 

Being overweight or living with obesity increases the likelihood of developing gallstones, especially in people assigned female at birth. Extra body weight can increase cholesterol levels in bile and lead to gallstone formation. Some evidence suggests that people with excess abdominal fat are more likely to develop gallstones compared to those who store fat around their hips and thighs. 

If you plan to lose weight, it’s important to approach it gradually and safely. People who undergo weight loss surgery (bariatric surgery) often develop gallstones because rapid weight loss can trigger the liver to release extra cholesterol in bile and prevent the gallbladder from emptying efficiently. 

Losing weight slowly and steadily can lower the risk of gallstones. Experts recommend achieving a healthy weight through a balanced approach—losing 5% to 10% of your starting weight over six months—including dietary changes and regular physical activity. 

Gallstones are generally not life-threatening, and most people with gallstones have an average life expectancy. Around half of people with gallstones never develop symptoms. For those who do and undergo gallbladder removal (cholecystectomy) surgery, some mild issues like bloating or diarrhea after eating fatty foods can occur. Overall, their life expectancy and quality of life are similar to those without gallstones. 

Living with gallstones can be manageable with the right strategies and lifestyle adjustments. Maintaining a healthy diet high in fiber and low in processed foods can help reduce symptoms and prevent gallstone attacks. Staying physically active and managing a healthy weight can also help prevent gallstone formation or gallbladder attacks. 

If you have gallstones and can’t or don’t want to undergo gallbladder removal surgery, work with your healthcare provider to develop a treatment plan that works for you. If you are considering weight loss, discuss your plans with a healthcare provider or dietician to help you create a healthy eating plan that promotes gradual, safe weight loss. What’s most important is to receive treatment when you have symptoms, as early intervention can limit the risk of complications and improve your quality of life.