Causes of Gallbladder Pain and Treatment Options

Your gallbladder is a pear-shaped organ located in your right upper abdomen, just under your ribcage. Gallbladder pain is more likely to happen after you have eaten a fatty meal, but it can also happen on an empty stomach in the middle of the night.

The pain is often in the right upper belly, under the ribs, but the pain may spread ("radiate") to the lower chest or your right shoulder blade, leading some people to worry they are having a heart attack. Unlike pain from gas, gallbladder pain is typically not relieved by changing position, burping, or passing gas. Heartburn is not a symptom of gallbladder problems, although a person may feel nauseated and vomit.

Given the location of the gallbladder, what seems like gallbladder pain may actually be pain related to issues other than gallbladder disease, such as those related to your heart, muscles, and other organs within your digestive system. This is why it's important to have your pain evaluated by a medical professional.

Causes

The following health problems are all potential sources of gallbladder pain:

Gallstones

The most common cause of "gallbladder pain" is gallstones (also called "cholelithiasis"), which are hard particles that form due to either an imbalance of the substances that make up bile (the fluid that the gallbladder secretes to aid in the digestion of food) or the gallbladder not emptying as it should. These particles can be quite small or grow to the size of a golf ball.

Typically, the formation of gallstones happens very slowly. A person may develop one large stone, multiple small stones, or a mix of the two. It is entirely possible to have gallstones and not have any symptoms. Such stones are considered benign because they do not interfere with the functioning of your digestive system.

Pain occurs, though, when a gallstone blocks one of the ducts in the biliary tract—the part of your body that contains your gallbladder and your bile ducts. The pain may ease when the gallstone moves and the bile duct is no longer blocked.

Serious complications can arise from having gallstones. The gallbladder, common bile duct, or the pancreas may become inflamed and infected, posing a great risk to your health. Rarely, gangrene or rupture of the gallbladder can occur, or a gallstone may cause a bowel obstruction.

Biliary Sludge

Besides gallstones, biliary sludge (thickened bile salts) may also form in the gallbladder. This sludge blocks healthy bile emptying out of the gallbladder, potentially causing similar symptoms and complications as gallstones.

Cholecystitis

Gallbladder inflammation (called "cholecystitis") most commonly develops as a result of gallstones. Less commonly, cholecystitis develops without gallstones (called "acalculous cholecystitis").

Acute Cholecystitis

When a gallstone becomes stuck within the gallbladder, inflammation ensues, causing sudden and sometimes severe abdominal pain (called "biliary colic") along with nausea, vomiting, fever, and a loss of appetite. Biliary colic describes a dull, cramping pain in the upper-right part of the abdomen.

Acalculous Cholecystitis

Acalculous cholecystitis causes the same symptoms as acute cholecystitis, although a gallstone is not the culprit. While the precise cause is not clear, experts suspect poor bile and blood flow within the gallbladder may cause this condition to develop. Acalculous cholecystitis is mostly seen in people who are severely ill, like those on mechanical ventilation or those with a major infection or severe burn injury.

Acute Cholangitis

Acute cholangitis occurs from a bacterial infection in the common bile duct, often as a result of an obstructing gallstone, or sometimes from a bile duct stricture or cancer of the gallbladder, bile duct, pancreas, or duodenum (first part of the small intestine). Symptoms of acute cholangitis may include upper-right-sided abdominal pain, fever, and jaundice. In more severe cases, a person may also develop low blood pressure and confusion, which can be signs of life-threatening sepsis.

Gallbladder Rupture

Rarely, your gallbladder may rupture or burst open as a result of gallbladder inflammation (cholecystitis). Even rarer, an injury like a motor vehicle accident or sports contact injury may result in gallbladder rupture, causing sudden and severe, sharp pain in the upper-right part of your abdomen.

Choledocholithiasis

Choledocholithiasis is where gallstones block the common bile duct, restricting the flow of bile from the liver to the intestine. The resulting rise in pressure can cause an increase in liver enzymes and also jaundice.

Functional Gallbladder Disease/Biliary Dyskinesia

Functional gallbladder disease (FGBD), sometimes referred to as "chronic acalculous gallbladder dysfunction" or "biliary dyskinesia," is the technical name for gallbladder disease without the presence of any gallstones. It includes dysfunction of the sphincter of Oddi, the muscular sphincter that helps to control gallbladder emptying. Symptoms may come on suddenly or occur chronically.

Biliary dyskinesia is a gallbladder syndrome that occurs when your gallbladder is not emptying properly. Due to improper drainage of bile, gallbladder pain and other symptoms, such as nausea and vomiting, may result.

Biliary dyskinesia is usually only identified after other causes of pain (like gallstones) have been ruled out.

Most of the treatment recommendations have been written to address people with gallbladder hypokinesia (underfunction), but there is a growing body of research about people with hyperkinesia, whose gallbladders empty too much.

Current research indicates that both hypokinesia and hyperkinesia of the gallbladder may benefit from gallbladder removal (cholecystectomy).

Gallbladder Cancer

Gallbladder cancer is rare and is often not diagnosed until it is fairly advanced. Besides gallbladder pain, a person with gallbladder cancer may be jaundiced and experience nausea, vomiting, and weight loss.

Because of its vague symptoms, gallbladder cancer is often found late. Gallbladder cancer that is diagnosed late can have a poor prognosis.

When to See a Healthcare Provider

If you are experiencing gallbladder pain, you should inform your healthcare provider as soon as possible, even if your symptoms have gone away. Your healthcare provider will want to make sure that you are not experiencing a problem that will put you at risk for a more severe disease in the future.

You should get immediate medical attention if you experience any of the following symptoms:

• Severe, intense pain that prevents you from getting comfortable
• Pain that increases when you take a breath
• Pain that lasts for more than five hours
• Yellow skin or yellow around the whites of your eyes (called jaundice)
• Fever and chills
• Rapid heartbeat
• Persistent vomiting
• Persistent lack of appetite or unexplained weight loss
• Cola or tea-colored urine
• Clay-colored stools

Diagnosis

Getting to the bottom of your gallbladder pain entails a medical history, physical exam, blood tests, and imaging tests.

Medical History

During your visit, your provider will ask you several questions about your discomfort. For example, they will ask you to pinpoint as best as you can exactly where you feel the pain on your belly. Your healthcare provider may also inquire whether your gallbladder pain occurs with eating fatty meals or whether you have any other symptoms like fever, nausea, or vomiting.

Physical Examination

During your physical exam, your healthcare provider will focus on your abdomen, specifically the right upper part where your gallbladder is located. In addition to examining the area for skin changes, swelling, tenderness, and guarding (tensing of the abdominal wall), they will likely press on your gallbladder to see if it is tender (a technique called "Murphy's sign").

During this maneuver, your healthcare provider will have you take a deep breath in, while they press on your gallbladder to see if any pain is elicited. If so, this indicates an inflamed gallbladder (a "positive" Murphy's sign).

Blood Tests

When evaluating gallbladder pain, your medical provider will usually order blood tests, including a complete blood count (CBC), a complete metabolic panel, a PT/PTT (blood clotting tests), and liver function tests.

Your provider may also order other tests to rule out other causes of your pain.

Imaging

In order to confirm that your pain is a result of a gallbladder disease, your healthcare provider will want to visualize your gallbladder. The first test, and sometimes the only test needed, is an ultrasound. Ultrasounds are non-invasive and painless. Sometimes, you will be sent to a radiology department for your ultrasound, but some healthcare providers' offices have the ability to perform the ultrasound there.

While trying to determine your diagnosis, your healthcare provider may also order the following imaging tests:

• Hepatobiliary iminodiacetic acid (HIDA) scan: By injecting you with a small amount of a radioactive substance, healthcare providers are able to see how the substance moves through your body, including your gallbladder, bile ducts and your liver. This can actually help your healthcare providers to see how your gallbladder is emptying in real time.
• Computed tomography (CT) scan ("CAT" scan): Multiple x-rays will be taken, often using a swallowed or IV contrast medium to help picture quality. A computer then puts these multiple images together into a three-dimensional image.
• Magnetic resonance cholangiopancreatography (MRCP): As a special type of magnetic resonance imaging (MRI), this test uses strong magnets to take detailed pictures of your common bile duct and surrounding structures.
• Endoscopic retrograde cholangiopancreatography (ERCP): For an ERCP, you swallow a tube with a light and a camera attached, while you are sedated. The camera allows healthcare providers to look for any problems, and attached tools can sometimes allow them to take care of the problem that day, like removing stones or widening a narrow bile duct.

Differential Diagnoses

While it is reasonable to think that pain in the right upper abdomen is related to the gallbladder, keep in mind that the liver is also located in this area. Therefore, liver disease, such as hepatitis, may be what is actually causing your presumed gallbladder pain.

Some of the diagnoses that your provider may explore include:

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease
• Gastritis
• Angina
• Acute coronary syndrome, which includes unstable angina and myocardial infarction (a heart attack)
• Pancreatitis (acute or chronic)
• Appendicitis
• Diabetic ketoacidosis (DKA)
• Irritable bowel syndrome

Treatment

The treatment of gallbladder pain depends on the precise cause.

"Watch and Wait" Approach

For people with asymptomatic gallstones, a "watch and wait" approach is taken, meaning surgery to remove their gallbladder is only done if and when their gallstones begin causing symptoms.

Only about 50% of people with asymptomatic gallstones will go on to develop symptoms, whereas surgery does carry some risks. A low-fat diet can be beneficial in preventing gallstone formation, as 80% or more of gallstones are made of cholesterol.

Medications

Medications are rarely used to treat gallstones, but your healthcare provider may recommend a medication like a nonsteroidal anti-inflammatory (NSAID) to ease your gallbladder pain.

Antibiotics may be given if a person develops a gallbladder or biliary tract infection, which is a complication of gallstone disease.

Bile acid pills are sometimes given to people with minimal symptoms and a well-functioning gallbladder. The medications ursodeoxycholic acid and ursodiol help to dissolve the cholesterol type of gallstones in two-thirds of patients within two to three months, but the stones may not disappear entirely.

Surgery/Procedures

There are two surgical ways to remove the gallbladder:

• Open cholecystectomy: The gallbladder is removed through a large cut in the abdomen. This is sometimes the only option for ruptured gallbladders or surgery where extensive exploration may be needed, as in cancer.
• Laparoscopic cholecystectomy: The surgeon uses long, thin instruments to remove the gallbladder through a much smaller cut in the abdomen. This is the most common gallbladder surgery.

An endoscopic retrograde choloangiopancreatogprahy (ERCP) is a procedure performed by a gastroenterologist. It can be used to both visualize and remove the problem, and it is most commonly used to relieve an obstructed bile duct.

Prevention

Focusing on a healthy lifestyle is your best chance to prevent gallstones and, thus, gallbladder pain.

Bear in mind, these strategies do more than keep your gallbladder healthy—they also keep your heart healthy:

• Visit your primary care healthcare provider for periodic checkups.
• Exercise for at least 30 minutes, 5 days per week.
• Eat a healthy diet rich in vegetables, fruits, low-fat dairy products, whole grains, legumes, and spices.
• Keep your weight low, but try to avoid rapid weight loss.
• Avoid foods high in saturated fat and cholesterol.
• If you are on a cholesterol medication or hormone replacement therapy, speak with your healthcare provider to find out if these medications have increased your risk for the development of gallstones.
  

A Word From Verywell

While gaining knowledge about your gallbladder pain is a good proactive step, be sure to get checked out by a healthcare provider. A thorough assessment and prompt treatment of your pain is the best way to prevent complications and get back to feeling your best.