Causes of Gallbladder Pain and Treatment Options

Your gallbladder is the pear-shaped organ located in your right upper abdomen, just under your ribcage. True gallbladder pain is more likely to happen several hours after you have eaten a heavy meal and in the evening or at night, waking you up from sleep. It may move ("radiate") to your right shoulder blade. 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.

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

The most common cause of "gallbladder pain" is gallstones, 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 or a bowel obstruction from a gallstone may occur.

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 the exact same symptoms and complications as gallstones.

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

Acute Cholecystitis

When a gallstone becomes stuck within the gallbladder, inflammation ensues, causing 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 occurs from an 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 intestines). 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.

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.

Biliary dyskinesia is a gallbladder motility syndrome that occurs when your sphincter of Oddi—a muscular valve that controls the flow of bile—is not working properly. Due to improper drainage of bile, gallbladder pain and other symptoms, such as nausea and vomiting, may result.

Functional gallbladder disease, sometimes referred to as chronic acalculous gallbladder dysfunction, is the technical name for gallbladder disease without the presence of any gallstones or sphincter of Oddi dysfunction. Symptoms may come on suddenly or occur chronically.

Gallbladder cancer is very 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.

If you are experiencing gallbladder pain, you should inform your physician as soon as possible, even if your symptoms have gone away. Your doctor 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
• Dark or tea-colored urine
• Light-colored stools

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

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

During your physical exam, your doctor 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), he will likely perform a technique called the "Murphy's sign."

During this maneuver, your doctor will have you take a deep breath in, while he presses on your gallbladder to see if any pain is elicited. If so, this indicates an inflamed gallbladder.

When evaluating gallbladder pain, a complete blood count (CBC) and a bilirubin level will be ordered.

In order to confirm that your pain is a result of a gallbladder disease, your doctor will want to visualize your gallbladder. The first test, and sometimes the only test needed, is an ultrasound.

Depending on potential diagnoses, your doctor may also order the following imaging tests:

• Hepatobiliary iminodiacetic acid (HIDA) scan
• Computed tomography (CT) scan
• Magnetic resonance cholangiopancreatography (MRCP)

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.

Even more, pain in the middle upper abdomen (called epigastric pain) can be confused with gallbladder pain. There are many causes of epigastric pain, such as:

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease
• Gastritis
• Angina
• Acute coronary syndrome, which includes unstable angina and myocardial infarction (a heart attack)

The treatment of gallbladder pain depends on the precise cause.

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.

Medications are rarely used to treat gallstones, but your doctor 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.

There are two surgical ways to remove the gallbladder:

• Open cholecystectomy: The gallbladder is removed through a large cut in the abdomen.
• Laparoscopic cholecystectomy: The surgeon uses long, thin instruments to remove the gallbladder through a much smaller cut in the abdomen.

An endoscopic retrograde choloangiopancreatogprahy (ERCP) is a procedure performed by a gastroenterologist, most commonly to relieve an obstructed bile duct.

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 physician for periodic check-ups.
• Exercise daily.
• 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 doctor to find out if these medications have increased your risk for the development of gallstones.

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