Gallbladder Pain (Gall Bladder Pain)

Gallbladder pain may vary or feel different depending on the cause.

Gallbladder pain (often misspelled "gall bladder") is an all-inclusive term used to describe any pain due to disease related to the gallbladder. The major gallbladder problems that produce gallbladder pain are biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis. Symptoms vary and may be triggered by eating certain foods, commonly fatty foods. The pain may be described as intermittent, constant, abdominal, radiating to the back, or mild to severe depending on the underlying cause.

A brief review of the gallbladder anatomy and function may help readers better understand gallbladder pain. The gallbladder is connected to the liver via ducts that supply bile to the gallbladder for storage. These bile ducts then form the common hepatic duct that joins with the cystic duct from the gallbladder to form the common bile duct that empties into the GI tract (duodenum). In addition, the pancreatic duct usually merges with the common bile duct just before it enters the duodenum. Hormones trigger the gallbladder to release bile when fat and amino acids reach the duodenum after eating a meal (see illustration below), which facilitates the digestion of these foods. Statistics suggest that women may have up to twice the incidence of gallstones than men.

In some cases, a gallbladder attack occurs when a gallstone obstructs one of the bile ducts, causing bile to back up in the gallbladder. This blockage leads to sudden, sharp, and intense pain in the upper-right abdomen, just beneath the ribcage, as the gallbladder becomes distended and inflamed. The pain may radiate to the back, particularly between the shoulder blades, or to the right shoulder. In some cases, the pain can be described as a cramping sensation or a constant ache. A gallbladder attack is often triggered by eating a large or fatty meal, as this prompts the gallbladder to release bile to aid in digestion. However, the pain typically persists until the blockage is resolved. Gallbladder pain relief can be achieved through medical treatment or surgery in the case of a gallstone obstruction.

Along with the intense pain that lasts several hours, gallbladder attack signs may include:

• Nausea and vomiting
• Fever and chills
• Jaundice
• A persistent sense of illness

Biliary colic is a term used to describe the type of pain related to the gallbladder when the gallbladder contracts and the cystic duct is partially or completely blocked by a gallstone. The symptoms are described below.

Illustration of gallstones forming in the gallbladder

As stated previously, the major gallbladder problems that produce gallbladder pain are biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis. Two major causes of pain either originate from the gallbladder or involve the gallbladder directly. They are due to:

1. intermittent or complete blockage of any of the ducts by gallstones; or,
2. gallstone sludge and/or inflammation that may accompany irritation or infection of the surrounding tissues, when partial or complete obstruction of ducts causes pressure and ischemia (inadequate blood supply due to a blockage of blood vessels in the area) to develop in the adjacent tissues.

Gallstone formation usually happens in the gallbladder but may form in any of the ducts. When the gallbladder is compressed (squeezed by musculature), bile usually goes out through the bile ducts into the GI tract; however, if gallstones or gallstone sludge is present, there can be partial or complete blockage of the ducts with pressure on the surrounding tissue, sometimes enough to cause local ischemia (inadequate blood supply).

Other processes such as trauma can cause gallbladder pain. Infection of the biliary ducts and the gallbladder, usually occurring after gallstone obstruction, also can cause pain.

Gallbladder pain may vary or feel different depending on the cause. In addition to severe pain in the upper-right abdominal area, gallbladder pain symptoms may include yellowing of the skin and whites of the eyes (jaundice), nausea and vomiting, fever and chills, and changes in stool or urine color, such as light-brown urine or light-colored stool. These symptoms could indicate complications, such as bile duct blockage or infection, which require immediate medical attention. Many people with gallstones never experience pain. However, some variations in gallbladder pain help the doctor to make a diagnosis.

• Biliary colic (intermittent duct blockage): Sudden and rapidly increasing pain (ache or pressure) in the right upper abdomen or epigastric area; some people will have pain radiating to the right shoulder (or back pain in the tip of the scapula) and/or also develop nausea and vomiting. The pain usually subsides in about 1 to 5 hours although a mild ache may persist for about a day.
• Cholecystitis (inflammation of the gallbladder tissue secondary to duct blockage): Severe steady pain in the upper-right abdomen that may radiate to the right shoulder or back, abdominal tenderness when touched or pressed, sweating, nausea, vomiting, fever, chills, and bloating; discomfort lasts longer than with biliary colic.
• Acalculous cholecystitis (no gallstones): Has similar symptoms to cholecystitis but occurs as a complication of other problems like trauma or burns; patients have severe symptoms and appear very ill.
• Pancreatitis: Gallstones from the gallbladder can block the pancreatic duct and cause pancreatitis (inflammation of the pancreas) with upper abdominal pain that may radiate to the back, tender abdomen, more pain after eating, nausea, and vomiting.
• Ascending cholangitis: Also known as cholangitis or infection of the biliary system, it causes symptoms and signs that include fever, abdominal pain, jaundice, and even hypotension (low blood pressure), and confusion; it is a medical emergency.

The history and physical exam help to establish a presumptive diagnosis. Murphy's sign (pain or temporary respiratory arrest on deep right subcostal palpation) has been estimated to be over 95% specific for acute cholecystitis.

• A few laboratory blood tests such as liver function tests, lipase, amylase, complete blood count (CBC), and an abdominal X-ray are done to determine the exact problem that is causing the pain.
• Ultrasound can detect gallstones and thickening (due to inflammation) of the gallbladder wall, and CT scans may delineate organ structural changes. CT scans are not as effective as ultrasound for diagnosing gallstones, but they provide more information than ultrasounds about other organs in the area.
• A HIDA scan (uses radioactive material) can measure gallbladder emptying, while an ERCP test uses an endoscope to place a dye in the ducts of the pancreas, gallbladder, and liver.
• Magnetic resonance imaging (MRI) is sometimes used to detail the organ structures (liver, gallbladder, and pancreas); other tests also may be considered.

The results of these tests help pinpoint the problem and establish the diagnosis.

If you have no gallbladder pain (even if you have gallstones but never had pain), you need no gallbladder treatment. Some patients who have had one or two gallstone attacks may elect to avoid treatment. Pain during an acute gallstone attack is often treated with morphine.

Medical treatments include:

• Oral bile salt therapy (<50% effective)
• Ursodiol (Actigall, for example)
• Dissolution
• Lithotripsy (shock waves)

The definitive treatment for gallbladder pain relief is gallbladder removal surgery (and/or the obstructing gallstones). Currently, the surgical method of choice is laparoscopic surgery, where the gallbladder is removed by instruments using only small incisions in the abdomen. However, some patients may require more extensive surgery. Usually, people do well once the gallbladder is removed unless there is an underlying cause that mimics gallbladder pain (for example, biliary dyskinesia, a motility disorder of the sphincter of Oddi).

Women who are pregnant are treated like women who are not pregnant, although pregnant women more commonly have cholesterol gallstone development than non-pregnant women. Although supportive care is tried in women who are pregnant, acute cholecystitis is the second most common surgical emergency in pregnancy (appendicitis is the first).

Home remedies for gallbladder pain relief include peppermint, alfalfa, apple cider vinegar, and others; you should check with your doctor before using these remedies.

Other home remedies for gallbladder pain relief include:

• Following a low-fat diet may reduce the frequency of biliary colic but has not been shown to dissolve gallstones.
• Coffee and regular exercise may reduce the incidence of gallstone disease and its associated gallbladder pain.
• Some health care professionals recommend decreasing dairy and grains in the diet after gallbladder removal; again, individuals should discuss such changes with their doctor.

The complications of gallbladder pain include:

• Discomfort with eating
• Poor food intake
• Weight loss
• Electrolyte abnormalities
• Consumption of pain medications
• Disruption of daily activities

Other complications of gallbladder disease include:

• Bile duct blockage
• Serious infections (empyema and gangrene of the gallbladder)
• Pancreatitis
• Peritonitis
• Infrequently, gallbladder cancer

• What is the fastest way to relieve gallbladder pain? The fastest way to achieve gallbladder pain relief, especially if caused by a gallstone, is through over-the-counter pain relievers like ibuprofen or acetaminophen. Applying a warm compress to the abdomen may also help relax muscles and reduce discomfort. However, if the pain is severe or accompanied by symptoms such as fever or jaundice, seeking immediate medical attention is critical, as these could indicate complications like cholecystitis or a blocked bile duct. Long-term gallbladder pain relief often requires surgical removal of the gallbladder (cholecystectomy).
• Are there natural remedies for gallbladder pain relief? There are several natural remedies that may help with gallbladder pain relief. These include drinking apple cider vinegar, peppermint tea, and dandelion root, which are thought to soothe the digestive system and alleviate discomfort. Turmeric, known for its anti-inflammatory properties, may also help reduce gallbladder inflammation. Also, staying hydrated and consuming a fiber-rich diet can support healthy bile production and overall gallbladder function. However, these remedies should not replace medical treatment for more serious complications.
• Can diet changes help with gallbladder pain relief? Diet changes can help provide gallbladder pain relief by reducing strain on the organ and improving bile flow. A low-fat, high-fiber diet with plenty of fruits, vegetables, and whole grains may reduce the risk of gallstones and support digestive health. At the same time, avoiding fatty, greasy, and processed foods can help prevent triggering pain or gallstone attacks. In some cases, a health care provider may recommend specific dietary adjustments to promote gallbladder pain relief and better manage gallbladder issues.
• What medications are used for gallbladder pain relief? For gallbladder pain relief, over-the-counter pain relievers such as ibuprofen or acetaminophen are often used to manage mild discomfort. In more severe cases, doctors may prescribe stronger medications, such as opioids for short-term pain relief or ursodeoxycholic acid to help dissolve certain types of gallstones. If an infection or inflammation is present, antibiotics or anti-inflammatory drugs may also be recommended.
• Is surgery the only option for long-term gallbladder pain relief? Surgery, specifically a cholecystectomy, is the most effective long-term solution for chronic gallbladder pain caused by conditions such as gallstones or cholecystitis. However, in some cases, medications such as ursodeoxycholic acid may be used to dissolve small, cholesterol-based stones if surgery is not an option. This approach is less common and may take months or years. Ultimately, surgery remains the most definitive treatment for long-term gallbladder pain relief and to prevent the recurrence of symptoms.
• How can I relieve gallbladder pain at night? For gallbladder pain relief at night, you can apply a warm compress or heating pad to the affected area to help relax muscles and ease discomfort. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can also provide temporary relief. However, it’s important to avoid heavy or fatty meals before bedtime, as they can trigger or worsen symptoms. If the pain persists or worsens, seeking medical attention is advised, as it could indicate a more serious condition.
• Does drinking water help with gallbladder pain relief? Drinking water can be beneficial for overall gallbladder health, as it helps maintain proper hydration and supports the flow of bile, which aids digestion. While water alone won't directly relieve gallbladder pain, staying hydrated can prevent bile from becoming too thick and may reduce the risk of gallstone formation, potentially preventing future pain episodes. However, if the pain is severe, it is important to seek medical attention for proper treatment.
• What exercises are good for relieving gallbladder pain? Gentle exercises can provide gallbladder pain relief by promoting digestion and reducing stress. Walking, light stretching, yoga, and deep breathing exercises are particularly helpful. Specific yoga poses, such as "child's pose" or "cat-cow," can stretch and relax the abdominal area, aiding in pain relief. However, intense physical activity or heavy lifting should be avoided, as it may worsen symptoms. Always consult a health care provider before starting any new exercise routine for gallbladder pain relief.
• Can gallbladder pain relief be achieved with essential oils? Essential oils such as peppermint, ginger, and lavender may help alleviate gallbladder pain by promoting relaxation, easing digestion, and reducing inflammation. Peppermint oil, in particular, has been noted for its ability to soothe digestive discomfort and relieve bloating, which can indirectly ease gallbladder pain. However, essential oils should be used cautiously, and they are not a substitute for medical treatment, especially in cases of severe or persistent pain.
• When should you seek medical attention for gallbladder pain? You should seek medical attention for gallbladder pain if you experience severe or persistent pain that lasts more than a few hours, particularly if it is accompanied by symptoms such as fever, chills, nausea, vomiting, or jaundice. If the pain spreads to your back or shoulder, it could be a sign of a serious condition, such as an infection, cholecystitis, bile duct blockage, or pancreatitis, all of which need immediate medical care.