Gallstones: Symptoms, Diagnosis, and When You Actually Need Surgery

Gallstones are one of the most common digestive problems worldwide, yet many people don't realize they have them until a stone blocks a duct and triggers sudden, severe pain. Others carry gallstones for years without any symptoms at all.

So how do you know if that pain under your right ribs is a gallstone attack — and does having gallstones automatically mean you need surgery? As a gastroenterologist and liver specialist in Chandigarh, Dr. Sandeep Pal explains what gallstones are, how they're diagnosed, and when treatment actually requires an operation.

What Are Gallstones?

Gallstones are hardened deposits that form in the gallbladder — a small organ beneath the liver that stores bile, a fluid used to digest fat. Stones form when bile contains too much cholesterol or bilirubin, or when the gallbladder doesn't empty properly.

There are two main types:

• Cholesterol stones — the most common type, made mostly of hardened cholesterol

• Pigment stones — smaller, darker stones made of bilirubin, more common in people with liver disease or blood disorders

Gallstones can range from as small as a grain of sand to as large as a golf ball, and a person can have just one or many at once.

Who Is at Risk?

Certain factors increase the likelihood of developing gallstones:

• Being female (especially with pregnancy or hormonal therapy history)

• Age over 40

• Obesity or rapid weight loss

• A diet high in fat and cholesterol, low in fibre

• Family history of gallstones

• Diabetes

• Certain liver conditions

Common Symptoms of Gallstones

Many gallstones are "silent" and cause no symptoms at all — these are often found incidentally during an ultrasound for an unrelated issue. Symptoms usually appear only when a stone blocks a bile duct. This is called a gallbladder attack or biliary colic, and it typically includes:

• Sudden, intense pain in the upper right abdomen, often radiating to the right shoulder or back

• Pain that worsens after eating fatty or fried food

• Nausea and vomiting

• Bloating and indigestion

• Pain lasting anywhere from 30 minutes to several hours

Warning signs that need urgent medical attention:

• Fever with chills

• Yellowing of the skin or eyes (jaundice)

• Persistent, severe abdominal pain

• Rapid heartbeat

These symptoms may indicate the stone has caused an infection, inflammation of the gallbladder (cholecystitis), or a blockage affecting the liver and pancreas — situations that need prompt evaluation.

(If you've noticed changes in stool color or blood in your stool alongside digestive symptoms, our earlier blog on [Blood in Stools: Common Causes, Warning Signs, and When to See a Gastroenterologist] covers when that needs urgent attention too.)

How Are Gallstones Diagnosed?

Diagnosis typically involves a combination of the following:

1. Abdominal ultrasound — the first-line test, highly effective at detecting gallstones

2. Blood tests — to check for infection, inflammation, or liver involvement

3. CT scan or MRI — used if complications are suspected

4. MRCP (Magnetic Resonance Cholangiopancreatography) — to check the bile ducts in detail

5. ERCP — used both diagnostically and therapeutically if a stone has moved into the bile duct

(We explained this procedure in detail in our earlier post: [What is ERCP? Understanding Advanced Biliary and Pancreatic Care].)

Do All Gallstones Need Surgery?

Not necessarily. Treatment depends entirely on whether the stones are causing symptoms or complications.

If gallstones are silent (no symptoms): Most doctors recommend a "watch and wait" approach. Surgery is generally not needed unless the person is at higher risk for complications, such as having very large stones or an underlying condition like diabetes.

If gallstones are causing symptoms: Once a gallstone causes pain or complications, the risk of recurring attacks is high. In these cases, surgical removal of the gallbladder — called a cholecystectomy — is usually recommended, as medications typically only manage symptoms temporarily rather than resolving the underlying problem.

If a stone has moved into the bile duct: This is a more urgent situation. An ERCP procedure may be needed first to remove the stone from the duct, often followed by gallbladder removal to prevent future episodes.

What Does Gallbladder Surgery Involve?

The standard treatment is laparoscopic cholecystectomy — a minimally invasive procedure done through small incisions, with most patients going home within a day or two and returning to normal activities within a week or two.

The good news: the gallbladder is not an essential organ. The liver continues to produce bile even after its removal, and most people digest food normally afterward, with only minor dietary adjustments needed in the initial weeks.

Can Gallstones Be Managed Without Surgery?

In select cases — such as small cholesterol stones in patients who aren't good surgical candidates — medication to dissolve stones may be considered. However, this approach is slow, works only for specific stone types, and stones often recur once medication stops. For most symptomatic patients, surgery remains the most effective long-term solution.

FAQs: Gallstones

Q1. What does a gallstone attack feel like? It typically feels like sudden, intense pain in the upper right abdomen that may spread to the back or right shoulder, often triggered after a fatty meal, and lasting from 30 minutes to a few hours.

Q2. Can gallstones go away on their own? Small stones rarely dissolve on their own. Some may pass without causing problems, but most remain in the gallbladder unless treated.

Q3. Is surgery the only treatment for gallstones? Surgery is the most effective treatment for symptomatic gallstones, but silent gallstones without symptoms often don't require any treatment beyond monitoring.

Q4. How long does gallbladder removal surgery take to recover from? Most patients recover from laparoscopic gallbladder removal within one to two weeks, though this can vary based on the individual and whether complications were present.

Q5. What happens if gallstones are left untreated? Untreated symptomatic gallstones can lead to complications such as gallbladder infection, inflammation, blockage of the bile duct, or pancreatitis, which may require emergency treatment.

Q6. Can diet help prevent gallstones? A diet lower in saturated fat and cholesterol, with adequate fibre, along with maintaining a healthy weight, can help reduce the risk of gallstone formation.

Get Expert Gallstone Evaluation in Chandigarh

If you're experiencing abdominal pain after meals or have been told you have gallstones, getting an accurate diagnosis is the first step toward the right treatment. Dr. Sandeep Pal, Gastroenterologist and Liver Specialist in Chandigarh, offers thorough evaluation — from ultrasound and blood work to advanced procedures like ERCP — to determine whether you need surgery or ongoing monitoring.

Book a consultation today to get clarity on your gallbladder health.