Biliary Colic
Pain from a gallstone temporarily blocking bile flow
Quick Facts
- Type: Gallbladder and bile duct problem
- Cause: Gallstone blocking bile flow
- Typical pain: Upper right abdomen, after fatty meals
- Seek urgent care: Fever, jaundice, lasting severe pain
Overview
Biliary colic is the term for episodes of pain that occur when a gallstone temporarily blocks the duct that carries bile out of the gallbladder. The gallbladder is a small organ under the liver that stores bile, a fluid that helps digest fats. When you eat, the gallbladder squeezes bile into the intestine. If a stone blocks the outlet during this squeeze, pressure builds up and causes pain.
Despite the word "colic," the pain is usually steady rather than coming in waves, and it often follows a fatty meal. The pain typically lasts from less than an hour up to a few hours and then settles as the stone falls back and bile flow resumes. Biliary colic itself is not an infection, but it is a warning that gallstones are present and that more serious complications, such as gallbladder inflammation, could follow.
Symptoms
The main feature is a recognizable pattern of pain:
- Steady, intense pain in the upper right or upper middle abdomen
- Pain that may spread to the right shoulder blade or back
- Onset often within an hour or so of a fatty or large meal, or at night
- Pain lasting from a short while up to a few hours, then easing
- Nausea and sometimes vomiting during an attack
Between attacks people usually feel well. If pain lasts more than several hours, or is accompanied by fever, chills, or yellowing of the skin or eyes, this suggests a complication and needs prompt medical care.
Causes
Biliary colic is caused by gallstones, which are hardened deposits that form in the gallbladder.
- Gallstones blocking bile flow: When the gallbladder contracts after a meal, a stone can lodge in the outlet (the cystic duct), trapping bile and raising pressure.
- Temporary blockage: The stone usually shifts back, bile flows again, and the pain settles, which is why attacks come and go.
Gallstones form when bile contains too much cholesterol or other substances, or when the gallbladder does not empty well. Many people have gallstones without symptoms; biliary colic occurs when a stone causes a temporary blockage.
Risk Factors
- Having gallstones
- Being female, especially during the reproductive years and pregnancy
- Older age
- Being overweight or rapid weight loss
- A diet high in fat and low in fiber
- A family history of gallstones
- Certain conditions such as diabetes
Diagnosis
Doctors diagnose biliary colic from the pattern of pain and imaging:
- History and examination: The timing, location, and triggers of the pain are key clues.
- Ultrasound: The main test, which can show gallstones and assess the gallbladder.
- Blood tests: Used to check for signs of inflammation, infection, or blockage of the bile ducts.
- Other imaging: Additional scans may be used if stones in the bile ducts or complications are suspected.
Treatment
Treatment focuses on relieving an attack and preventing further episodes and complications.
- Pain relief: Medication helps control the pain during an attack.
- Surgery to remove the gallbladder (cholecystectomy): The usual treatment for repeated biliary colic, typically done with keyhole (laparoscopic) surgery. People can live well without a gallbladder.
- Dietary measures: Reducing fatty meals may lessen attacks while awaiting surgery.
- Treating complications: If a stone causes inflammation or blocks the main bile duct, additional procedures or urgent care may be needed.
Removing the gallbladder prevents future gallstone pain in most people.
Prevention
- Maintain a healthy weight and avoid rapid weight loss
- Eat a balanced diet rich in fiber and lower in saturated fat
- Stay physically active
- Eat regular meals rather than long periods of fasting
- Manage conditions such as diabetes
- Discuss persistent or recurrent attacks with your doctor
When to See a Doctor
See a doctor if you have repeated episodes of upper-right abdominal pain after meals, so gallstones can be checked for and treatment discussed. Seek urgent or emergency care if you have:
- Severe abdominal pain that lasts more than several hours
- Fever and chills with the pain
- Yellowing of the skin or eyes (jaundice)
- Persistent vomiting, or pain with a fast heartbeat and feeling very unwell
These can signal gallbladder inflammation, infection, or a blocked bile duct, which need prompt treatment.
Frequently Asked Questions
What does biliary colic feel like?
It is usually a steady, intense pain in the upper right or middle of the abdomen, often after a fatty meal, that can spread to the right shoulder blade or back. It may last from under an hour up to a few hours and is often accompanied by nausea.
What causes biliary colic?
It is caused by a gallstone temporarily blocking the outlet of the gallbladder, which raises pressure as the gallbladder contracts after eating. When the stone shifts back, bile flows again and the pain eases.
How is biliary colic treated?
Attacks are managed with pain relief, and the usual long-term treatment for repeated episodes is surgery to remove the gallbladder, often done with keyhole surgery. People can digest food normally without a gallbladder.
When is gallstone pain an emergency?
Seek urgent care if the pain lasts more than several hours or comes with fever, chills, or yellowing of the skin or eyes. These can signal gallbladder inflammation, infection, or a blocked bile duct.
Can I prevent gallstone attacks?
Maintaining a healthy weight, avoiding rapid weight loss, eating a balanced high-fiber diet lower in saturated fat, and staying active may reduce gallstone risk and attacks. Surgery prevents recurrence once the gallbladder is removed.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones.
- Mayo Clinic. Gallstones — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Gallstones.
- American College of Surgeons. Cholecystectomy: Surgical Removal of the Gallbladder.