Gallstones are a common ailment for older adults – but what are the signs and symptoms? Robert Mair reports.

In this article:

  • What are gallstones?
  • Symptoms
  • Risk factors
  • Treatment

What are gallstones?

Gallstones are incredibly common. In England approximately 10% of the adult population has gallstones, in over 75’s this rises to 35% of women and 20% of men. For these individuals, there is only a 2% chance the gallstones will cause symptoms. For most it’s just a bit of biliary colic and only the minority develop more troublesome symptoms or complications.

Gallstones are found in the gallbladder, a small bag under the liver which stores and excretes bile – a useful substance in the digestive system to digest fats. Gallstones form once the gallbladder can no longer store all of the bile as a liquid. Gradually, the bile crystallises before turning into gravel and then stones.

There are 2 different types of gallstones. These are:

  • Cholesterol stones. These stones are made of cholesterol and are usually green, white or yellow. They are the commonest form of gallstones, found in about 80% of all cases.
  • Pigment stones. These are small dark stones made up of calcium salts and bilirubin (a by-product of dead red blood cells) and are responsible for the remaining cases of the complaint.

Despite the frequency of gallstones, many cases are asymptomatic – meaning people live with them and don’t experience any discomfort. But if the stones grow too big or move from the gallbladder into a narrow bile duct, they can cause intense pain.


The most common symptom is the pain caused by stones blocking narrow bile ducts. This is called biliary colic, and the pain can last for a few hours. Biliary colic may also cause nausea and vomiting. Usually, the pain is down the right hand side of the body and under the ribs. The pain, which comes and goes in waves, may extend as far as the abdomen manifesting itself as a dull ache.

Also, the wall of the gallbladder may become inflamed. This is called cholecystitis, and again causes pain down the right hand side of the body. In severe cases cholecystitis can cause the walls of the gallbladder to rupture resulting in bacterial infections such as e.coli.

Gallstones may also cause jaundice if a gallstone blocks the main tube between the liver and intestine. This traps bile and bilirubin in the body, causing a build up and adding a yellow pigment to the eyes and skin, fever and turning urine dark yellow.

In some cases, gallstones move into the pancreas causing that to become irritated and inflamed. This condition is called pancreatitis.

Risk factors

Gallstones are something of an enigma. What affects one person may be asymptomatic in someone else – which is why gallstones can range from tiny pebbles to the size of tennis balls before they are removed.

Risk factors are vague and wide ranging, but the following may contribute greatly to the condition:

  • Genetics
  • Gender – women are 2-3 times more likely to be affected than men
  • Being a mother – particularly women who have had multiple pregnancies
  • Being over 40 years old
  • High cholesterol diets
  • Being overweight
  • Poor gallbladder movement, meaning the gallbladder fails to empty properly
  • Increased levels of estrogen

But diets that include wine and wholegrain bread may reduce the risk of gallstones developing. Vegetarians are less likely to get gallstones, as are coffee drinkers, because the bitter taste stimulates bile flow.

Approximately 600 cases of cancer of the gallbladders are diagnosed in the UK each year. Another complication is where the bowel is actually obstructed by a gallstone. This is known as gallstone ileus. Symptoms include constipation and vomiting.

Only people in a very poor state of health normally risk death from gallstones. Only 1 in 175 people actually die from the condition.


Gallstones are usually diagnosed by an ultrasound scan. However, blood and urine samples may also be required if there is a chance of infection.

In many cases, gallstones may be left untreated if they don’t provide any symptoms. Instead, they may be monitored and removed once they become painful.

There are a number of different treatments available for gallstones. These include:

  • Cholecystectomy. This is the removal of the gallbladder, and is usually done by open surgery or a laparoscopic cholecystectomy (a type of keyhole surgery)
  • Dissolution. Medicine is used to dissolve the gallstones, but the treatment can be a lengthy procedure and does not work in every case
  • Shock wave lithotripsy. Sound waves are used to break the gallstones into tiny pieces, before medication is used to dissolve the remnants
  • Endoscopic retrograde cholangio-pancreatography (ERCP). This is removal of the gallstones without removing the gallbladder. A thin, flexible telescope (endoscope) is passed down the mouth and throat to the gallbladder, and special instruments are used to remove the stones


There is no guaranteed method of preventing gallstones, however, a diet low in cholesterol and fats, but high in wholegrains, fresh fruit and vegetables should help.