Gallbladder disease: Types, diagnosis, and treatment

Your gallbladder is one of those organs you never think about… until it throws a full-blown tantrum at 2 a.m. If you’ve ever had sharp pain under your right ribs after a greasy meal, you’ve already met one of the most common gallbladder villains: gallstones. Gallbladder disease is very common in the United States, affecting tens of millions of people and costing billions of dollars in healthcare each year.

In this in-depth guide, we’ll walk through the main types of gallbladder disease, how doctors diagnose them, and which treatments actually help. We’ll also talk about what life looks like after surgery and share real-world experiences so the topic feels a little less scary and a lot more understandable.

What does the gallbladder actually do?

The gallbladder is a small, pear-shaped pouch tucked under your liver. Its main job is storage, not drama. The liver makes bile (a yellow-green fluid that helps digest fats), and the gallbladder stores and concentrates that bile. When you eat, especially fatty foods, the gallbladder squeezes and sends bile down the bile ducts into your small intestine to help break down your meal.

When everything works smoothly, you never notice it. Gallbladder disease happens when something interferes with this flow – usually stones, inflammation, or structural problems in the gallbladder or bile ducts.

Common types of gallbladder disease

1. Gallstones (cholelithiasis)

Gallstones are by far the most common gallbladder problem. They’re hard, pebble-like deposits that form from components of bile, most often cholesterol. In the U.S., most gallstones are cholesterol stones, while a smaller portion are pigment stones made from bilirubin, a breakdown product of red blood cells.

Many people have “silent” gallstones and never know it. Trouble starts when a stone tries to exit the gallbladder and gets stuck, blocking the flow of bile. This can lead to:

• Biliary colic: Sudden, crampy pain in the upper right abdomen or middle of the upper belly, often after a heavy or fatty meal. The pain may radiate to the right shoulder or back and can last from minutes to several hours.
• Recurrent attacks: Some people get repeated episodes of this pain until the underlying problem is treated.

2. Acute and chronic cholecystitis

Cholecystitis is inflammation of the gallbladder. It’s usually caused by a gallstone blocking the cystic duct (the channel that drains bile from the gallbladder). This is called acute calculous cholecystitis and often presents with:

• Severe, steady right upper quadrant pain lasting more than a few hours
• Fever and chills
• Nausea and vomiting
• Tenderness when a doctor presses under the right ribs

Less commonly, cholecystitis can occur without stones (acalculous cholecystitis), usually in very ill or hospitalized patients.
Repeated bouts of inflammation can lead to chronic cholecystitis, where the gallbladder becomes thickened, scarred, and less effective at squeezing out bile.

3. Choledocholithiasis and bile duct problems

When gallstones migrate out of the gallbladder and lodge in the common bile duct, it’s called choledocholithiasis. This can cause:

• Jaundice (yellowing of the skin and eyes)
• Dark urine and pale stools
• Fever and chills if infection develops (cholangitis)
• Pancreatitis (inflammation of the pancreas) if the pancreatic duct is blocked

Choledocholithiasis and related conditions like cholangitis and gallstone pancreatitis are medical emergencies. They often require urgent endoscopic or surgical treatment.

4. Functional gallbladder disorder (biliary dyskinesia)

Sometimes people have classic gallbladder-type pain, but no stones show up on ultrasound. In some of these cases, the problem is functional – the gallbladder doesn’t contract properly. A special scan (HIDA scan) can measure gallbladder ejection fraction (how well it squeezes). If the ejection fraction is low and the symptoms fit, doctors may diagnose a functional gallbladder disorder.

5. Gallbladder polyps and cancer

Gallbladder polyps are small growths that project from the inner wall of the gallbladder. Most are benign, especially when they’re tiny, but larger polyps (typically over 1 cm) or those associated with gallstones may carry a higher cancer risk.

Gallbladder cancer is rare but aggressive. Risk is higher in people with long-standing gallstones, a “porcelain gallbladder” (heavy calcification of the wall), or large polyps. Many gallbladder cancers are discovered incidentally during surgery for what was thought to be routine gallbladder disease.

Who is at risk for gallbladder disease?

Classic teaching talks about the “four F’s”: female, forty, fat, and fertile – meaning women around middle age with higher body weight and a history of pregnancies have higher risk. That’s an oversimplification, but some risk factors are well established:

• Being assigned female at birth
• Older age (risk rises over 40)
• Family history of gallstones
• Overweight or obesity
• Rapid weight loss (including after bariatric surgery)
• Pregnancy or use of estrogen therapy
• Certain medical conditions such as diabetes, liver disease, or hemolytic anemias

Interestingly, people who undergo bariatric surgery have a higher risk of developing gallstones due to rapid weight loss. Some guidelines suggest using medications like ursodeoxycholic acid in selected patients after surgery to reduce this risk.

Symptoms you shouldn’t ignore

Not everyone with gallbladder disease looks the same, but common symptoms include:

• Sudden, intense pain in the upper right abdomen or middle upper abdomen, especially after eating
• Pain that radiates to the back or right shoulder blade
• Nausea and vomiting
• Abdominal bloating or feeling “overly full” after small meals
• Fever and chills (more concerning for infection)
• Yellowing of the skin or eyes, dark urine, or very pale stools (possible bile duct obstruction)

If you have severe abdominal pain that doesn’t improve, especially with fever or jaundice, it’s time to stop Googling and get emergency medical care.

How gallbladder disease is diagnosed

History and physical exam

Diagnosis starts with your story. Your healthcare professional will ask:

• Where is the pain, and what does it feel like?
• How long does it last?
• Does it happen after eating, particularly fatty foods?
• Do you have nausea, vomiting, fever, or jaundice?

During the exam, they’ll press on your abdomen to check for tenderness, especially in the right upper quadrant. A sharp increase in pain when pressing under the right ribs while you take a breath (Murphy’s sign) can suggest cholecystitis.

Blood tests

Lab tests can’t “see” the gallbladder, but they provide important clues:

• Complete blood count (CBC): Looks for elevated white blood cells, suggesting infection or inflammation.
• Liver enzymes and bilirubin: Elevated levels may point to bile duct obstruction or liver stress.
• Pancreatic enzymes (amylase, lipase): Help detect pancreatitis if stones have blocked the pancreatic duct.

Imaging tests

Imaging is where things get very practical. Several tools help visualize stones and inflammation.

Abdominal ultrasound

Ultrasound is usually the first imaging test for suspected gallbladder disease. It’s noninvasive, doesn’t use radiation, and is very good at detecting gallstones and signs of inflammation like gallbladder wall thickening or fluid around the gallbladder.

HIDA scan (hepatobiliary iminodiacetic acid scan)

If the ultrasound is inconclusive, a HIDA scan may be done. This nuclear medicine test tracks a small amount of radioactive tracer injected into your bloodstream as it moves through the liver, gallbladder, and bile ducts. If the gallbladder doesn’t show up or fails to empty properly, that can confirm acute cholecystitis or a functional problem with gallbladder contraction.

CT scan, MRI, and MRCP

CT can help identify complications like perforation, abscess, or other abdominal problems. MRI and MRCP (magnetic resonance cholangiopancreatography) are particularly useful for detailed views of the bile ducts and can show stones in the common bile duct.

ERCP (endoscopic retrograde cholangiopancreatography)

An ERCP uses an endoscope passed through the mouth into the small intestine, combined with X-ray dye, to visualize and treat bile duct problems. If stones are blocking the common bile duct, ERCP can remove them. This is both a diagnostic and therapeutic procedure and is often used in more complex or emergency cases.

Treatment options for gallbladder disease

Treatment depends on the type and severity of your condition. Not every gallstone needs to be evicted, but some absolutely do.

Watchful waiting for silent gallstones

If gallstones are found by accident and you have no symptoms, many guidelines support a “watch and wait” approach. The risk of complications from silent stones is relatively low, so routine surgery for everyone is not recommended.

Medications

Medicines play a supporting role in gallbladder care:

• Pain relievers: NSAIDs or other pain medications help manage biliary colic or post-operative discomfort.
• Antibiotics: Used in acute cholecystitis or cholangitis to treat infection alongside other interventions.
• Ursodeoxycholic acid (UDCA): This medication can help dissolve certain cholesterol stones and is sometimes used in patients who cannot undergo surgery, or to prevent stones after bariatric surgery. It’s most effective for small, non-calcified stones and may take months of treatment.

Medication alone is rarely a permanent solution for symptomatic gallstones, but it can be useful in specific situations.

Minimally invasive procedures

For stones in the bile duct or severe infection, procedures like ERCP or percutaneous drainage may be necessary:

• ERCP with stone removal: Used for choledocholithiasis (bile duct stones), sometimes followed by gallbladder removal in a separate step.
• Percutaneous cholecystostomy: Placement of a drainage tube into the gallbladder through the skin, often used in very sick or high-risk patients as a temporary measure.

Surgery: laparoscopic cholecystectomy

For persistent biliary colic, recurrent cholecystitis, certain polyps, or complications, the most definitive treatment is cholecystectomy – surgical removal of the gallbladder.

The standard approach is laparoscopic cholecystectomy:

• Several small incisions in the abdomen
• Use of a camera and instruments to remove the gallbladder
• Usually a short hospital stay and relatively quick recovery

In more complex situations (severe inflammation, scarring, or unusual anatomy), an open surgery may be necessary, but this is less common.

You can live without a gallbladder. After surgery, bile flows directly from the liver into the small intestine instead of being stored and concentrated. Some people experience temporary diarrhea or changes in how they tolerate fatty foods, but many feel significantly better once the painful attacks are gone.

Living with gallbladder disease or after gallbladder removal

Whether you’re trying to prevent attacks or recovering after surgery, some lifestyle strategies can support your digestive system:

• Moderate fat intake: You don’t have to eat zero fat, but very greasy, fried foods are classic gallbladder triggers.
• Balanced meals: Include fiber, lean proteins, and healthy fats instead of huge, heavy meals.
• Maintain a healthy weight: Avoid crash diets or rapid weight loss, which can increase gallstone risk.
• Stay hydrated: Adequate fluids support overall digestion and bile flow.
• Follow post-surgery instructions: Gradually expand your diet as recommended by your surgical team.

Most people are back to normal activities within days to weeks after laparoscopic cholecystectomy, with long-term relief from gallbladder attacks.

Important note: This article is for general information only and is not a substitute for medical advice, diagnosis, or treatment. Always talk with a qualified healthcare professional about your specific symptoms and options.

Real-world experiences with gallbladder disease and treatment

Medical textbooks do a great job explaining bile ducts and ejection fractions, but if you’ve ever had gallbladder pain, you know it’s not just about numbers – it’s about real life. Let’s look at what gallbladder disease often feels like in practice and what people commonly experience along the way.

From “just indigestion” to a diagnosis

Many people describe their first biliary colic attack as “the worst heartburn of my life.” Imagine this: you eat a big, late dinner – maybe something fried or cheesy – and go to bed feeling fine. A few hours later, a sharp, squeezing pain wakes you up. It’s high in your belly or tucked under your right ribs. You walk around, try antacids, change positions, but nothing really helps. After an hour or two, it fades. You shrug it off.

A few weeks later, it happens again. This time the pain wraps around to your back. You might feel nauseated, sweaty, and completely unable to get comfortable. When these episodes repeat, many people finally see a doctor or head to the emergency department. That’s often where an ultrasound reveals gallstones and everything suddenly makes sense.

The emotional side of choosing surgery

Hearing “you need your gallbladder removed” can be unsettling. It’s totally normal to have questions:

• “Will I be able to eat normally afterward?”
• “How long will I be out of work?”
• “Is it really necessary, or can I just change my diet?”

For someone with occasional mild biliary colic, a doctor might discuss watchful waiting and lifestyle changes. But if attacks are frequent, severe, or complicated by infection or bile duct problems, surgery is usually recommended as the safest long-term fix.

Many patients report that the fear before surgery was worse than the surgery itself. Laparoscopic cholecystectomy is a very common procedure, and most people go home the same day or the following day. Soreness around the incisions and bloating from the gas used during surgery are typical but usually improve over several days.

What recovery often feels like

The first week after surgery, fatigue is normal. People often say they felt good enough to do more than they actually should have – then discovered their body strongly preferred naps. Light walking helps reduce the risk of blood clots and eases gas pains, but heavy lifting and intense workouts are usually off the table for a bit, based on your surgeon’s instructions.

Bowel habits can change temporarily. Some people have looser stools, especially after fatty foods, because bile flows directly into the intestine instead of being stored and released in “bursts.” Over time, most bodies adapt and digestion settles into a new normal. Others notice almost no change in digestion at all and simply feel relieved that the attacks are gone.

Practical tips people commonly share

People who’ve been through gallbladder disease often pass along a few practical lessons:

• Don’t ignore repeated attacks: If you keep having upper right abdominal pain after meals, especially with nausea, don’t just keep a bottle of antacids on standby – get checked.
• Write down your symptoms: Keeping track of when pain occurs, how long it lasts, and what you ate can be incredibly helpful when you talk to your doctor.
• Ask about your imaging results: Knowing whether you have stones, inflammation, duct dilation, or other findings helps you understand why certain treatments are recommended.
• Plan your schedule: If surgery is recommended, ask about typical recovery time so you can coordinate time off work, childcare, and help at home.
• Start gently with food afterward: Many people do well starting with small, low-fat meals after surgery and gradually working up to their usual diet.
• Give yourself grace: Pain, fear, and disrupted sleep can take a toll. It’s okay to feel anxious and to ask lots of questions.

Perhaps the most common sentiment from people after successful treatment is, “I wish I’d dealt with this sooner.” Once the constant worry about when the next attack will hit is gone, daily life often feels lighter. Understanding the basics of gallbladder disease – what’s happening, how it’s diagnosed, and which treatments actually fix the problem – can make that whole journey less overwhelming and empower you to make informed decisions with your care team.