Why Do I Have Gallstones & Does It Matter?

The human body is complex. Really complex. With remarkable complexity comes the occasional “glitch.” According to NIH’s Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), gallstones affect 10-15% of the U.S. population – that’s roughly 25 million people. So why are so many bodies making gallstones?

What Are Gallstones, and Why Do They Form?

Gallstones, or biliary calculi, are solid particles that form in the gallbladder – the small organ under your liver that stores bile. That bile is released as your food moves through the digestive tract and helps break down fats, cholesterol, and bilirubin (a yellowish substance made when the body breaks down old red blood cells). Gallstones form when there is too much cholesterol or bilirubin and not enough bile salts to keep them dissolved, causing solid crystals that can clump into stones.

Why they form depends on several factors – bile salt imbalance is just one part of the picture. Sometimes, the gallbladder doesn’t empty completely or frequently enough. When bile sits still too long, it thickens and gives cholesterol and other materials time to form stones.

Hormones can also play a role. Higher-than-normal levels of estrogen can increase the amount of cholesterol in bile and slow down how fast the gallbladder empties. This is why fertile female patients are more likely to develop gallstones.

Body weight and metabolism matter, too. People with obesity or type 2 diabetes tend to produce more cholesterol, which can tip the balance in bile and increase the risk of stones.

Even rapid dieting or fasting can set the stage for stone formation. When you’re eating regularly, the gallbladder contracts to release bile into the digestive tract. However, with reduced food intake, it empties less frequently, allowing bile to sit longer and become more concentrated, which makes it easier for cholesterol crystals to form into stones.

Genetics is another factor. If gallstones run in your family or if you’re part of certain ethnic groups, your risk may be higher. Certain medical conditions – like cirrhosis, Crohn’s disease, sickle cell anemia, hypothyroidism, or cystic fibrosis – can also play a role by disrupting how bile is made, moved, or processed in the body.

One more thing – there’s not just one type of stone. Cholesterol stones, the most common type, form when bile contains more cholesterol than it can dissolve, causing the excess cholesterol to clump together into solid crystals. The other type, called pigment stones, develops when there is too much bilirubin in the bile. This can occur due to medical conditions such as blood disorders or liver disease, but infections or aging can also contribute. While one is more common than the other, both types cause similar symptoms.

How Do You Know You Have Gallstones?

Many people with gallstones may not experience symptoms, and often their stones are discovered by chance during scans for unrelated reasons. These “silent gallstones” remain in the gallbladder without causing pain or problems. When symptoms do appear, they can range from mild discomfort to intense pain. If a stone blocks bile flow or irritates the gallbladder, symptoms may include sudden, sharp pain in the upper right abdomen or between the shoulder blades that’s often accompanied by nausea, vomiting, or digestive upset, especially after fatty meals. And it’s the type of pain that doesn’t go away by shifting your position. – not even a bowel movement will make it any more comfortable.

To confirm a diagnosis of gallstones, doctors most often use ultrasound, a non-invasive imaging technique that uses sound waves to create pictures of the gallbladder. Ultrasound is preferred because it is highly accurate in detecting stones even as small as a few millimeters.

In some cases, additional imaging methods may be necessary to detect complications. CT (computed tomography) uses X-rays to create detailed cross-sectional images of the body, making it helpful in detecting infections, abscesses, or gallbladder stones.

MRI (magnetic resonance imaging) uses magnetic fields and radio waves to produce detailed images, especially of soft tissues like the bile ducts and pancreas.

Scintigraphy utilizes a special substance that travels through the liver and bile ducts, enabling doctors to monitor the flow of bile using a gamma camera. If the gallbladder isn’t filling properly, like when a duct is blocked, it creates a noticeable blank area on the image where the gallbladder should appear.

How Many Is Normal?

There is no specific “normal” number of gallstones, as individuals can have anywhere from a single stone to hundreds of tiny stones. The condition cholelithiasis (which translates to “bile stone pathology”) can be diagnosed even if there is just one gallstone – the number doesn’t matter.

What matters is whether gallstones are present, whether they’re causing symptoms, and whether they’re seen on imaging. So, if a single gallstone is found, even by accident, and confirmed through imaging, a person can be diagnosed with cholelithiasis.

How Do You Make Gallstones Go Away?

Gallstones do not typically go away on their own. If they’re not causing symptoms, doctors may recommend watching and waiting. But once gallstones cause problems, they usually don’t resolve without treatment.

For Common Treatments and Preventive Options:

• Watch and wait: Most people with silent gallstones never develop symptoms. If it’s not broken, you don’t have to fix it – without symptoms, doctors usually recommend no treatment.
• Healthier habits, such as eating a balanced diet, avoiding rapid weight loss, and staying active, may help prevent gallstones from forming in the first place.
• Cholecystectomy: For those with symptoms, gallbladder removal is standard and typically performed with minimally invasive laparoscopic surgery.

For More Complicated Cases:

• Prophylactic cholecystectomy: This is when gallbladder removal is performed as a preventative measure in medically high-risk populations.
• Percutaneous cholecystostomy (gallbladder drainage): When patients cannot safely undergo gallbladder removal surgery, non-surgical drainage methods are used.
• Endoscopic retrograde cholangiopancreatography (ERCP): This procedure combines imaging and treatment to help remove stones stuck in the bile ducts, especially when there’s an infection or blockage causing problems.
• Gallstone pancreatitis management: For gallstone pancreatitis, IV fluids and pain control are needed to reduce inflammation before removing the gallbladder.

From what you eat to your genes, many factors can tip the balance and cause stones to form. The good news? Not all gallstones cause trouble, and many people live just fine without ever knowing they have them. But if pain or other symptoms show up, it’s smart to get checked and explore treatment options before they get out of hand.

Your next step is to consult with a qualified professional, such as Dr. Chang, and determine if surgery is the right choice. Give our office a call so we can be your next step in getting (and staying) healthy.