What Are Gallstones and What Symptoms Do They Cause?
Understanding gallstones, gallbladder pain and when treatment may be needed
By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD — Compass Surgical, Auckland
This is the first article in our 8-part guide to gallstones and gallbladder surgery.
Gallstones are one of the most common digestive conditions affecting adults, yet many people know very little about them until they are diagnosed on an ultrasound scan.
Some people never develop symptoms. Others experience recurrent attacks of pain that can significantly affect their quality of life.
The most important thing to understand is that having gallstones does not automatically mean you need surgery. The key question is not simply whether gallstones are present, but whether they are responsible for your symptoms.
What are gallstones?
Gallstones are solid deposits that form inside the gallbladder.
The gallbladder is a small pouch beneath the liver that stores bile, a digestive fluid that helps break down fats. When you eat, particularly fatty foods, the gallbladder squeezes bile into the intestine to aid digestion.
Gallstones develop when substances within bile crystallise and gradually form stones. They may be as small as grains of sand or as large as several centimetres.
Most gallstones are made primarily of cholesterol, although some form from bile pigments produced during the normal breakdown of red blood cells.
Gallstones are extremely common, particularly as people get older, and many are discovered incidentally during scans performed for unrelated reasons.
What causes gallstones?
Gallstones usually develop gradually over many years.
Factors associated with gallstone formation include:
- Increasing age
- Female sex
- Pregnancy
- Family history of gallstones
- Being overweight
- Rapid weight loss
- Diabetes
Many patients assume they have caused the problem themselves. In reality, gallstones often develop despite an otherwise healthy lifestyle and are usually the result of a combination of genetics, hormones and body chemistry.
What symptoms do gallstones cause?
Many gallstones cause no symptoms at all.
When symptoms occur, the most common pattern is known as biliary colic, which develops when a gallstone temporarily blocks the outlet of the gallbladder.
Typical symptoms include:
- Pain beneath the right rib cage
- Pain in the upper abdomen
- Pain after eating, particularly fatty meals
- Pain that spreads to the back or right shoulder blade
- Nausea or vomiting during attacks
- Episodes lasting 30 minutes to several hours
Many patients feel completely normal between attacks.
What does gallstone pain feel like?
Patients commonly describe:
- A steady ache beneath the ribs
- A deep, gripping discomfort
- Pressure or tightness in the upper abdomen
- Pain that gradually increases in intensity
Unlike indigestion, gallstone pain is often difficult to relieve by changing position, passing wind or taking antacids. Many patients describe it as a pain that is impossible to ignore once it begins.
While attacks often occur after rich or fatty meals, they can also occur without an obvious trigger and may even wake patients from sleep.
Could my symptoms be caused by something else?
Absolutely. One of the most important principles in gallbladder surgery is recognising that not all upper abdominal pain is caused by gallstones.
Other conditions that can produce similar symptoms include:
- Acid reflux
- Gastritis
- Stomach ulcers
- Irritable bowel syndrome
- Liver conditions
- Pancreatic disorders
- Musculoskeletal pain
Finding gallstones on an ultrasound does not automatically prove they are responsible for your symptoms. This is why treatment decisions should never be based on scan results alone.
At Compass Surgical, we take time to understand the pattern of symptoms, review investigations carefully, and consider whether alternative explanations should be explored before recommending treatment.
When should I seek urgent medical attention?
Most gallstone attacks settle without causing lasting harm. However, you should seek urgent medical assessment if you develop:
- Severe abdominal pain that does not settle
- Fever or chills
- Yellowing of the skin or eyes (jaundice)
- Dark urine or pale stools
- Persistent vomiting
- Increasing abdominal tenderness
- Feeling generally unwell
These symptoms may indicate infection, inflammation of the gallbladder, bile duct blockage or pancreatitis and require prompt assessment. If you are seriously unwell or believe you may have a medical emergency, call 111.
Additional patient information about gallstones and gallbladder disease is available through the Royal Australasian College of Surgeons (RACS) patient information resources and Healthify NZ.
Do all gallstones need treatment?
No. Many people live their entire lives with gallstones and never require treatment.
For patients with typical symptoms, surgery is often the most effective long-term treatment. For others, observation may be entirely reasonable.
The decision depends on the pattern of symptoms, the impact on quality of life, overall health, and individual preferences.
At Compass Surgical, we focus on treating patients rather than treating scan results.
The Compass Surgical approach
Compass Surgical was founded on a simple principle: recommend surgery when it is likely to help. Avoid surgery when it is unlikely to help.
Our approach combines patient-centred care, surgical integrity, evidence-based decision-making, collaboration with GPs and specialist colleagues, and personalised treatment plans.
Working within a multidisciplinary environment allows us to collaborate closely with gastroenterologists, dietitians and other specialists when additional assessment is needed.
The goal is not simply to identify gallstones. The goal is to determine whether they are genuinely responsible for your symptoms and whether treatment is likely to improve your quality of life.
What next?
Now that we have covered what gallstones are and the symptoms they can cause, the next question is often the most important: "Do gallstones always need surgery?"
The answer is no. Many people live with gallstones for years without requiring an operation, while others benefit significantly from gallbladder removal. Understanding when surgery is appropriate, and when observation may be reasonable, is one of the most important parts of managing gallstone disease.
In the next article in this series, "Do Gallstones Go Away Without Surgery?", we explore conservative management, what the latest evidence tells us, and how surgeons help patients decide between observation and surgery. Further articles in this series will be added to the library.
Need advice about gallstones?
If you have been diagnosed with gallstones or are experiencing symptoms that may be related to gallbladder disease, Compass Surgical can help.
Working closely with your GP, we provide personalised, evidence-based advice tailored to your individual circumstances. Whether the right answer is reassurance, observation or surgery, our goal is to help you make an informed decision with confidence.
Contact Compass Surgical to arrange a consultation.
About the author
Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD
Dr Thomas Hanna is a general and transplant surgeon practising in Auckland. He trained in the United Kingdom before moving to New Zealand in 2019. He has specialist interests in gallbladder surgery, hernia repair, minimally invasive surgery and complex abdominal surgery. Tom is a founding partner of Compass Surgical and is committed to patient-centred surgical care, clear communication and surgery performed with integrity.
This article is part of the Compass Surgical patient education series, hosted by Loupa as an example of our patient education library.
Reviewed by Dr Thomas Hanna. Last reviewed: July 2026.
This article provides general information and education. It does not provide individual medical advice, diagnosis or treatment, and does not replace advice from your own healthcare professional. If you are seriously unwell, have severe or rapidly worsening symptoms, or believe you may have a medical emergency, call 111 or seek urgent medical care.