Most people never think about gallstones, and that’s a good thing. These pebble-like pieces of cholesterol, or bilirubin, can build up in your gallbladder and just stay there. (Bilirubin is a compound that’s made from the normal breakdown of red blood cells.)

They affect as many as 25 million Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “The vast majority of people who have gallstones never actually have symptoms and therefore never need treatment,” says Vivek Cherian, MD. He’s an internal medicine physician who works for the Maryland Medical System in Baltimore.

But sometimes, they grow large enough to block the bile ducts. And that’s an experience you’re not likely to forget: The blockage causes sharp, intense pain in the upper right part of your abdomen. It’s called a gallbladder attack for good reason.

While they tend to be more common in the summer, according to the Journal of Surgical Research, they can happen any time of year. And research has shown that gallstones are 2 to 3 times more common in women than in men. They’re more likely to appear as you age, too.

Once gallstones are causing pain, they’re typically severe enough to be treated. This usually consists of either the medication ursodiol (Actigall®), which helps dissolve gallstones, or surgery to remove the gallbladder.

“The good news is that you do not need your gallbladder to survive, and removing it does not affect your life or your ability to digest food,” says Dr. Cherian. (Get a coupon for ursodiol now.)

Experiencing gallstones can be more challenging than many people realize. Here’s what it’s like to live with gallstones, straight from those who have had them.

What gallstone symptoms feel like

Upper abdomen pain is the main sign of gallstones. It can come on suddenly and out of nowhere, like it did for Amy, 37. “I woke up in an incredible amount of pain,” she says. “It was almost like back spasms. I couldn’t breathe. It was pretty terrifying. I couldn’t stand up, and I didn’t know what was happening. [My gallbladder] wasn’t even on my radar.”

The pain can also steadily increase, which is what Codie, 29, experienced. “I was walking to my mother-in-law’s with my toddler, and I started to feel really funny. It just kept getting worse. By the time I got there, I was completely pale, and I couldn’t cope. I thought I was having a heart attack or something,” she says. “The pain made me vomit. It was just absolutely awful.”

While the pain is usually localized in the lower chest or upper abdomen, it can span your whole trunk, which is what tipped off Tess, 28, to the fact that something unusual was happening to her. “The back of my shoulder blades hurt really bad, which I thought was kind of weird,” she explains. In addition to the shoulder pain, Tess experienced stomach pain and vomiting.

Other common symptoms include fever (even low-grade), chills, yellowing of your skin and/or eyes, tea-colored urine or light-colored stools, according to NIDDK.

Once the symptoms of a gallbladder attack begin, they usually last for several hours before the feelings of pain end. Make no mistake, gallstone pain is very serious: Codie, who has a son, says it is by far worse than labor and childbirth.

While pain itself isn’t a medical emergency, Dr. Cherian says you shouldn’t ignore it. For mild pain, make an appointment with your primary care physician, he says. “But if you are having more alarming symptoms such as excruciating abdominal pain, fevers, chills or jaundice” — yellowing of the skin or the white parts of your eyes — “you should make your way to your local emergency department for a prompt evaluation.”

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Getting a diagnosis of gallstones

Since the pain of a gallstone attack is so severe and lasts for so long, some people rush straight to the hospital, which is what Amy did. “It’s really disconcerting when you don’t know what [is causing your pain],” she says. “I ended up taking an ambulance to the emergency room.”

Once there, several nurses who had gallstones before recognized the same symptoms they’d experienced and were able to get Amy an ultrasound quickly, which confirmed their suspicions. An ultrasound isn’t the only way to detect gallstones, but it’s the most common one, says Dr. Cherian.

Tess also suspected that she had gallstones not long after her first attack. As soon as she told her mom about her unexplained shoulder-blade pain, her mom revealed that she had felt the same kind of pain from her own gallstones.

“It turned out every woman in my family on both sides had either had gallstones or had their gallbladder removed,” Tess says. (Having a family history of gallstones makes it much more likely you will also have them.)

Tess’ primary care doctor ran a food-sensitivity test even though she, too, was pretty sure it was gallstones. When that test didn’t turn up anything, she sent Tess off for an ultrasound that confirmed she had gallstones.

Sometimes it isn’t that easy to get a correct diagnosis, though. Codie, who is currently 30 weeks pregnant, also went to the hospital after her first gallstone attack. But she was told her symptoms were likely acid reflux, which is very common during pregnancy.

“They told me to stop eating anything acidic, but it just kept flaring up again and again,” she says. She mentioned her symptoms during a prenatal ultrasound, and the technician offered to look at her gallbladder while inspecting the baby.

“She had a look and was like, yeah, I can a thousand percent see gallstones,” says Codie. Only then did she get her diagnosis. In fact, it is not uncommon for someone to receive an incorrect diagnosis of acid reflux before being correctly diagnosed with gallstones, according to a study in Medicine.

How to treat and manage gallstones

Gallstone attacks usually have triggers. Most commonly, they are brought on by large, heavy meals and fatty foods. For Codie, who currently cannot have surgery or take medication due to the risks it would pose to her pregnancy, eating a bland, low-fat diet is her best defense against future attacks.

“Hopefully, they’ll say we’ll take [your gallbladder] out when the baby’s here, but for now it’s a case of eating very low fat,” she says. “I can tolerate about 6 grams of fat per meal. I want to eat the things the baby craves, but I have to just eat dead-boring low-fat things,” she says.

Tess also manages her gallstones through diet. “By the time I got my first ultrasound, my symptoms had kind of gone away.” She says this is because she cut out alcohol, acidic foods, greasy foods and raw vegetables. “When I went to get my ultrasound, they said my gallbladder didn’t look inflamed anymore.”

Tess says that due to her adjusted diet, she hasn’t had an attack in some time, though she knows she will eventually need her gallbladder removed. “Everyone I’ve talked to has told me that before I get pregnant, I need to get it taken out,” she says. Pregnancy can make gallstones more likely and, as Codie has experienced, more difficult to treat.

Managing gallstones with diet may not work for everyone. For some, surgery is more urgent. In fact, the most common treatment for gallstones is gallbladder removal. Amy had surgery after her third attack. It was a minimally invasive, laparoscopic procedure. “I was surprised how soon I felt better,” says Amy. “I bounced back pretty quickly!”

If surgery isn’t a good option, there is the medication route. Ursodiol can help break up the stones. However, you usually need to take the medication 2 or 3 times a day, and it can take up to 2 years to dissolve the stones. It’s also possible that they will return.

The important thing to remember: When it comes to treating gallstones, you have options. And your doctor can help you decide which one is right for you.

You also have options when it comes to paying for your medication. Download the Optum Perks app to find coupons you can use at pharmacies nationwide.

Additional sources
Gallstone basics and stats: National Institute of Diabetes and Digestive and Kidney Diseases
Gallstones in summer: Journal of Surgical Research (2020). “Seasonal variation in acute cholecystitis: an analysis of cholecystectomies spanning three decades”
Gallstones and acid reflux: Medicine (2017). “Epigastric symptoms of gallbladder dyskinesia mistaken for functional dyspepsia”