Gallbladder pain, as described in this article, can arise from the gallbladder or bile ducts.
The gallbladder is located in the upper right abdomen underneath the lower edge of the liver and the lower border of the rib cage (Diagram 1) [1].
Diagram 1. The gallbladder is located
underneath the lower border of the right rib cage.
Where is gallbladder pain felt?
Pain from the gallbladder or bile ducts is usually felt in the upper right abdomen below the rib cage or in the upper central abdomen (Diagram 2) [17].
Gallbladder Referred Pain
Gallbladder pain can be referred to the right lower chest, flank, lower back, shoulder or neck, or between the shoulder blades (Diagram 2) [17].
Diagram 2. Gallbladder pain and referred pain location
Gallbladder and Chest Pain
Gallbladder problems can cause pain in the lower right or middle chest area, but not likely in the center of the chest. Common causes of upper abdominal pain with central chest pain are gastroesophageal reflux disease (GERD), peptic ulcer or heart disease.
Gallbladder and Back Pain
Gallbladder pain often extends from the right upper abdomen toward the right middle back, between the shoulder blades or into the right shoulder blade. Other common causes of upper abdominal pain and back pain include kidney and liver disease, peptic ulcer and acute pancreatitis.
Gallbladder and Right Shoulder Pain
Gallbladder pain can be referred to the tip of the right shoulder or both shoulders, but not likely only to the left shoulder [4]. Shoulder pain arising from the gallbladder is not aggravated by touch or shoulder movements. Other causes of abdominal pain with right shoulder pain include liver or stomach problems, abdominal infections and lung cancer.
Can gallbladder pain be felt on the left side?
Gallbladder pain can extend from the right over the middle toward the left side of the abdomen, but the pain on the left side alone is not typical for gallbladder problems. In a very rare anatomical variant, in which the liver and gallbladder are located on the left side, the pain from gallbladder would be on the left.
What does gallbladder pain feel like?
Characteristics of gallbladder pain [2,3,4,13]:
- The pain in the right upper abdomen usually appears suddenly, initially increases in severity and continues as a constant (not crampy) pain that can last from several minutes to few days.
- The pain is usually deep, dull and severe.
- The pain may be aggravated by deep inhalation but not likely by the body movements.
- It can flare up within few hours after a large meal or at any time, commonly at night.
- It is not relieved by antacids, vomiting, passing gas, a bowel movement or by changing body position.
- It is recurrent; it can occur every few days, months or years and there is no pain between the attacks.
How long does gallbladder pain last?
- In gallstones without gallbladder inflammation: several minutes to less than 6 hours [2,20]
- In gallbladder inflammation (cholecystitis): 6 hours to few days (but not likely weeks) [2]
- In gallbladder dyskinesia and sphincter of Oddi dysfunction: 30 minutes to several hours [21]
- In gallbladder cancer: chronic discomfort or dull pain [22]
What is gallbladder attack or biliary colic?
The terms gallbladder attack and biliary colic both refer to sudden severe pain arising from the gallbladder or bile ducts [16]. Historically, the term biliary colic has been used for pain from gallstones without gallbladder inflammation.
Other Symptoms and Signs of a Gallbladder Disease
Symptoms, other than pain that may appear in a gallbladder disease [13]:
- Nausea or vomiting that occurs only when pain occurs
- Fever, jaundice, itchy skin, dark urine and pale stools
- A palpable lump or tenderness in the right upper abdominal quadrant
Indigestion, dyspepsia after fatty meals, abdominal bloating, excessive belching, heartburn, constipation or diarrhea are not specific for a gallbladder disease – they can also occur in other abdominal disorders [2,4,13]. Gallbladder disorders do not seem to be directly connected with a headache, but some people believe they can trigger a migraine.
Chart 1. Causes of Gallbladder Pain |
|
Condition |
Symptoms |
| Gallbladder sludge | Rare (complication: pancreatitis) |
| Gallbladder polyp | Rare (complication: cancer) |
| Gallstones | Recurrent RUQ* pain and nausea |
| Acute gallbladder inflammation (acute cholecystitis) | Recurrent RUQ pain, often fever and nausea |
| Chronic gallbladder inflammation (chronic cholecystitis) | Rare |
| Gallbladder cancer | Intermittent RUQ pain, poor appetite, weight loss |
| Biliary dyskinesia | Recurrent RUQ pain |
| Sphincter of Oddi dysfunction | Recurrent RUQ pain |
| Infection of the bile duct (acute cholangitis) | Sudden RUQ pain, fever, jaundice, dark urine, gray stools |
| Autoimmune inflammation of the bile ducts (primary sclerosing cholangitis) | Chronic RUQ pain, fever, jaundice, dark urine, gray stools |
Chart 1: *RUQ = right upper abdominal quadrant
Gallbladder Pain Without Stones
Gallbladder pain without gallstones can appear in:
- Acute acalculous cholecystitis, usually related to severe disease or surgery
- Gallbladder dyskinesia
- Sphincter of Oddi dysfunction
- Gallbladder cancer
Diagnosis
Abdominal ultrasound can reveal:
- Gallbladder stones as small as 2 mm in 95% cases and, sometimes, stones in the common bile duct
- Acute or chronic cholecystitis, gallbladder polyps and cancer [2]
Endoscopic ultrasound–via the tube inserted through the mouth into the intestine–can reveal stones in the common bile duct and biliary sludge [6].
Magnetic resonance imaging (MRI) can show biliary sludge, gallbladder polyps and cancer.
Magnetic resonance cholangiopancreatography (MRCP) can show stones, tumors and inflammation in the common bile duct [2,12,13].
Endoscopic retrograde cholangiopancreatography (ERCP) can reveal stones in the bile duct and enables their removal, drainage of the infected duct and cutting the sphincter of Oddi.
X-ray shows gallstones in only up to 20% cases and CT scan in up to 80% cases [15].
Hepatobiliary scintigraphy (HIDA scan) is used to evaluate the gallbladder filling and emptying in gallstones or gallbladder dyskinesia; no filling or poor emptying (ejection fraction <40%) is an indication for the gallbladder removal.
Blood tests may show:
- Increased white blood cells: in cholecystitis and cholangitis
- Increased liver enzymes or bilirubin: in bile duct obstruction
Chart 2. Conditions That Can Mimic Gallbladder Pain |
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|
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Gallbladder Pain Treatment
Analgesics
Analgesics for either mild or severe pain should be tried in this order [11,18]:
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
- Ibuprofen
- Diclofenac (intramuscular injection or a suppository)
- Ketorolac
- Narcotic analgesics:
- Meperidine
- Codeine, hydrocodone or oxycodone + paracetamol
- Morphine or pethidine (intramuscular injection)
- Antispasmodics:
- Dicyclomine
- Butylscopolamine (hyoscine butylbromide)
Note, that analgesics can have significant side effects: NSAIDs may cause or worsen peptic ulcer and opiates can cause constipation, nausea and drowsiness.
In the third trimester of pregnancy, certain nonsteroidal anti-inflammatory drugs or NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen) should be avoided because they may cause birth defects, but aspirin, paracetamol and opiates (codeine, fentanyl, morphine, pethidine) appear to be safe [7,8].
Fasting
To prevent additional pain from gallbladder contractions during gallbladder attack, do not eat anything and drink only plain water [10].
Diet
There are no specific foods to eat or avoid that would prevent gallbladder pain. Avoiding large, especially fatty, meals [16] and coffee [19] may help prevent recurrent pain attacks caused by gallstones.
Avoiding Stress
In some individuals diagnosed with gallbladder dyskinesia or sphincter of Oddi dysfunction, avoiding stress and learning how to cope with it can prevent pain.
Home Remedies
Remedies that may help relieve gallbladder pain, according to anecdotal reports:
- A heating pad or castor oil compress
- Hot bath
There is no reliable scientific evidence that gallbladder flush or cleanse using the following herbs or beverages helps to ease gallbladder pain [9,14]: alfalfa, apple cider vinegar, apple juice, a mixture of beet, carrot and cucumber juice, barberry bark, calendula, catnip, chamomile tea, chicory, dandelion, Epsom salt, fennel seed, garlic, ginger, goldenseal, honey with turmeric, lemonade, milk thistle, nettle, olive oil, peppermint tea, psyllium, quebra pedra, rosemary, salt water, St. John’s Wort, wild yam root, yellow dock and yellow root.
Surgical Gallbladder Removal (Cholecystectomy)
Gallstones that cause recurrent pain or inflammation, and gallbladder cancer are treated by gallbladder removal.
- References
- Gallbladder InnerBody
- Steel PAD, Acute Cholecystitis and Biliary Colic Emedicine
- Heuman DM, Gallstones (Cholelithiasis) Emedicine
- Heuman DM, Gallstones (Cholelithiasis), Clinical Presentation Emedicine
- Gallstones and cholecystitis Patient.info
- Rana SR et al, 2012, Role of endoscopic ultrasound in idiopathic acute pancreatitis with negative ultrasound, computed tomography, and magnetic resonance cholangiopancreatography PubMed Central
- Babb M et al, 2010, Treating pain during pregnancy PubMed Central
- Kennedy D et al, 2011, Analgesics and pain relief in pregnancy and breastfeeding Australian Prescriber
- Picco MF, What is a gallbladder cleanse? Is it an effective way to flush out gallstones? Mayo Clinic
- Acute cholecystitis NHS.uk
- 2014, Biliary colic and complications from gallstones The Best Practice Advocacy Centre New Zealand
- Heuman DM; Gallstones (Cholelithiasis), Workup Emedicine
- Gallstones Merck Manuals Home Edition
- Nutritional Approaches to Prevention and Treatment of Gallstones Alternative Medicine Review
- Brunetti JC, Imaging of Gallstones (Cholelithiasis) Emedicine
- Gallstones NIDDK
- Gallstones symptoms and causes Mayo Clinic
- Johnston MJ et al, 2013, Outpatient management of biliary colic: A prospective observational study of prescribing habits and analgesia effectiveness ScienceDirect
- Douglas BR et al, 1990, Coffee stimulation of cholecystokinin release and gallbladder contraction in humans PubMed
- Gallstones Merck Manuals Home Edition
- Zakko SF et al, 2016, Functional gallbladder disorder in adults UpToDate
- Denshaw-Burke M, Gallbladder Cancer, Clinical Presentation Emedicine
there is such a thing as karma Doctor look a the derivation of all of the words you use doctoring practice medication etc PURE EVIL
I’m wondering if my gallbladder is acting up. Here are some of my symptoms. I had what I call reflux on and off for sometime. It can hit me out of the blue with intense burning pain that builds upwards under my breastbone into my throat and sometimes jaw. Been on the increase last couple nights has jolted me from sleep but can also happen during the daytime. Sometimes a drink of water will help. But I also have bouts of intense itching head to toe starting soon after a meal and dies down once this burning pain starts I’ve just started noticing the conection to the two. Over the counter ulcer antacids don’t seem to help.
Acid reflux can actually present with burning pain after the breastbone, especially when you are lying. Itching soon after meals typically occurs in food allergies.
Actually the itching can be related to high bilirubin caused by a backup from the gallstones, please check it out
I have a pain in my abdominal area along with my diaphragm. I was recently diagnosed with Bilateral Colic. I live with it mostly the pain is bearable for the most part except when it goes lower in my stomach or it hits my Diaphragm with pain so intense reminds me of a knife slice. My friends are concerned it might not be the same thing. Last time I went to the doctor I was diagnosed with a appendicitis. They did a bunch of unnecessary tests to find out from another doctor it was sludge in my Gall bladder. I really don’t want to go back if its unnecessary again. I generate a foam even when not in pain. the other doctors said its due to the colic as well what do you think?
One possible cause of such pain (“bilateral colic”) is trapped gas.
Hi there health 35 yo female. I have struggled off and on with heartburn and indigestion and a dull ache in upper right side right below the rib cage for 16 years. I can usually push gentle on the area and hear a squishing noise and it feels better. I have had a consistent dull ache for 4 days. The first day I got it to “drain” but the ache continued.
Such pain can be due to trapped gas in the part of the large intestine in the right upper abdominal quadrant.
http://www.ehealthstar.com/trapped-gas-pain.php
Usually you can’t remove gallbladder pain by the maneuver you’ve mentioned.
I had my hall bladder removed 2 years back….get pains only in d early mornings like 4 a.m…..only when I had woken up and do some house chores/ physical movements…. bit does not occur while asleep….it all starts with bloating….when I would.know that in anthr half n hour d paid will start…..tge pain is as severe as I used to have during gall stones…..what should I do
Such symptoms can be due to trapped gas or biliary dyskinesia, among other. You can try to consume less soluble fiber (legumes, oats, barley, certain fruits and vegetables…) to decrease bloating. If it does not help, visit a doctor.
Your body can still make stones even if you’ve had your gallbladder out, it just stores them in other locations and it can be just as painful. High fiber foods may cause bloating, but they also have a HUGE benefit of cleaning out old bile (which forms stones). Check out Karen Hurd’s bean diet for helping to keep your bile clean and flowing freely. Without a gallbladder you should also be taking certain supplements and eating a diet low in fat.
Left side back pain thats dull. Weird digestive isses for a few months. Now im having these horrible migranes on the right side of my head that are completely debilitating. I went to the hospital this week and they prescribed me fioricet. Im still having the migranes. The one thing i have noticed is that when I wake up in the middle of the night with these migranes, they subside once I use the bathroom. Has anyone else ever experienced this?
Interesting ?
my gall bladder was surgically removed about to years ago, the gallstone blocking my ampulah was also succesfully removed via ercp three months later. after the ercp i had pancreatitis. at present, i am experiencing severe upper back pains, initially within the shoulder area then the pain radiated to my right arms. i initially took mefenamic acid in hopes to ease the pain to no avail. the pain in have is throbbing stabbing pain that i am now forced to bind my right arm with elastic bandage and the application of liniment. please enlighten me. is the pain i am having now an offshot of previous procedures or related too past procedure associated with the removal of my gallbladder?
Throbbing pain in the shoulder/arm area can arise from a compressed artery or from an infection.
The pain that occurs as a complication of a gallbladder removal is usually:
– constant
– can radiate to the right shoulder blade or, rarely, down the right arm; the shoulder or shoulder blade is not tender to touch
Such pain can be caused by:
– papillary stenosis (at the site of the blockage by the stone you’ve mentioned)
– sphincter of Oddi dysfunction
– pancreatitis
– inflammation of the bile duct (cholangitis)
I suggest you to visit a doctor.
People with gallbladder issues tend to have nerve issues and pain in the right shoulder and back. If the gallbladder area is irritated it may be sending pain into your right shoulder area. There is not really anything you can apply topically to the shoulder that will help. Keeping the inflammation down would be your best bet. Animal flesh and diary cause inflammation in the body. Try not eating those things for a few days and see how you feel. In addition, without a gallbladder, you should not be eating highly fatty foods. Your body can still make stones without a gallbladder. They just removed the place where you body typically stores them. Look into how to support your body without a gallbladder. There are supplements and a diet you should be following.
help does it only hurt in your back?? thats where mine is and it won’t stop! tried the apple cider vinegar thing it helped but its back!!! When do you give up and go to ER??
Having recurring attacks is enough of the reason you go to the doctor. It could be possible to have gallbladder pain only in the back.
Recently I had a very painful attack of gallstones which lasted several hours and i had to go to hospital.The doctor told me I had inflammation and put me on antibiotics for a week,he also said he would remove my gallbladder,but when he asked me my age (72) he changed his mind,and told me I had a one in five chance of another attack.My general health is very good and if I get a cut it heals very quickly.What do other people think? Ps personally I would prefer to have my gallbladder removed.
Every surgery has its risks and consequences. After gallbladder removal, some people have diarrhea lasting for several weeks or months, for example. It’s totally your decision. It seems that doctors are a bit reserved about a surgery after a single attack.
When I went to hospital after my gallstone attack they did an ultrasound,which showed I had three gallstones of moderate size,one apparently had stuck in one of the tubes,I can’t remember which tube it was,but the pain was worse than any I’ve ever had.previously I had a biopsy for prostrate cancer where ten samples were taken,the pain did not even come close to the gallstone attack.Does anyone else have any thought on which course of action I should take on the matter. Kind regards James
A gallstone can stick either in the cystic duct or common bile duct (see Diagram 1 in the article). Sometimes, a stone blocks the exit of the gallbladder (the beginning of the cystic duct) and then moves back. If it sticks in the middle of the cystic or common bile duct, it can stay there for a long time or moves further into the small intestine. It’s not clear, what happened in your situation.
At this point, I’m not aware of any single action (diet or anything) you could take and would help. There are tablets with bile acids available, which, if you take them for several months, can slowly dissolve small stones, mainly cholesterol ones, but not bigger stones. But such stones then tend to repeat.
Jan.would you please give me the name of the tablets,I would then ask my doctor if he would give me a script for them.Many thanks James
The generic term of tablets with bile acids is ursodiol (which is short of ursodeoxycholic acid); for brand names you can search online.
I should say that multiple stones may not dissolve well with ursodiol. Also, having a stone in the bile duct is a contraindication for ursodiol. The stone also need to be pure cholesterol stones without calcium (and hence visible on ultrasound but not on X-ray).
Hi. I am 33 years old. I thought I had the flu, but no fever. Due to fairly constant stomach cramping for three days I thought maybe it was gallbladder? Diarrhea went along with it and I could not keep food down for 24 hours. A few months ago mine was inflamed but not serious enough for surgery. I didn’t make an appointment with my Dr this week because the pain went away today (day 4). Tonight my left side keeps spasming. Should I still be concerned?
A mild food poisoning is probably a more common cause of diarrhea and cramping on the left side than an inflammation of the gallbladder. gallbladder pain is typically on the left. I can’t exclude anything, though.
You mean on the right ? I’ve right left side gallbladder pain is rare. That your gallbladder is on your right side located near the lower right rib
I have itching skin since 6 week mild right uper abdomen pain
I am taking antihistamine but no result I have no rash
No irritation
I have consult my dermatolog he could not give me diagnosise
The gallbladder can cause this itching
Karl, the itch caused by a gallstone or liver disease typically goes with jaundice (yellow skin) and possibly white, floating stools. You may want t ask a gastroenterologist.
I have right epigastric pain with nausea,diarrhea ,radiating to back for the last month. I had my gallbladder removed over 15 years ago. I had an ERCP x 3 for a stone after surgery a year later. Now the pain is starting again.
Kitty, after gallbladder removal, the pain can still arise from the bile ducts, either due to stones or “sphincter of Oddi dysfunction,” for example. You may want to get this checked again.
i had my gallbladder removed in January this year, soon after the surgery i couldn’t seem to stomach anything because o would vomit and felt bloated and then the itching started. It was horrible i would scratch all over the itching wouldn’t stop, my eyes were yellow, my urine was dark orange like, then i went to the doctors but they couldn’t give me anything that would stop all this until i meet an old friend who referred me to a natural herbalist. I went there and she recommended natural activated charcoal which i diluted a teaspoonful in a glass of water twice a day and everything stopped now im fine. No more itching, no more jaundice my urine is ok
Millicent, symptoms you have described usually arise from a blockage of the bile ducts outside or inside of the liver (extrahepatic or intrahepatic cholestasis). It is a good idea to ask a doctor to find the exact cause; in your case it could be a small stone lodged in the bile duct.
Hi I’m Rose I had my gallbladder removed after my son in 1991 was born and I’ve always had the phantom pains every do often always a numb type feeling along when it does anyone else have both. Please let,me know if anyone else has this same thing
luv39, it is possible that pain arise from the bile duct or the sphincter of Oddi at the end of the duct. You may discuss with a gastroenterologist about the related conditions called “biliary dyskinesia” or “sphincter of Oddi dysfunction.”
Have had persistent diarrhea since 11/15. Am now experiencing pain in my gallbladder area, fast throbbing pain that comes and goes since 2/23/16. Have a history of hemagionomas (had a mass removed in 2014, 9 hemagionomas), polyp on gallbladder and cyst on liver. Not sure exactly if it’s the gallbladder or liver….
Vicki, your symptoms sound serious enough to see a doctor. It does not matter is it liver or gallbladder issue; either can block the bile flow and cause diarrhea. You can try to eat less fatty foods and see if it helps for diarrhea, but go and see a doctor.
my sister is going through the exact same thing right now except she never had a hemangioma.
A cup of milk helps morning pain disappear for me and a few ibuprofen a day gets rid of the 3+ times a day diharrea, I only get the real pain if I drink hard liquor or malt beverage drinks, I havent had an attack for a few years now,except on some mornings I found if I drink a little bit of milk the pain instantly dissapears but if I drink anything else OMG the pain starts and won’t stop till I take oxycodone ,so I’ve learned to live with it just by drinking milk and taking ibuprofen 800 mg a day…
Going through the same issues,last week a had a endscopy seen mild gastritis some inflammation also took a biopsy.back gi MD 12-23-15…it will take a few office visits..he went to one of the top medical school in the country.my upper bel!y discomfort.I will keep you posted..
Hi, I am a 34 year old female. Four months ago I started with nausea which I ended up in the ER. No pain what’s so ever. They did ultrasound and found gallstones. Two and half months ago I had the surgery to remove my gallbladder and that’s when everything started. I been having the nausea pretty much everyday, upper middle abdominal pain radiating to my back which last from 3-5 min. I have loose stool some days and then constipated other days. my appetite is nothin how it was before which I’ve lost 10 pounds. I’ve gone to ER for this pain but blood work Was done on enzymes and all came normal. I have no fevers, no vomiting, no blood on stools.
And all this started after I had my gallbladder remove which I never had this symptoms before the surgery other than the nausea. I woke up last night with the pain on my upper abdominal lasted like 2 min or so going to my back and it went away with some tingling down my arms.
Need help!
Nausea without pain is not typical for gallstones; not saying it’s not possible, but it really is not typical. So, it could be possible that the nausea did not come from your gallbladder even when you had stones.
When the gallbladder is removed, the bile flows constantly from the liver directly to the bowel and can irritate it. It’s a common issue. You can search for a diet after gallbladder removal on some reliable medical website. Next, sphincter of Oddi dysfunction (SOD) could be a possible cause of pain. It is typically treated with an endoscopic surgery, but results are often not satisfactory.
Pancreatitis and gastritis could also cause nausea and upper abd. pain. I recommend you to write a really detailed list of your symptoms and eventual their triggers (eating, lying down…) in a chronological order and speak with a gastroenterologist.
Tingling down the arms, nausea and upper abdominal pain can also occur in heart disease. At 34, a typical heart pain–angina pectoris–is less likely, but there may be some other cause.
Possibly bile reflux. Check with gastroenterologist. That happened to me 8 months after having my gallbladder removed. Bile backs up into stomach. I had constant nausea, no appetite, lost 20 pounds, pain under right ribs. I was sick for 3 1/2 months before they finally diagnosed it. Hope you are better now.
What did they do to help you get relief if you don’t mind me asking?