Biliary colic is abdominal pain caused by blockage of the bile ducts, which carry bile (digestive fluid) from the liver to the gallbladder and into the small intestine.
When gallstones block the bile ducts, bile builds up in the gallbladder, causing biliary colic (“gall attack”). This causes intense pain in the upper right side of the stomach that can last for several minutes to several hours, usually after eating a large meal. You may experience nausea and vomiting.
Your primary care physician (PCP) may refer you to a gastroenterologist, a health care professional who specializes in gastrointestinal (digestive) and liver conditions. Initial treatment for biliary colic may focus on pain relief and dietary modifications, but experiencing one episode increases the risk of future attacks and potential complications. Cholecystectomy (surgical removal of the gallbladder) may be necessary.
Medications are often the first line of treatment for biliary colic, providing significant relief by reducing pain and inflammation. Here are some medications that can be used:
Pain relievers
Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve the pain of biliary colic. Your doctor may prescribe oral NSAIDs (taken by mouth), such as diclofenac, ketorolac, flurbiprofen, ibuprofen, or tenoxicam, to reduce pain and inflammation.
In some cases, they may prescribe intravenous (IV) NSAIDs to deliver the drug through a vein or intramuscular injections for more immediate pain relief. Long-term use of NSAIDs can cause gastrointestinal problems, such as ulcers or bleeding.
Antispasmodics
Antispasmodic drugs, such as hyoscyamine butyl bromide (scopolamine) and drotaverine, can help relax the gallbladder muscles to prevent spasms and possibly reduce the pain of biliary colic. However, these drugs are sometimes ineffective and can cause side effects such as dry mouth, dizziness, sweating and drowsiness.
Antiemetics
Antiemetic drugs such as ondansetron, droperidol, and metoclopramide can help control nausea and vomiting associated with biliary colic. Possible side effects of antiemetics include constipation, confusion, difficulty urinating, visual disturbances such as blurred vision, and rapid heart rate.
Dissolution Therapy
Gallstone dissolving therapy involves taking oral medications, such as Actigall (ursodiol) and Chenik (chenodiol), to break up and slowly dissolve small cholesterol gallstones. This long-term treatment may require months or years of drugs to break up the stones. Possible side effects include headache, dizziness, frequent or painful urination, muscle pain, and hair loss.
If your symptoms are severe or you have a history of recurring episodes of biliary colic, your healthcare provider may recommend removing your gallbladder or breaking up your gallstones with surgical or nonsurgical procedures.
Cholecystectomy
Surgical removal of the gallbladder, cholecystectomyis the only definitive treatment for biliary colic. Although the gallbladder stores bile, it is not an essential organ. The liver can directly release bile into the small intestine without the gallbladder. Your healthcare provider can perform a cholecystectomy in one of two ways:
- Laparoscopic cholecystectomy: This minimally invasive procedure involves a surgeon making small incisions in the abdomen and inserting a laparoscope—a flexible tube with a camera and surgical tools—into the abdomen to visualize and remove the gallbladder. Most people can resume normal activities within 1-2 weeks after laparoscopic surgery, although full recovery can take up to six weeks.
- Open cholecystectomy: This surgery involves a surgeon making a large incision in the abdomen to access and directly remove the gallbladder. It may be necessary in complex cases involving severe inflammation or scarring from previous surgeries. You may need to stay in the hospital for up to a week afterwards so that health professionals can monitor your health. Recovery takes 4-8 weeks, and you may experience abdominal pain, bruising, and redness around the incision site.
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) procedure combines endoscopy and X-ray imaging to visualize the bile ducts, gallbladder, and pancreas. Your healthcare provider may recommend ERCP if you have recurrent biliary colic and cannot have surgery to remove your gallbladder, or if a gallstone is stuck in the bile duct.
You will be given a sedative to reduce discomfort during the procedure. Your doctor will insert an endoscope (a thin, flexible tube with a camera) into your mouth, stomach, and small intestine. They will inject a contrast dye to highlight the bile ducts to help identify and remove gallstones that are blocking the ducts.
You may stay in the hospital or surgery center for up to six hours after ERCP to allow the sedation to wear off. Nausea, bloating or sore throat may occur after the procedure. Your healthcare provider may ask you to wait up to 24 hours before eating solid food.
Extracorporeal shock wave lithotripsy (ESVL)
Extracorporeal shock wave lithotripsy (ESVL) is a non-invasive procedure that uses high-energy sound waves to break up gallstones into smaller pieces that can easily pass through the bile ducts.
During an ESVL procedure, an ultrasound or X-ray helps healthcare professionals determine where to target the gallstone. The lithotripter device generates shock waves that break the gallstone into fragments. The procedure usually takes 45-60 minutes.
ESVL is not a standard treatment for biliary colic because many people who undergo it develop future gallstones.
Lifestyle modifications can help manage biliary colic symptoms and reduce the risk of future gallbladder attacks. Here are some possible changes you’ll need to make:
Diet
A low-fat diet can help prevent gallstones and reduce the risk of biliary colic. Eat a high-fiber diet with lots of whole grains, fruits and vegetables, and lean protein. Limit your intake of high-fat and processed foods and refined carbohydrates. Eat healthy fats, such as fatty fish (eg salmon) and olive oil, to promote gallbladder health.
Avoid eating large meals that can trigger gallbladder attacks, and opt for smaller, more frequent meals throughout the day.
Weight management
Obesity is a risk factor for gallstones. A nutritious, balanced diet and regular exercise can help you achieve and maintain a healthy weight and reduce your risk of gallstones and future episodes of biliary colic.
Sudden weight loss can increase the risk of gallstones, so aim for gradual weight loss. Focus on healthy lifestyle modifications, not sudden weight drops.
The prognosis for people with biliary colic is generally good with appropriate treatment. Treatment can effectively manage symptoms, prevent complications, and help prevent future gallbladder attacks.
Untreated biliary colic can lead to serious complications such as inflammation of the gallbladder, inflammation of the bile ducts, jaundice (yellowing of the skin and eyes) and pancreatitis (inflammation of the pancreas). Each of these requires immediate medical attention and treatment and, in some cases, hospitalization.
Living with biliary colic means adopting healthy lifestyle habits to manage symptoms and prevent future episodes. This may include dietary modifications and maintaining a healthy weight.
Biliary colic pain can be intense and prevent you from doing your daily activities. If you have frequent episodes of biliary colic, talk to your doctor about treatment options that can prevent gallstones and improve your quality of life.