Got Gall?

A closer look at living with gallstones—and without the gallbladder

WRITTEN BY Holly Fisher
PHOTOGRAPHS BY Scott Henderson

As a Roper St. Francis Healthcare general surgeon, Dr. Sara Wilson has removed gallbladders from teens to octogenarians. Her patients have been middle-aged and overweight as well as in their 20s at a healthy weight. Gallbladder disease affects more than 25 million people in the U.S., and the finicky organ generally doesn’t discriminate when it comes to acting up.

So how can the average person have a happy gallbladder? “There’s not really a perfect answer,” says Dr. Wilson. “The gallbladder can bother people even when they follow a healthy diet and are exercising. Sometimes it just gets mad and starts causing pain.” That doesn’t mean we have no control over our risk for gallbladder problems—though such troubles can happen to anyone, people can limit their vulnerability by eating foods low in saturated fat and getting regular physical activity. Beyond smart diet and exercise choices, the best defense against a disagreeable gallbladder may be understanding the warning signs of a problem.

The Ins & Outs

While you might know the gallbladder sits somewhere in the abdomen, most people can’t explain exactly what it does. The gallbladder acts as a storage shed for bile, a thick fluid produced by the liver to aid in digestion. This pear-shaped organ is situated beneath the liver, under the right side of the rib cage. A normal gallbladder is about four inches long and two inches wide. When it becomes inflamed or irritated, however, the small muscular organ can swell up to 10 inches.

Though it has just one job, this organ can be at the root of a number of medical problems, including gallstones and gallbladder cancer. Gallstones are the most common issue, impacting up to 15 percent of Americans. These crystallized collections of cholesterol may form as a single four-centimeter stone or hundreds of tiny stones no bigger than sand grains. Regardless of how they take shape, gallstones can become painful and perhaps lead to further medical complications. For instance, stones might escape the gallbladder and travel through the bile ducts, causing a pancreatic obstruction that develops into pancreatitis. In rare cases, a stone will move into the intestine and result in a bowel obstruction.

Gallstones impact people in a variety of ways, including not at all, as the majority of people with gallstones never develop symptoms. However, a small percentage of people experience pain in the upper right abdomen that can radiate to the upper back. Some also report a stabbing sensation between the shoulder blades, and others suffer with gastrointestinal discomfort, nausea or vomiting.

While there’s no clear answer as to why some people don’t experience any symptoms of gallstones and others do, there is evidence that certain individuals are more susceptible to gallstones. To start, gallstones are often genetic. The majority of gallstone issues also occur in women and people who are obese. There isn’t a strong explanation for why more women get gallstones than men, though some observational studies indicate estrogen may play a role. Medical professionals have also noticed a connection in women who take estrogen supplements.

Diet plays a strong part in the formation of gallstones, too. People who consume high-fat diets have a greater risk, and that’s not just confined to fatty fried foods, pizza or burgers—even foods that contain healthy fats, like avocados and nuts, can be the culprits. “In general, I promote a healthy balanced diet and exercise to maintain a healthy weight,” says Dr. Wilson.

Action Plan

When it comes to gallbladder health, Dr. Wilson’s most important piece of advice is to avoid brushing off ongoing pain. “Don’t ignore something that’s bothering you,” she says. “If you feel like your body has changed, see someone. Pain is not normal.”

Because pain usually occurs after eating, people often chalk it up to heartburn or a food intolerance. “They may self-diagnose the problem as acid reflux and resign themselves to avoid trigger foods. Or they assume the issue is too trivial,” says Dr. Wilson. “Don’t dismiss those ongoing issues.” Patients ultimately wind up in the doctor’s office when the pain becomes too great, or they land in the ER with an acute gallbladder infection.

While medication can help dissolve gallstones, that’s not the best long-term treatment. Surgeries to remove the stones also aren’t effective or safe. Unlike with kidney stones, gallstones can’t just be broken down with a laser because the walls of the gallbladder are too thin. Those thin walls also prevent doctors from simply cutting into the gallbladder and removing the stones. Plus the gallstones would most likely continue to form.

The best course of action, and most common, is to surgically remove the entire gallbladder. “Fortunately, since the gallbladder merely stores rather than produces bile, a person can live without it,” explains Dr. Wilson. “Overall, people usually recover very well from this surgery in just a week or two. And for patients who have been suffering chronic issues, it can make dining enjoyable again,” says the surgeon, recalling one patient who finally realized that she didn’t have to hurt every time she ate.

While most people live perfectly fine without their gallbladder, Dr. Wilson says in rare cases, a patient doesn’t tolerate certain foods well after surgery. Some may also experience diarrhea after eating, which can be treated with medication.

Gallbladder surgeries spike around the holidays, when people tend to indulge in more fatty foods. “Last year I was on call the week after Thanksgiving, and I performed seven gallbladder surgeries in one day and 12 in one week,” remembers Dr. Wilson. “That Thanksgiving meal made a lot of gallbladders unhappy.” With the winter holidays just around the calendar corner, now is a good time to consider the health of this curious little organ.