Evidence checked as of October 2026. Written by The Wellness Team.
What are gallstones and do they always cause symptoms?
Gallstones are hard deposits that form in the gallbladder when the chemistry of bile is out of balance. NICE Clinical Knowledge Summaries puts the prevalence at about 10 to 15% of adults in Europe, and many people never know they have them. Stones found by chance on a scan, with no symptoms, usually need no treatment.
Trouble starts when a stone blocks a duct. That can cause a type of pain called biliary colic, or in some people inflammation of the gallbladder, a blocked bile duct or pancreatitis. The aim of an assessment is to work out which of these you have, because the next step is very different for each.
What do gallstone symptoms feel like?
Biliary colic is the most common presentation. NICE describes a steady pain in the upper middle or right upper abdomen that usually lasts more than 30 minutes but less than eight hours. It is often severe and may come with nausea or vomiting. It is typically not accompanied by fever or marked tenderness. Pain that comes and goes in a few minutes is less likely to be biliary colic.
Many people notice it after a meal, particularly a fatty one, or at night. Some feel it in the right shoulder blade or back. Milder symptoms such as bloating or a sense of heaviness under the right ribs are common but are not specific, so they should not be put down to gallstones without checking.
Which symptoms mean you should not wait?
Call 999 or go to A&E if you have severe upper abdominal pain with a high temperature, shivering, yellow skin or eyes, or pain so intense you cannot find a comfortable position. The NHS advises urgent help for pain that lasts longer than 30 minutes. These features can point to infection of the gallbladder or bile ducts, or to pancreatitis, and they need hospital assessment rather than a routine appointment.
Dark urine, pale stools and itching together with yellow skin suggest the bile duct may be blocked. That needs same-day medical review.
How are gallstones diagnosed?
NICE guideline CG188 recommends liver function tests and an ultrasound scan for people with suspected gallstone disease. Ultrasound is the first-line test because it is accurate for stones in the gallbladder, quick, and uses no radiation. It also shows the thickness of the gallbladder wall and the size of the bile duct.
Blood tests add context. Raised liver enzymes or bilirubin can suggest a stone has moved into the bile duct. A raised white cell count or inflammatory markers can suggest infection. If the ultrasound does not show a duct stone but the duct is dilated or the liver tests are abnormal, NICE advises considering an MRI of the bile ducts (MRCP) and, if needed, endoscopic ultrasound.
Technology matters here. A scan reported by a consultant radiologist, read alongside blood results by a doctor, gives a clear answer on the same pathway rather than a series of separate appointments.
When is surgery recommended?
For people with symptomatic gallstones, NICE CKS advises referral to a surgeon to consider laparoscopic cholecystectomy, which is keyhole removal of the gallbladder. The urgency depends on clinical judgement. Anyone systemically unwell with a suspected complication needs emergency admission, and anyone with known gallstones and jaundice needs urgent specialist referral.
NICE CG188 also advises reassuring people whose stones were found by chance and cause no symptoms. Removing a gallbladder that is not causing problems carries risk without a clear benefit.
You can live normally without a gallbladder. Some people notice looser stools for a time after surgery, and a doctor can advise on diet and what is expected.
Can diet or lifestyle change the picture?
Diet does not dissolve most gallstones. Steady weight, regular meals and limiting very high fat meals can reduce the chance of attacks in some people. Very rapid weight loss, including some crash diets and weight loss medicines, is a recognised risk factor for forming stones, so tell your doctor about any recent weight change. Other risk factors include female sex, older age, pregnancy, family history and some medicines.
How can The Online GP help?
A doctor can take a careful history, examine you, arrange liver blood tests and decide whether an ultrasound is needed. As of October 2026, a telephone consultation with The Online GP is £59 and a video consultation is £150. Abdominal ultrasound at The Wellness is available from £445, with a consultant radiologist report. If surgery is the right route, a referral to a surgeon can be arranged.
To discuss a non-emergency appointment, call +44 20 3951 3429, message on WhatsApp on 07961 280835 or email team@thewellnesslondon.com. Same-day availability is confirmed at the time of booking.
Evidence and limits
NICE guideline CG188, gallstone disease: diagnosis and management. https://www.nice.org.uk/guidance/cg188/chapter/Recommendations
NICE Clinical Knowledge Summaries: gallstones. https://cks.nice.org.uk/topics/gallstones/
NHS: gallstones. https://www.nhs.uk/conditions/gallstones/
This is general information, not personal medical advice. Severe or worsening abdominal pain with fever or yellow skin is an emergency.