Gallstones and Biliary Colic

What are gallstones and biliary colic? 

Gallstones are hardened deposits that form within the gallbladder—a small, pear-shaped organ located beneath the liver. The gallbladder’s primary role is to store and release bile, a digestive fluid that helps break down fats. Gallstones develop when substances in bile, such as cholesterol or bilirubin, become imbalanced and crystallise. These stones can vary in size, ranging from as small as a grain of sand to as large as a golf ball.

Biliary colic refers to the sudden and intense discomfort caused by gallstones. This condition occurs when a gallstone temporarily blocks the cystic duct, which drains bile from the gallbladder. The hallmark symptom is a sharp, cramping pain in the upper right or central abdomen, often radiating to the back or shoulder. The pain typically arises after a fatty meal and can last from several minutes to a few hours.

Gallstones and biliary colic are common digestive conditions that can significantly affect quality of life if left untreated. In more severe cases, complications such as inflammation of the gallbladder (cholecystitis), bile duct obstruction, or pancreatitis may arise, which require prompt medical attention.

What causes gallstones and biliary colic? 

Gallstones develop when the chemical balance of bile becomes disrupted — particularly when there is too much cholesterol, too much bilirubin, or not enough bile salts to keep these substances dissolved. Bile is produced by the liver and stored in the gallbladder, where it plays a key role in digesting fats. When this balance is disturbed, tiny crystals can begin to form. Over time, these crystals can grow and clump together, forming stones.

There are two primary types of gallstones:

• Cholesterol gallstones — the most common type, these form when bile contains excess cholesterol that the body is unable to dissolve

• Pigment gallstones — made up of excess bilirubin, a substance produced from the breakdown of red blood cells

Gallstones themselves may remain silent for years. However, when one of these stones travels and becomes lodged in the cystic duct — the narrow channel that allows bile to exit the gallbladder — it blocks the normal flow of bile. In response, the gallbladder contracts, often forcefully, to try and move the stone along. This contraction against the obstruction causes a sharp, cramping pain in the upper abdomen known as biliary colic.

The pain usually starts suddenly, intensifies over time, and may radiate to the back or right shoulder. It often follows a fatty meal, which stimulates the gallbladder to release bile into the digestive tract. If the stone moves and the duct becomes unblocked, the pain typically subsides on its own. But if the obstruction persists, it can lead to complications — including gallbladder inflammation, infection, or even blockage of the common bile duct — all of which require medical attention.

What are the symptoms of gallstones and biliary colic? 

Gallstones can exist for years without causing any noticeable symptoms. However, when a stone obstructs the flow of bile — especially in the cystic duct — it can trigger biliary colic or lead to more serious complications. Recognising the signs early can help prevent the condition from worsening.

Common symptoms include:

• Sudden, sharp pain in the upper right or central abdomen — often occurring after a fatty meal and lasting from minutes to several hours

• Pain —  the pain usually radiates to the back or right shoulder blade

• Nausea or vomiting — especially during or after pain episodes

• Bloating or a feeling of fullness — particularly after eating and tends to occur at night. Commonly mistaken for “gastric” issue

• Jaundice (yellowing of the skin or eyes) — may occur if a stone blocks the bile duct

• Fever and chills — can be a sign of gallbladder infection or inflammation (cholecystitis)

If any of these symptoms are persistent or severe, medical attention should be sought promptly. At Tan Siong San Surgery, we offer timely assessment and treatment options to manage gallstone-related conditions effectively.

Who is at risk of gallstones and biliary colic in Singapore? 

Gallstones are a common condition in Singapore, particularly among certain segments of the population. While anyone can develop them, several factors make some individuals more prone to gallstone formation and biliary colic.

You may be at higher risk if you are:

• Female — due to hormonal influences, especially during pregnancy or when taking oestrogen-based contraceptives or hormone replacement therapy.

• Aged over 40 — the likelihood of gallstone formation increases with age.

• Overweight or obese — excess body weight affects bile composition and gallbladder function.

• On a diet high in fat and low in fibre — eating habits can contribute to imbalances in bile.

• Experiencing rapid weight loss — sudden dieting or weight reduction can disrupt normal bile flow.

• Living with diabetes — insulin resistance may contribute to higher cholesterol levels in bile.

• Having a family history of gallstones — individuals with close relatives who have had gallstones are more likely to develop them themselves, as genetic factors may influence bile composition, cholesterol metabolism, or gallbladder motility, all of which can contribute to stone formation. 

• Living with certain medical conditions — underlying health issues such as liver disease, haemolytic blood disorders (e.g. thalassaemia or sickle cell anaemia), and conditions that affect bile production or flow can increase the likelihood of gallstone formation by altering the balance of substances in bile or impairing gallbladder function. 

How are gallstones and biliary colic diagnosed? 

If gallstones or biliary colic are suspected, we use a combination of clinical assessment and imaging tools to confirm the diagnosis and rule out other possible conditions.

Diagnostic methods we may use include:

• Detailed medical history and physical examination — our healthcare expert starts by discussing your symptoms, diet, and medical background, followed by a focused abdominal examination to check for tenderness or signs of gallbladder inflammation. 

• Ultrasound scan of the abdomen — a non-invasive and highly effective imaging test that allows us to visualise the gallbladder and detect the presence of gallstones or gallbladder thickening. 

• Blood tests — to check for signs of infection, inflammation, or bile duct obstruction, including liver function tests and white blood cell counts. 

• CT scan or MRI — in selected cases, we may recommend cross-sectional imaging to get a clearer view of the bile ducts or to assess for complications such as pancreatitis or bile duct stones. 

• MRCP (Magnetic Resonance Cholangiopancreatography) — a specialised MRI technique that provides detailed images of the bile ducts and pancreatic ducts, especially useful if a bile duct stone is suspected. 

Once we have a clear diagnosis, we will walk you through your results and explain the best treatment options based on your condition, lifestyle, and overall health.

What are the treatment options for gallstones and biliary colic in Singapore? 

Treatment plans will be planned based on the severity of your symptoms, the presence of complications, and your overall health. While some people with gallstones without symptoms may not require immediate intervention, patients with symptoms from the gallstones will need surgery. At Tan Siong San Surgery, we have vast experience with minimally invasive laparoscopic (keyhole) surgery for gallbladder stones with an excellent safety track record. With a short hospital stay and reduced pain from the surgery, patients can recover and return to work and life quickly. 

Other procedures that may be needed in the treatment of gallstones and its complications:

• Endoscopic Retrograde Cholangiopancreatography (ERCP) — if a gallstone has migrated into the bile duct, ERCP (link to service page) may be used to locate and remove the stone without the need for open surgery. 

• Open cholecystectomy — in rare cases where laparoscopic surgery is not suitable — such as in severe inflammation or scar tissue from previous surgery — an open operation (link to service page) may be necessary. 

If you are experiencing persistent abdominal pain, nausea, or other symptoms suggestive of gallstones, schedule a consultation  with us for a thorough evaluation and personalised treatment plan.