Your gallbladder is like a little storage sac: It sits under your liver, collecting bile until the liquid is needed to help break down fats. After you eat fatty foods, your gallbladder contracts to pump bile into your small intestine for digestion. William Silverman, MD, a professor of medicine in the Division of Gastroenterology and Hepatology at the University of Iowa Hospitals and Clinics and the Iowa governor of the American College of Gastroenterology, says that when people develop a problem in this pear-shaped organ, it's typically one of two things: "Gallstones, which are incredibly common, or gallbladder cancer, which is exceedingly rare." Read on to learn more about both.
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What exactly are gallstones?
In most cases, gallstones are small pieces of crystallized cholesterol. (The pebble-like lumps can form when there's an imbalance of substances in the bile.) More than 25 million Americans have thembut most never even know it. Symptomsand possibly infectionstrike when the stones get stuck in the gallbladder's narrow outlet, or in the ducts that drain the organ.
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Women are more likely to get gallstones
This is especially true as we age. (Gallstones occur in almost a quarter of women by age 60.) It's thought that the female hormone estrogen stimulates the liver to divert cholesterol into bile.
Pregnancy ups your risk. "During pregnancy you secrete the hormone progesterone in an increased amount and that decreases the gallbladder contraction," explains Dr. Silverman. Bile lingering in the organ may become stagnant and stones may precipitate out.
Certain populations are predisposed to gallstones, says Dr. Silverman, including the Pima Indians in Arizona. But most cases aren't related to genetics, he says.
Waist size, however, does play a role: A large 2013 study published in Hepatology found that the higher a woman's BMI, the more likely she was to develop gallstones.
Diabetes also raises a person's risk, as well as bariatric surgery and extreme weight loss. (Gallstones are one of the reasons you should seek medical supervision when you hope to lose a large amount of weight.)
But the truth is, the majority of people who get gallstones don't have any of the major known risk factors, says Dr. Silverman. "That would suggest that there are many things that we still really don't understand."
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How are gallstones treated?
Sometimes doctors discover gallstones by accident while looking for something else. In that case it's generally best to leave them alone. But if you're experiencing symptoms, your doc will likely suggest cholescystectomyan operation to remove the gallbladder (which may be done laparoscopically). Fortunately, the organ isn't essential; once it's gone, bile will flow directly from your liver to your small intestine.
Oral medications are sometimes prescribed to patients who can't undergo surgery, although it may take months or years for them to work, if they work at all.
In the 1980s, doctors began experimenting with a procedure called extracorporeal shock wave lithotripsy, which successfully pulverized gallstones using sound waves. But the treatment has since fallen out of use. "The stones would simply recur for whatever reasons caused them in the first place," explains Dr. Silverman.
In the slides ahead you'll find the most common signs of a gallbladder problem.
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Symptom: Pain in the upper right abdomen
This is where your gallbladder is located, just beneath your liver. Sudden, extreme pain could mean that stones are causing a blockage: Your gallbladder may be contracting but unable to drain, "so pressure builds up and it hurts," explains Dr. Silverman. But there are many other reasons you might experience pain in this area, he stresses, including muscle spasms. Call your doctor for emergency advice.
Sudden, intensifying pain in your intestineslocated in the center of your abdomencould also be a sign of gallstones.
Jaundice can by a sign of gallstones, but when it's accompanied by abdominal pain and weight loss, it may be a symptom of gallbladder cancer. If a tumor is blocking the flow of bile, the yellow-brown fluid may build up in the body and give the skin and the whites of the eyes a yellow tint. Keep in mind, though, that jaundice is caused more often by hepatitis than cancer. In any case, it's a good idea to see your doctor right away.
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A sign you may need your gallbladder removed
Gallbladder polyps are growths on the inside of the gallbladder wall show up on ultrasounds, often when doctors are investigating unrelated problems. Most of the time, they're nothing to worry about. But people with big polyps have a higher risk of developing gallbladder cancer, Dr. Silverman says: "I would emphasize that these are very large polyps, not tiny ones." As a preventative measure, your doctor may recommend gallbladder removal.
People who have a history of gallstones or large polyps are more likely to develop gallbladder cancerbut even among this group, the risk is very small. The American Cancer Society estimates there are fewer than 11,000 cases diagnosed per year. Still, if you've dealt with gallbladder problems in the past and begin experiencing abdominal pain, bloating, itchiness, loss of fever, nausea, or unexplained weight loss, then make an appointment with your doctor.