Biliary Colic: Causes, Symptoms, Diet, and Treatment

Biliary ColicBiliary colic sounds rather ominous, and while it can be very painful, it is important to keep in mind that diet plays a big role in treatment for this condition. Here we explore the causes, symptoms, and common treatments for biliary colic.

Biliary colic isn’t exactly a phrase you hear often, so just what is biliary colic? Well, an intermittent ache in the upper abdomen, usually under the right side of the rib cage, is the best and most concise biliary colic definition. In actual fact, it is a condition that occurs when something blocks the normal flow of bile from the gallbladder. Bile is liquid, made in the liver that helps to digest fats.


When we consume a meal, our bile passes from the gallbladder into the small intestine, which is where it mixes with partially digested foods. Bile is crucial for digestion and absorption of fats and fat-soluble vitamins in the small intestine.

What Causes Biliary Colic?

There are a number of different causes of biliary colic, but in the vast majority of cases, gallstones are the problem. The list below outlines the various causes of biliary colic, starting with gallstones.


These are small stones that are made of cholesterol and form in the gallbladder. Sometimes, they don’t cause any symptoms; however, if they become trapped in the duct, which is the opening of the gallbladder, it can lead to sudden, severe abdominal pain. This pain can last a few minutes or several hours.

Bile Duct Obstruction

This really means a blockage of the bile ducts. Bile helps clear waste products, but an obstruction can lead to a number of unpleasant symptoms, most notably pain in the upper right side of the abdomen. Dark-urine and light-colored stool are also common. If left untreated, the blockage can cause life-threatening liver disease.

Gallbladder Inflammation

When the liver gets blocked by a gallstone and bile backs up, it can lead to gallbladder inflammation. This inflammation can cause the organ to become enlarged, and in some cases, the build-up of fluid in the gallbladder creates a secondary infection. About 90 percent of inflammation cases are from gallstones. It is believed that 20 percent of Americans have gallstones and one-third will develop inflammation. Gallbladder inflammation risk increases with age. With this condition, upper right quadrant pain usually comes on suddenly and shortly after eating a high-fat meal.


This means inflammation is in the pancreas. The pancreas is located behind the stomach in the upper abdomen. Biliary pancreatitis can occur suddenly and last a few days or can be chronic and occur over many years. Mild cases disappear without treatment, but severe cases can be life-threatening. Upper abdominal pain is the primary symptom. This pain tends to radiate to the back.

Other Causes

There are other biliary colic causes that center on bacteria and parasites. Biliary cirrhosis, biliary fascioliasis, or sclerosing cholangitis, which is a disease that destroys the bile ducts, are considered causes.

Research suggests that half of the patients with biliary pancreatitis experience warning signs of biliary colic that are similar to other gallstone complications. Complications usually occur due to delays in diagnosis and treatment.

Biliary Colic Risk Factors and Symptoms

Before we address the symptoms of biliary colic, let’s take a look at some risk factors. There are some people who are more prone to developing gallstones and are at an increased risk for biliary colic. Women, individuals over the age of 40, those who are obese, Native and Mexican-Americans, people with gastrointestinal conditions, people who have lost weight quickly, and those who have diabetes are at a higher risk. So are people who take certain medications, such as birth control. It is also important to point out that it is not uncommon to see biliary colic in pregnant women. This may be due to the fact that women are at a higher risk of getting gallstones when they are expecting a child.

Here are some typical biliary colic symptoms:

  • Sudden intense stomach pain that lasts between one and five hours
  • Pain in the middle of the abdomen
  • Pain underneath the ribs on the right-hand side
  • Pain on the side of the body or the shoulder blade
  • Pain that is triggered by eating a big meal or fatty foods
  • Nausea and vomiting

Diet and Lifestyle Changes for Biliary Colic

Biliary colic treatment includes lifestyle adjustments. For instance, a biliary colic diet is vital and should be low in fiber since too much fiber can increase the risk of developing gallstones. Refined carbohydrates, such as white bread and white rice, can also increase the risk of gallstone formation. A healthy diet contains a lot of fresh fruits and vegetables, along with lean proteins and whole-grain carbohydrates.

Following the tips outlined here can help lower the risk of developing gallstones and ultimately biliary colic, as well as help those who have already been diagnosed with biliary colic.

Maintain a Healthy Weight

Being overweight is a risk factor for developing gallstones, but remember that losing weight too fast can also lead to the forming of gallstones. A weight loss goal should be one to two pounds per week. It is best to discuss a weight-loss plan with your doctor or nutritionist.

Avoid Certain Foods

Limit the amount of fat in your diet. Fried foods, cookies, and crackers are filled with trans fat. Foods that are high in salt and sugar should also be avoided. Pre-packaged foods tend to have a lot of added salt and sugar, so start by eliminating them from your diet. Don’t cut salt and sugar completely from your diet, as you need some for energy.

Do Not Eat Oysters or Raw Fish

These contain bacteria that can cause problems, especially if you have already been diagnosed with biliary colic.

Increase Healthy Foods

This includes fruits and vegetables, but also lean meat, fish, beans, and low-fat dairy products. Certain nuts, including walnuts and almonds, may help keep gallstones at bay since they are high in omega-3 fatty acids. You can also look to vitamin and mineral supplements to make sure you are getting everything your body needs.

Avoid Smoking and Drinking Alcohol

Smoking and drinking can make biliary colic worse. If you smoke, ask your doctor about cessation options. When it comes to drinking, try to have only one or two drinks a week at the most or better yet, none.

How to Diagnose and Treat Biliary Colic

So how does a doctor determine if a patient has biliary colic? Blood tests and urine tests might explain why a person is experiencing uncomfortable pain in the abdomen. However, in many cases, to make a definitive diagnosis, an X-ray of the abdomen may be required. Alternatively, an ultrasound may be able to show blockages. CT scans can also detect blockages. Sometimes, a special dye is used before the pictures are taken to help the healthcare provider get a better view. An MRI is another tool that is used to detect blockages or growths. Naturally, a medical history, including details about the symptoms you are experiencing, will help the doctor.


In terms of how to relieve biliary colic pain, the approach is two-fold—to help the patient feel comfortable since he or she is likely in extreme pain, and work on removing the source of the problem. For gallstones, treatment can mean surgery to remove the gallbladder. The procedure is known as a cholecystectomy. Thanks to modern medicine, laparoscopic surgery is commonly performed. It is much less invasive than open surgery. There are cases where the doctor will recommend techniques to dissolve or break up the gallstones. In some situations though, the gallstones come back in a few years time.

Since the gallbladder is not crucial to digestive health, it can be removed. When a gallbladder is taken out, bile flows directly from the liver to the intestine and rarely causes any health problems. If treatment of biliary colic doesn’t involve surgery, it is important to follow the doctor’s instructions, including any diet guidelines. It is equally important to check in with your physician from time-to-time just to make sure your recovery is on the right track.

Related: Bile Duct Obstruction (Biliary Obstruction): Causes, Symptoms, Treatment, and Diet


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Gallbladder pain: Causes, symptoms, diagnosis, and treatment

Enlarged bile duct: Causes, symptoms, and treatment

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