Gallstones in Seniors: Causes, Symptoms and Treatment

How Common Are Gallstones?

Gallstones are very common, affecting about 10 to 15 percent of the U.S. population, which equals nearly 25 million people. Each year, about a quarter of the nearly 1 million people newly diagnosed with gallstones will need treatment, usually surgery. Because risk climbs with age, gallstones are a health concern that older adults should not overlook.

Who Is More Likely to Develop Gallstones?

Several factors raise the chance of developing gallstones. Women are more likely than men to form them, especially women with higher estrogen levels from pregnancy, hormone replacement therapy, or birth control pills. Age matters too: as you get older, the likelihood of gallstones rises. A family history of gallstones also increases risk.

Certain health conditions make gallstones more likely, including cirrhosis, infections in the bile ducts, hemolytic anemias such as sickle cell disease, some intestinal conditions that affect nutrient absorption like Crohn’s disease, high triglycerides, low HDL cholesterol, metabolic syndrome, and diabetes with insulin resistance.

Weight also plays a role. People with obesity, especially women, are at higher risk, as are those who lose weight very quickly, such as after weight-loss surgery, and people who follow a diet high in calories and refined carbohydrates but low in fiber.

What Are the Symptoms of a Gallbladder Attack?

When gallstones block a bile duct, bile builds up in the gallbladder and causes a gallbladder attack. These attacks typically produce pain in the upper right abdomen that may last for several hours, often following heavy meals and occurring in the evening or overnight. If you have had one attack, more are likely to follow.

Seek medical care right away if you have any of these signs during or after an attack: abdominal pain lasting several hours, nausea and vomiting, fever even a low-grade one, chills, a yellowish tint to the skin or the whites of the eyes known as jaundice, tea-colored urine, or light-colored stools. These can signal a serious infection or inflammation of the gallbladder, liver, or pancreas. Because symptoms of gallstones can resemble appendicitis, ulcers, pancreatitis, or acid reflux, a doctor should evaluate them as soon as possible.

What Causes Gallstones?

Gallstones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Researchers do not fully understand why these changes in bile occur. Stones can also develop if the gallbladder does not empty completely or often enough. Risk factors such as obesity and certain eating patterns make these changes more likely.

How Is Gallstones Diagnosed?

To diagnose gallstones, a health care professional takes your medical history, performs a physical exam, and may order laboratory and imaging tests. During the exam, the doctor checks for tenderness in your abdomen and asks about symptoms, family history, and your typical diet. A blood test can reveal signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

Imaging tests used to find gallstones include ultrasound, which is the best method and uses safe sound waves; a CT scan, which combines x-rays and computer imaging but can sometimes miss stones; an MRI, which uses radio waves and magnets to show stones in the bile ducts; cholescintigraphy, also called a HIDA scan, which uses a small amount of safe radioactive material to track bile movement; and ERCP, which combines an endoscope with x-rays and can both locate and remove a stone stuck in the common bile duct.

What Are Treatment Options?

Silent gallstones that cause no symptoms usually do not need treatment. If you are having gallbladder attacks or other symptoms, contact your doctor, who may refer you to a gastroenterologist or surgeon.

The usual treatment is surgery to remove the gallbladder, called cholecystectomy, one of the most common operations performed on adults in the United States. The gallbladder is not an essential organ, and you can live normally without it. Surgeons perform the procedure laparoscopically whenever possible, which often allows you to go home the same day and return to normal activity within about a week.

An open cholecystectomy may be needed if the gallbladder is severely inflamed, infected, or scarred; this usually requires a hospital stay of up to a week and about a month to return to full activity.

Nonsurgical options are used only in special situations, such as cholesterol stones in someone too unwell for surgery. ERCP can remove a stone stuck in the bile duct, oral dissolution therapy uses bile-acid medicines like ursodiol to gradually break up small cholesterol stones, and shock wave lithotripsy uses sound waves to shatter stones. Even with treatment, gallstones can return, so long-term monitoring may be needed.

What Is Recovery and Prevention?

After gallbladder removal, a small number of people notice softer and more frequent stools because bile now flows into the duodenum more often; these changes are usually temporary. Gallbladder surgery complications are rare, though the most common is injury to the bile ducts, which can cause infection and may require additional operations.

You can lower your risk of gallstones by eating a healthy, high-fiber diet rich in fruits, vegetables, beans, peas, and whole grains such as brown rice and oats; cutting back on refined carbohydrates and added sugar; and choosing healthy fats like fish oil and olive oil while avoiding unhealthy fats from desserts and fried foods. Maintain a healthy weight with regular physical activity, but avoid losing weight too quickly, since very low-calorie diets and rapid weight loss can actually raise the risk of gallstones.

Talk with your health care professional before making major changes to your eating plan.

What Are Frequently Asked Questions?

A: Most silent gallstones cause no symptoms and do not need treatment. However, any gallstone can eventually block a bile duct, so report new or persistent symptoms to your doctor.

A: Gallstones do not usually disappear on their own. Silent stones may stay harmless for years, but stones that block the bile ducts typically need medical treatment.

A: No. Silent gallstones usually do not require surgery. Surgery is recommended when gallstones cause gallbladder attacks or complications.

A: A healthy, high-fiber diet and maintaining a steady, healthy weight lower your risk. Rapid weight loss, in contrast, raises the chance of forming stones.

What Are Key Takeaways?

• Gallstones are hard deposits, usually of cholesterol or bilirubin, that form in the gallbladder and are common in about 10 to 15 percent of adults.
• Risk rises with age, female sex, family history, obesity, diabetes, and certain health conditions.
• Most gallstones are silent and need no treatment, but a blocked bile duct causes a gallbladder attack with upper right abdominal pain.
• Seek care immediately for severe abdominal pain, fever, jaundice, or vomiting, which can signal a serious complication.
• Surgery to remove the gallbladder is the standard treatment and is safe; the gallbladder is not essential for living normally.
• Eating a high-fiber diet, choosing healthy fats, and maintaining a steady healthy weight help lower your risk.