Biliary Colic


What Is It?

Biliary colic is a steady or intermittent ache in the upper abdomen, usually under the right rib cage. It happens when gallstones interfere with the normal flow of bile from the gallbladder. Bile is a liquid that helps to digest fats. Under normal circumstances, bile is produced in the liver and stored in the gallbladder. When you eat a meal, bile passes from the gallbladder through the cystic duct and the common bile duct into the small intestine, where it mixes with partially digested food. If a gallstone blocks either of these ducts, the normal flow of bile into the intestine is disrupted. The muscle cells in the bile duct contract vigorously to try to move the stone, causing the pain of biliary colic.


A person with biliary colic usually complains of an ache or a feeling of pressure in the upper abdomen. This pain can occur in the center of the upper abdomen just below the breastbone, or in the upper-right portion of the abdomen near the gallbladder and liver. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also experience nausea and vomiting.

Because symptoms of biliary colic usually are triggered by the digestive system’s demand for bile, they are especially common after fatty meals. The symptoms also can occur when a person who has been fasting suddenly breaks the fast and eats a very large meal.


After you describe your symptoms, your doctor will perform a physical examination, paying particular attention to the upper right portion of your abdomen (the area of your liver and gall bladder). Ultrasound, the same painless procedure used to produce pictures of babies in teh womb, will be used to produce pictures of your abdomen so your doctor can look for gallstones. Blood tests also may be ordered, especially if you have any fever or if your pain persists.

Expected Duration

Most episodes of biliary colic pass after one to five hours. After the most intense pain passes, your abdomen may continue to ache mildly for about 24 hours.


Because biliary colic is usually related to gallstones, it can be prevented by controlling the risk factors for gallstones. Some of these risk factors, such as heredity, increasing age and pregnancy, are a normal part of life. Others, such as obesity and a high fat diet, are risk factors you can modify by eating a healthy diet and getting regular exercise.


At first, your doctor will prescribe pain medication and tell you to eat a fat free diet. If the biliary colic is recurrent or persistent, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done through small incisions using an instrument called a laparoscope. The procedure usually requires only brief hospitalization. It is currently the most widely used treatment in people troubled by painful gallstones, because it is very effective and safe, with no complications in more than 90 percent of cases.

If surgery cannot be performed and symptoms of biliary colic are persistent, medication that dissolves gallstones may be used. However, this medication is expensive and can take two years to work. Also, only small stones will dissolve. Rarely, medication to dissolve gallstones is combined with shock wave lithotripsy, a procedure that uses carefully aimed shock waves to break up gallstones. However, in many people treated with medication and/or lithotripsy, gallstones tend to form again within a few years.

When To Call A Professional

Call your doctor whenever you have severe abdominal pain, with or without nausea and vomiting. If you have symptoms of biliary colic and you suddenly develop a fever and shaking chills, this may signal a gallbladder infection (cholecystitis), so call your doctor immediately.


As long as you have gallstones that can block your cystic duct or common bile duct, you are at risk for repeated episodes of biliary colic. There is also a 25 percent chance that you will develop acute cholecystitis, or some other complication of gallstones, within 10 to 20 years.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.