All About Your Gallbladder

photo credit: 
dubnars on flickr
Why you have it, keeping it healthy, and living without it

It was my last day at a very stressful job. My coworkers were gathered at a going away party, when I had a bad attack of indigestion. For weeks I'd been having bad indigestion and had been living on antacids; I'd just chalked up my "stomach problems" to the miscarriage I'd had earlier in the month and the pain of leaving a start-up I'd helped grow but finally had to leave in frustration. I went into the women's room to take a dose of antacid.

But as soon as I downed it, suddenly pain--searing pain, pain that felt as if I were dying--bubbled up from my chest and I collapsed on the floor in agony, pain radiating from my front to my back. I thought maybe I was having a heart attack; my staff called 911. I was carried out of my party on a gurney and taken by ambulance to the emergency room, where I was diagnosed as having a panic attack, given the sedative Demerol and sent home as soon as I woke up.

Fast forward four years almost to the day and one baby later. I was three months pregnant with my second child when I thought had a stomach flu I just couldn't shake; I was in such pain that I could barely walk by the time I got to the doctor's office. Dr. Pete listened to my story, poked at my tummy a few times, asked some pointed questions and sent me for an ultrasound with the words "suspected cholecystitis" on the order slip. That, I knew, meant gallbladder disease. A little research and suddenly everything that happened four years previous made sense: I wasn't having a panic attack, I'd passed a gallstone, and classically at that.

What the gallbladder does
The gallbladder is a little smaller than your fist, shaped somewhat like a pear. It nestles under your liver, about mid-torso to the right. Its main purpose is the storage of bile, a substance produced by the liver that aids in the digestion of fat. Bile is released as needed into the digestive system when the gallbladder contracts and squeezes it out through two bile ducts into the small intestine.

The gallbladder can become irritated and cause pain when gallstones form. Gallstones are small, hard, rocklike masses made up of bile salts and cholesterol that form rather like pearls form in an oyster; over time the stones get larger as they add more layers of cholesterol and bile salts to them, and new ones can form. Between 15 and 20 percent of the US population have gallstones, but of those people, only a quarter will ever know the stones exist; the rest experience no pain or other symptoms.

Irritation of the gallbladder occurs when the gallbladder contracts to secrete bile into the small intestine and the gallstones stop or reduce the flow of the bile. The bile then builds up and concentrates, causing the irritation. This is called cholecystitis and it usually occurs after the sufferer eats a fatty meal, especially animal fats. The pain is often confused with heartburn or indigestion.

In particularly bad attacks, or when the stone actually gets into the bile duct and is passed into the small intestine, the pain is excruciating, radiating through to the back and mimicking heart problems. (When I passed my stone, I would happily have shot myself if there'd been a gun handy, just to make the pain stop.) If the stone gets stuck in the bile duct there is a chance the situation can deteriorate into pancreatitis, a serious and potentially fatal condition.

Risk Factors for Gallbladder Problems
  • Being female
  • Pregnancy
  • Use of oral contraceptives
  • History of intestinal disease such as ulcerative colitis or Crohn's Disease
  • Overweight
  • Diabetes mellitus
  • Alcoholism
  • Increasing age (more likely over age 40)
  • Asian or African ancestry

Symptoms of Gallbladder Problems
  • A feeling of fullness or gassiness
  • Abdominal pain, from fairly uncomfortable to excruciating, in the upper right side or middle of the abdomen radiating through to the back in the worst cases
  • Recurring similar attacks
  • Occurs within minutes of eating, especially after fatty meals
  • Fever
  • Nausea and vomiting
  • In advanced cases, jaundice--a yellow tint to the skin
  • Heartburn
  • Waves of chills and shaking

If you have more than a couple of these symptoms and the pain is moderate to severe, get to the emergency room immediately for evaluation.

Avoiding and dealing with gallbladder problems
Once gallstones form they are very difficult to dissolve; though there are drug therapies and other procedures available for people who cannot have surgery for some reason, they're not terribly effective. Even alternative medicine practitioners admit that after a certain point there's nothing to be done but remove the entire organ.

For those of us susceptible to gallbladder problems, the best thing to do is keep the diet low in saturated fats. Limit animal fats in particular and stick to nonsaturated vegetable sources of fat, such as olive oil. It's important to eat foods high in fiber as well. Keep your weight down, but don't go on crash diets; rapid weight loss can lead to gallstone formation. If you must lose weight, avoid very low calorie diets and lose weight at a slow, sensible pace focusing on exercise instead of calorie restriction.

If you suspect or are diagnosed as having gallstones and/or chronic (recurring) cholecystitis, the most helpful thing you can do is to immediately and seriously limit the fat in your diet, especially animal fats. Basically, this means going vegan--no dairy, no meat, no eggs. Most fish is okay, in fact, alternative medicine practitioners consider fish oil and olive oil to be beneficial in mild gallbladder cases when eaten in sensible amounts.

It sounds like a difficult regimen, but in fact once you slip up, eat something fatty and end up in the emergency room in pain, it becomes surprisingly easy. Some people keep it up for years. I myself managed it for about nine months, long enough to get through my pregnancy and a couple of months postpartum after diagnosis. In that time I had only two major attacks, and they both occurred after I had my baby, at which time my fat sensitivity seemed to become much, much worse.

Gallbladder surgery, or: Yank that sucker!
At some point it becomes clear (for about 900,000 Americans a year) that the gallbladder just has to go; there are too many stones causing too many bouts of too much pain. Luckily the gallbladder is one of the few organs we humans can live without if we have to. The usual way the gallbladder is removed is via a procedure called laparascopic cholecystectomy.

Before this procedure was developed a few years ago, removing the gallbladder required a large abdominal incision, and it took at least a week of hospital time and several weeks of downtime at home to recover. Now, using a fiber optic camera inserted through a small incision at the bellybutton, surgeons can remove the gallbladder through a set of three or so much smaller cuts that heal relatively quickly. Most patients are in and out of the hospital in less than 24 hours and back to most activities within a week to ten days.

Since pregnancy is a risk factor for gallstones, sometimes women face the prospect of gallbladder surgery while carrying a baby. The best time for cholecystectomy during pregnancy is in the second trimester; the uterus is still small enough to be out of the way, allowing the laparascopic approach instead of requiring the big abdominal cut.

Unmitigated gall
I chose to tough out my pregnancy, worrying that even though the rate of complications from cholecystectomy is low I'd be the unlucky statistic. I managed my disease through diet, successfully forestalling gallbladder attacks until just after my pregnancy. At that point I suddenly became hypersensitive to any fat at all, not just animal fats.

Seven weeks after a really difficult c-section, I had my gallbladder removed. The pathology report later said there were 15 gallstones in there, and the largest was 1.5 centimeters--about half an inch--in diameter.

Like everyone else who has had this surgery, I can now eat pretty much whatever I want, pain-free. Stories told to me by others in the same boat say that at some point I may actually eat too much fat and have a nasty bout of diarrhea, but that's about it; the level of "too much fat" apparently varies from person to person, but most people tell me it's the equivalent of a double bacon cheeseburger AND a super-size fry AND a supersize milkshake, ALL IN THE SAME MEAL. If you eat a meal like that (and not that I haven't in this life), I figure diarrhea is the least you deserve.

And, like everyone else without a gallbladder, my bile--my gall--instead of being held back until needed dumps straight into my small intestine. That's right, I now have unmitigated gall. (OK, I admit I stole that line from my friend Theresa, who had the surgery two weeks before me.) But in this situation, unmitigated gall is okay.

Lynn Siprelle is gallbladder-less, even as she edits this site.