Gallbladder Attack Symptoms: What Biliary Colic Feels Like, the Triggers and the Warning Signs

A gallbladder attack (biliary colic) is a sudden, severe, gripping pain high in the upper right abdomen, usually coming on after a fatty meal and lasting from a few minutes to a few hours before it eases. It happens when a gallstone temporarily blocks the gallbladder’s outlet, and it is the classic sign that stones have stopped being silent¹.

I spent a fortnight arguing with my own body over exactly this pain, convinced each time that I had simply eaten something that disagreed with me. This is the plain account of what an attack actually is, so you can recognise it sooner than I did. If you want the wider picture of the stones behind it, start with what gallstones are and why they form; my own first attack is written up in full in the attack that sent me to hospital.

What is a gallbladder attack?

A gallbladder attack is an episode of pain caused by a gallstone blocking the narrow outlet of the gallbladder, so the organ contracts against the obstruction instead of emptying. The medical name is biliary colic, and the pain typically settles once the stone falls back and the blockage clears².

It helps to know how common the underlying stones are. Around 10 to 15% of adults have gallstones, more often women, and the rate rises with age³. Roughly 80% of those stones never cause a single symptom. An attack is simply the moment a stone stops sitting quietly and starts getting in the way, which is why the pain can arrive years after the stones first formed.

What a gallbladder attack feels like

It is a steady, intense, gripping pain high under the right ribs or in the centre of the upper abdomen, often spreading to the right shoulder blade or through to the back, and it does not ease with a change of position or a burp. Despite the word colic, the pain usually holds at a constant level rather than gripping and releasing in waves¹.

For me it was a band of pain that climbed up under my right ribs an hour after dinner and simply sat there while I stood at the kitchen sink, sure it was indigestion. That mistake is the commonest one there is: the pain sits where heartburn and a strained muscle sit, so a first attack is easy to talk yourself out of. Nausea, sometimes with vomiting, often comes alongside it.

What triggers a gallbladder attack

Attacks are most often set off by a fatty or heavy meal, because fat signals the gallbladder to contract, and a gallbladder squeezing against a stone lodged in its outlet is what generates the pain. Many attacks come on in the evening or overnight, a few hours after eating².

The fatty-meal link is real but not absolute. Plenty of attacks arrive with no obvious trigger, and no meal is reliably “safe”, which is one reason strict low-fat eating rarely prevents the problem for long. The trigger is worth noticing all the same, because a pattern of pain after rich food is often the clue that finally points a doctor toward the gallbladder.

How long an attack lasts and how often they come

A single attack usually lasts from a few minutes up to a few hours, then fades as the stone shifts; attacks tend to recur rather than strike once and vanish. Once stones are causing symptoms, the risk of a complication such as a blocked duct or an inflamed gallbladder runs at roughly 1 to 4% each year⁴.

That steady yearly risk is the reason symptomatic stones are usually treated rather than watched. My own attacks came four times over a fortnight before I went in, each one a little easier to dismiss than it should have been. If you are weighing up whether recurring attacks mean an operation, the honest version is in whether you actually need your gallbladder removed.

When an attack is something more serious

Pain that lasts beyond a few hours, especially with a fever or shivering, or any yellowing of the skin or the whites of the eyes, is a warning that an attack has become a complication and needs same-day assessment. Prolonged pain with fever suggests the gallbladder has become inflamed and infected (acute cholecystitis); jaundice suggests a stone has passed into the main bile duct⁵.

Severe pain that bores through to the back can also signal pancreatitis, another stone-related emergency. The line between a self-limiting attack and one of these is time and extra signs: an ordinary attack settles, while a complication builds. When in doubt, the deeper detail on the inflamed gallbladder is set out in acute cholecystitis, but the safe move is to be examined, not to wait out a pain that is not settling.

What to do about recurring attacks

Repeated attacks are the usual reason gallbladder removal is offered, because with symptomatic stones the definitive treatment is to take the gallbladder out rather than to keep managing the pain. NICE recommends laparoscopic (keyhole) cholecystectomy for people with symptomatic gallstones, including those who have had biliary colic⁴.

That does not mean rushing into surgery from a single episode, but a pattern of attacks is worth taking to a doctor who can arrange a scan and talk you through the options. The full account of the operation, the recovery, and life afterwards sits in the guide to gallbladder removal. Recognising an attack for what it is, sooner than I managed, is the first step in that conversation.