The other organ for our digestion

What is the gallbladder?

The gallbladder is an extremely important organ of the digestive system. It sits directly beneath the liver in a shallow hollow called the gallbladder fossa. A connective tissue bridge firmly attaches the gallbladder to the liver. Where it does not lie directly against the liver, it is covered by the peritoneum.

In shape, the gallbladder resembles a pear. With a length of about 8 to 12 centimetres and a width of 4 to 5 centimetres, this hollow organ can store roughly 30 to 80 millilitres of bile produced by the liver. That is plenty for a substantial meal.

Whenever you eat something fatty, the gallbladder releases the stored bile through a small “tube” (ductus cysticus) into the duodenum. To prevent it from flowing out continuously, there is a kind of valve at the gallbladder neck (Heister's valve) that opens only when truly needed.

What is the function of the gallbladder?

Our liver produces up to a litre of yellow bile each day – a mixture of water, bile acids, cholesterol, phospholipids, bilirubin and other substances. This bile flows from the liver into the gallbladder where it is concentrated by water removal and changes colour from yellow to green. In the end about 50 to 60 millilitres of concentrated gallbladder bile remain. The wall of the gallbladder contains muscle tissue that can contract to release bile when required.

After eating, especially when fatty foods are consumed, the small intestine produces the hormone cholecystokinin. This hormone signals the gallbladder to contract. At the same time a ring muscle (sphincter) at the outlet of the bile duct into the duodenum relaxes. This forces the concentrated bile through the bile duct into the duodenum. There the bile does its main work: it breaks down fat clumps into tiny droplets so that digestive enzymes can process the fats more effectively.

What are the symptoms of gallbladder dysfunction?

Typical symptoms include abdominal pain on the right side, often under the ribs. Pain may radiate into the back or occur in colicky, cramping attacks – especially after eating. Consumption of fatty foods can cause nausea, bloating and digestive problems. Many affected people complain of recurrent nausea or even vomiting. A prolonged loss of appetite can lead to unintentional weight loss.

In so‑called biliary dyskinesia, a movement disorder of the gallbladder without stones, similar symptoms often occur – particularly upper abdominal pain after eating and digestive difficulties.

If the skin and the whites of the eyes turn yellow, this is a warning sign that the bile is not draining properly. Generalised itching can also be related to bile issues. Fever or chills may indicate a possible inflammation of the gallbladder. A sign that bile is not reaching the intestine properly is light brown urine and fatty or clay‑coloured stools. General tiredness and exhaustion may also occur.

What problems can the gallbladder cause?

The gallbladder can cause various problems, especially if gallstones form. These develop when cholesterol, bile pigments and salts deposit in the gallbladder or bile ducts. Often such gallstones remain unnoticed and cause no symptoms. Sometimes, however, they block the flow of bile into the intestine and trigger severe, cramp‑like pain in the upper abdomen, often accompanied by nausea and vomiting. This is called a biliary colic.

If bile cannot drain properly, bilirubin accumulates in the body, leading to a yellowing of the skin and eyes – jaundice. Gallstones can cause inflammation of the gallbladder (cholecystitis) or the bile ducts (cholangitis). Cholecystitis most commonly arises from the pressure of backed‑up bile on the gallbladder wall.

In most people the bile duct and the pancreatic duct join, and in this case a gallstone can also trigger a pancreatitis. If the gallbladder is excessively stressed by the pressure of blocked bile, it can even rupture. That is life‑threatening and leads to a peritonitis.

Repeated inflammations can permanently damage the gallbladder and cause it to shrink. Long‑term irritation from gallstones increases the risk of malignant tumours in the gallbladder or bile ducts. A backlog of bile can also adversely affect the liver and pancreas.

The gallbladder often tries to move stones by muscle contractions to restore bile flow. If this fails and symptoms recur, doctors usually recommend removing the gallbladder surgically to avoid more serious problems.

What consequences can a blockage of the gallbladder have?

Many people initially do not notice they have gallstones, as they may cause no symptoms for a long time. Only when stones move and obstruct bile outflow do typical symptoms appear – above all so‑called “biliary pains”, which can also radiate to the right shoulder, the back or even the chest. When the bile duct is blocked by a stone, cramp‑like pains come in waves and stop when the stone moves again.

These pains usually last at least 30 minutes, intensify and subside after a few hours. The colics occur at irregular intervals, not necessarily daily. Other symptoms may accompany them such as nausea and vomiting, sweating, bloating, intolerance to certain foods (especially fatty and spicy dishes), occasional fever and ultimately weight loss.

If the obstruction also impairs liver function, jaundice may occur: the skin can turn yellow and the urine darken. If bile cannot drain, fluid accumulates in or in front of the gallbladder. Without treatment this can lead to infections – in the gallbladder itself, the bile ducts or even pancreatitis. The risk of chronic liver problems or even abscess formation also increases.

To prevent more serious complications, gallbladder obstructions are treated with medication. Surgery is performed when necessary.

Gallbladder removal: when is surgery necessary?

Sometimes painkillers, antispasmodics or antibiotics help for a while. Small gallstones can be dissolved with medication, but they often recur. In such cases surgery to remove the gallbladder (cholecystectomy) is necessary because symptoms caused by gallstones or other issues cannot be permanently relieved otherwise.

When gallstones cause recurrent or very severe pain (e.g. biliary colic), this operation is often the best way to resolve the problem.

In cases of acute cholecystitis, prompt surgery is usually required to avoid complications – for example the increased risk of gallbladder cancer in a shrunken gallbladder or the risk of rupture in severe inflammation.

Personal factors also play a role in the decision, such as the risk of surgical complications (age, comorbidities) and quality of life. The standard method today is the keyhole operation (laparoscopic cholecystectomy). A small incision at the navel allows insertion of a camera, plus a few tiny incisions for instruments. The gallbladder is removed completely and there are hardly any visible scars. Patients can often go home shortly afterwards or stay only a few days in hospital.

In severe inflammation or adhesions from previous surgeries a larger abdominal incision may be necessary. Recovery time after an open cholecystectomy is then longer.

What can a patient expect after gallbladder removal?

After gallbladder removal recovery is generally relatively quick and uncomplicated, especially if the procedure was performed laparoscopically. Already on the day of surgery patients can take light food and from the next day a normal diet is usually possible. A special diet is not strictly required, but it is sensible to avoid fatty and hard‑to‑digest foods initially.

Complete wound healing takes about 10 to 14 days. During this time light activities such as walking are beneficial, but heavy lifting and intensive sports should be avoided.

After the operation bile flows directly from the liver into the intestine without being stored, and fat digestion can be somewhat less efficient. Therefore, after fatty meals digestive issues such as a feeling of fullness, bloating or occasional diarrhoea may occur. In such cases a reduced‑fat diet minimises discomfort. It is important to listen to your body and adjust eating habits accordingly. The altered fat digestion and metabolism can cause weight gain in some patients.

Life without a gallbladder is perfectly possible and most people lead a normal, healthy life. Occasional mild abdominal discomfort or diarrhoea can occur but are usually temporary.

Keep your gallbladder healthy: prevent rather than suffer later

• Consume more fruit and vegetables: these counteract stone formation and promote healthy digestion.
• Choose a fibre‑rich diet: whole grains, legumes, fruit and vegetables help regulate digestion and prolong satiety.
• Ensure adequate protein intake: lean meat, fish, legumes and low‑fat dairy products support muscle maintenance and stabilise blood sugar.
• Opt for healthy fats: instead of trans fats from processed foods, prefer omega‑3 fatty acids from fish, nuts and seeds.
• Avoid hard‑to‑digest foods. Very fatty, fried or heavily spiced dishes can burden the gallbladder.
• Overweight is a risk factor for gallstones, so a healthy body composition is important. Avoid extreme diets and very rapid weight loss, as these can promote stone formation.
• Eat regularly in small portions. Large portions can overload the gallbladder.
• Include fasting and rest periods to relieve and calm the gallbladder.
• Make sure to drink enough. This keeps bile thin and prevents stagnation.
• Daily physical activity is also good for the gallbladder. Exercise helps control weight and supports digestion.
• Try to reduce stress, as it can negatively affect digestion and gallbladder function.
• Use prophylactic medicinal plants. Greater celandine and fumitory may regulate bile secretion, artichoke leaves promote bile production, horseradish root relaxes gallbladder muscle. In case of gallstones, turmeric should be avoided as it can irritate the gallbladder.
• If there is a family history or symptoms, seek medical advice early. If you take cholesterol‑lowering medications or hormone replacement therapies, consult your doctor as they can promote gallstone formation.
• Take abdominal pain, nausea or digestive problems seriously and seek medical assessment at the first symptoms. Painkillers and antispasmodics should be taken only after consultation.
• For acute problems seek prompt medical help, especially for inflammations or blockages, to avoid complications.

Although the gallbladder may at first seem unimportant, it plays a major role in digestion. It ensures optimal fat processing and helps the body obtain essential nutrients. Even small disturbances can therefore lead to significant complaints. A conscious lifestyle and timely prevention, however, help keep this organ healthy and maintain long‑term fitness and vitality.