I've Got Back Pain. Could it Be Gallstones?

I'm definitely not one to run to the doctor at the first sign of pain, but a persistant dull, achy pain between my shoulder blades recently prompted me to schedule a visit with my primary care physician. I'd been dealing with this upper back pain for a few months, along with indigestion, flatulence, and occasional sharp pains in the upper right part of my abdomen. Realizing that I fit the profile for gallbladder disease-- that is, I'm female, fat, fertile, fair, and (almost) forty-- I figured it would be wise to go get checked out.

Let's talk gallbladders...

The gallbladder is a small, pear-shaped sac located just under the liver. Most of the time, it quietly stores and concentrates bile, contracting and releasing the bitter fluid after a meal to help the body digest fats. Many people develop gallstones as they age. Gallstones are usually made of cholesterol, but they can also be made of pigments that get caught in the gallbladder and crystallize.

Eventually, the crystals can turn into stones, which can cause pain in the gallbladder along with other troubling symptoms. However, most people who have gallstones don't know it, because gallstones are often so small that they don't cause symptoms. It's when the stones get caught in the ducts that carry bile from the liver to the small intestine that they start to cause pain and inflammation. If a stone blocks a bile duct for a long time, it can cause significant damage or lead to infection of the gallbladder, liver, or pancreas. Infections that develop in the gallbladder, liver, or pancreas can lead to serious illness or even death.

Fortunately, not many people die of gallbladder disease. Most people never get to the point of ever having an infection because people who have symptoms of gallbladder disease are often advised to have the organ removed. Indeed, gallbladder surgery, medically termed cholecystectomy, is one of the most commonly performed surgeries today. Most people never miss their gallbladders, though some people do notice that they don't tolerate certain foods as well once their gallbladder is gone.

Thankfully, today's cholecystectomy is usually also a minimally invasive procedure. Approximately 95% of people who undergo a cholecystectomy have their gallbladders removed laporoscopically. This surgery can often be done with just an overnight hospital stay. Some patients can even go home the same day of the surgery. There are certain patients who are not good candidates for the laporoscopic procedure and require an open cholecystectomy. Those patients will likely have a longer hospital stay and recovery time.

Back pain and gallstones... and other signs and symptoms

The classic signs of gallstones include pain in the pit of the stomach, particularly in the upper right quadrant of the abdomen. The pain may spread from the abdomen to the right upper back or between the shoulder blades or there may be more pain in back and shoulder blade area than in the abdomen. The pain may be mild or it may be very sharp. It may come and go or it may be persistant. Some people notice that the pain gets worse after eating, particularly if the meal was particularly fatty.

During an attack, the pain may be so severe that you're unable to take deep breaths and moving around does not alleviate the pain. Gallbladder attacks can happen at any time, but many people experience them at night. The attack may last for a few minutes or a few hours.

Along with pain, there may also nausea, vomiting, heartburn, bloating, and flatulence. Emergency symptoms include jaundice (yellowing of the skin and whites of the eyes), dark urine, light colored stools, and fever and chills. My doctor advised me to go straight to the emergency room if I ever experience vomiting green bile or severe abdominal pain.

Is surgery always necessary?

Though many doctors do advise people with symptomatic gall bladders to have the troublesome organ removed, not everyone ends up having surgery. Those who only have one or two mild attacks may do well to alter their diets and eliminate fried or fatty foods to reduce the frequency and severity of the attacks. Other people may opt to take a medicine known as Actigall or undergo lithotripsy, which is a treatment that involves using ultrasound waves to break up the stones. There are several other non-surgical therapies that have been used to treat gallstones. The downside to not having surgery is that the gallstones usually come back eventually and the treatments may take a long time before the patient gets any relief.

Who's at risk for gallstones?

As I mentioned before, a lot of doctors rely on the 5-F mnemonic device to guess who's at risk for gallstones-- female, fat, forty, fair, and fertile. But other people can get gallstones, too. Gallbladder disease is most common in:

* Women
* People over age 55
* People of Mexican or Native American descent
* People who are overweight or obese
* People who have lost a significant amount of weight in a short time
* Yo yo dieters, crash dieters, or people who fast
* People who have a family history of gallstones
* People have diabetes, sickle cell disease, or Crohn's Disease
* People who don't get much exercise
* Women who are pregnant or have had several babies

Will I be having surgery?

At this point, the jury is still out as to whether or not I will be going under the knife for gallbladder surgery. I still need to have an ultrasound done and, since I have military health insurance and live in an area where there aren't many military treatment facilities, I have to wait for the okay to get the ultrasound done. I have a strong feeling that I probably will end up having gallbladder surgery. If it happens, it will be my first time ever having surgery, which should give me plenty to write about. Every cloud has its silver lining, right?

Just remember that gallstones don't always present with pain in the belly. Sometimes, that nagging upper back pain can also be a signal that your gallbladder's in distress.

Sources:

www.webmd.com
www.cigna.com
National Digestive Diseases Information Clearinghouse (NDDIC) http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/

Personal experience
Doctor's visit