Gastrointestinal tract

Bile pain - causes and symptoms

Bile pain - causes and symptoms


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Many people suffer from bile pain every now and then. Both the gallbladder and the bile duct are extremely sensitive to external influences, so even the smallest changes can cause severe pain. The complaints are often caused by a reduced flow of bile due to stone problems. inflammation of the gallbladder. Physical and psychological stress can also be responsible for the complaints and lead to the proverbial "bile".

In any case, a doctor should be consulted to find out the cause of the bile pain. With the help of a detailed examination, laboratory tests and imaging methods (such as ultrasound), the patient can clarify whether there is actually a biliary disease. A visit to the doctor is very important, because e.g. Treating gallbladder inflammation in a timely manner can lead to serious complications such as a liver abscess or bowel obstruction occurs.

Bile pain definition and symptoms

The term “bile” is used colloquially to refer to both the gallbladder and the bile it contains. But that is not entirely true, because the “bile system” also includes numerous bile ducts, some of which are finely branched within the liver and lead to the gallbladder and from there out of the liver as a bile duct. Together with the main or execution duct of the pancreas, this ends up in the papilla of the duodenum ("duodenum"), which forms the connecting piece between the stomach and the empty intestine.

The pear-shaped gallbladder is located on the underside of the liver and - such as also the lungs and uterus - a so-called "hollow organ". The job of the gallbladder is to store the bile produced by the liver, to thicken it and, if necessary, to release it into the duodenum via the bile ducts. The secretion created between meals serves on the one hand through its fat-soluble components for fat digestion. In addition, the bile supports the removal of fat-soluble breakdown products from the liver by getting them into the intestine with the liquid and excreting them (“bowel movements of the liver”).

The gallbladder and bile ducts are very sensitive structures, which is why even the smallest changes can cause complaints in this area. If the flow of bile is e.g. Blocked by gallstones, this can be the most severe upper abdominal pain and a number of other unpleasant consequences such as Cause sweating, nausea and vomiting. However, an organic cause of the bile pain cannot always be identified. Instead, it can also be a functional disorder of the gallbladder and biliary tract. Although this causes similar or the same symptoms as a recognizable biliary disease, it is based on psychological stress such as pent-up anger, anger or unresolved conflicts.

Pain from gallstones

Gallstones in particular can cause severe pain. These are solid, crystal-like deposits in the gallbladder or bile ducts, which affect up to 20 percent of all people in this country. However, the deposits often go unnoticed ("silent stones") and only lead to problems in about every fourth case. The size of the stones can vary widely and range from a few millimeters ("semolina") to several centimeters.

There are various reasons for the formation of gallstones. The bile consists mostly of water, in addition there are a number of other substances such as Cholesterol, bile acid, calcium carbonate and the bile pigment bilirubin. If these components are in a certain relationship to each other, they remain dissolved in the liquid and form a stable bile juice. However, if one of the substances is present in too high a concentration, it can crystallize out and gallstones form - which in most cases consist of cholesterol (cholesterol stones) or bilirubin pigment material (pigment stones). Gender obviously plays a central role here, because women are affected much more often than men. Other important risk factors are a high-fat diet, lack of exercise, obesity and old age.

Likewise, certain diseases such as diabetes mellitus and inflammatory bowel diseases such as Crohn's disease and ulcerative colitis can have a beneficial effect on the development. Experts often speak of the so-called “6F rule” in connection with gallstones. According to this, women ("female") over 40 years ("forty") who have already had several children ("fertile"), are overweight ("fat") and are of a more Nordic type ("fair") are particularly common Gallstones affected. In addition, there is a genetic predisposition to the disease, which is why the likelihood increases further if gallstone problems have already occurred within the family (“family”).

In most cases, gallstones pose no danger, but if they reach a certain size, serious problems can arise. If they block the gallbladder or main bile duct, an increase in pressure in this area is possible, which in turn can lead to severe bile pain.

The pain referred to as “biliary colic” occurs in the right upper abdomen, but can also radiate up to the shoulder and be accompanied by nausea and vomiting. In most cases, sufferers of gallstones suffer from attack-like upper abdominal pain, which can last up to several hours, but then go away on their own. If the bile can no longer flow unhindered and builds up accordingly, serious health consequences such as inflammation of the gallbladder or bile ducts, jaundice, liver damage or, in very rare cases, even a gallbladder tumor can occur. Therefore, the complaints should definitely be clarified medically.

Gallbladder infection

Acute gallbladder infection (cholecystitis) can also be the reason for the complaints. This is a febrile illness, which in most cases is caused by gallstones (calculus). In rare cases, however, it is also possible that it occurs without gallstones (acalcous), for example as a result of major abdominal surgery, a wound in the upper abdomen or inflammation of other organs (e.g. kidneys). Other rarer causes are infections (e.g. from Salmonella), malformations, polyps and tumors of the gallbladder, and parasites such as e.g. Roundworms responsible for the complaints. Typical of a disease caused by gallstones are violent, attack-like pain (“biliary colic”) in the right upper abdomen, which many sufferers describe as dull or oppressive and can last from a few minutes to several hours. Often they radiate in the shoulder and back area at the same time and are therefore experienced as hardly bearable.

Such colic often occurs after copious, high-fat meals that stimulate the gallbladder to release bile acid. The stone is moved and transported into the narrow biliary tract, where it can get stuck in various places and cause massive pain. In addition to this, constipation, abdominal distension, flatulence, nausea and vomiting as well as the symptoms of jaundice (jaundice) such as Yellow eyes appear because the bilirubin, the biliary pigment, can no longer flow freely as a result of the obstacle and is deposited in the tissue. Since this is also absent in the small intestine, light bowel movements or, in some cases, fatty stools occur. It is also possible to have a strikingly dark urine as a result of the "redirected" excretion of the dye via the kidneys and a strong itching sensation due to the increased concentration of bile acid in the blood and skin.

The stasis of bile on the way to the small intestine increases the risk of infection of the bile system with bacteria, which can spread from the point of the occlusion (usually the gallbladder duct) back to the gallbladder. Typically, the upper abdominal pain persists in this case and there is a fever, chills, a painfully tense or hard abdominal wall, pressure pain when touching and discomfort when inhaling are common. If the inflammation takes a chronic course, those affected often suffer from dull, persistent pain in the right upper abdomen, some of which also occur at intervals. Besides that, indigestion is a typical symptom.

If the symptoms described occur, a doctor should be consulted as soon as possible in order to clarify the exact cause and to avoid serious complications. Early treatment is very important, then the inflammation heals in most cases without problems and consequences. However, if acute cholecystitis is left untreated, this can lead to life-threatening complications. For example, it is possible that the gallbladder tears, causing the bile to flow into the abdominal cavity. In this case, there is a risk of severe, purulent peritonitis, which must be treated immediately.

In addition, there is a risk that the inflammation of the gallbladder will pass to the liver and lead to delimited accumulations of pus (liver abscess). The gallstones can reach the intestine and, for example, cause an intestinal obstruction (“gallstone ileus”). Pus accumulation in the gallbladder (gallbladder empyema) is also possible. If there is chronic inflammation that is not treated appropriately, the risk of developing gallbladder cancer increases.

Bile disorders due to psychological stress

"My bile comes up" or "I could spit poison and bile": Proverbs like this indicate that bile pain can also be triggered by physical stress or anger, intense tension and inner unrest. Since no organic disease can be found in this case, doctors speak - such as also with irritable stomach or irritable bowel syndrome - from functional complaints. In this so-called "biliary dyskinesia" (also "irritable bile bladder") muscle cramps ensure that the function of the gall bladder and bile ducts is impaired and, as a result, the bile can no longer flow freely towards the intestine.

As with gallstone disease, this causes colic-like abdominal pain on the right side, which occurs both briefly and permanently and can also manifest itself in the form of shoulder stinging.

In addition to this, stomach problems and indigestion such as e.g. after eating greasy, sumptuous food and after enjoying coffee or alcohol can Flatulence, fatty stools or diarrhea occur. In view of these symptoms, the irritable gall bladder often leads to a misdiagnosis, so a thorough examination of the person concerned is very important. However, it is often difficult to rule out other gallbladder disorders - therefore a clear determination of the cause can only be carried out using a comprehensive blood test and imaging methods such as Ultrasound done.

Diet for bile pain

In many cases, nutrition plays a central role in biliary pain. In the event of problems, these should therefore always be carefully considered and, if necessary, changed. This is far less bad than it may sound to many. Because while in the past it was often advised to eat gently radical foods, from today's perspective there is nothing to be said against a largely "normal" diet - provided that a few important points are observed. Even after gallbladder surgery, there are usually no major restrictions. However, during an acute biliary colic as well as immediately afterwards, it is important to avoid eating.

People suffering from biliary problems should generally avoid too much fat. Because very high-fat foods can cause biliary colic and are therefore not recommended, especially for gallstones. The reason for this is that these animate the gallbladder to contract to release additional bile for the purpose of digestion.

It is important to find the right measure, because a largely fat-free diet is also not recommended, because the bile juice is therefore rarely needed in the gallbladder. As a result, the fluid collects and concentrates in the gallbladder, which also increases the risk of gallstones. This situation often also occurs during a diet or fasting cure, which is why people with an increased tendency to suffer from stones should better refrain from it.

It is important to pay attention to a balanced, high-fiber diet, whereby smaller portions are better taken instead of sumptuous dishes. It can serve as a guide that you eat so much per meal that you feel full but still flexible. Experts recommend reducing animal fats and instead of vegetables, salads, whole grain products etc. more often e.g. Eating fish. In general, a high-quality vegetable oil should be used in the preparation to relieve the liver and gallbladder. Hard-boiled eggs should also be avoided, as they are particularly difficult to digest and can even cause colic in large quantities. Prepared differently and in smaller portions, on the other hand, there is usually no need to worry, so that bile patients can eat egg-containing foods every now and then.

Flatulent foods are often not well tolerated, so it is advisable to be careful with cabbage, legumes, salsify, onions and garlic. Here, affected people should try out for themselves which foods are problematic or where the individual limits are and design their meal plan accordingly.

In the case of biliary pain, foods such as e.g. Soybeans, lentils, peas, zucchini, chicory and artichokes, as they are good for liver health and support the flow of bile. Fruits rich in vitamin C can also have a positive effect, as this converts excess cholesterol into bile acid and can thus prevent gallstones. There is a particularly high amount of vitamin C in sea buckthorn berries, rose hips and black currants. Grapefruits, guavas, grapefruits and strawberries are particularly good.

Treatment

In the case of inflammation of the gallbladder, the therapy depends on the cause or the form of the disease. Surgical removal of the inflamed gallbladder (cholecystectomy) is recommended for most patients, especially if these are caused by large gallstones. To avoid complications, this should be done as soon as possible after the onset of symptoms and is usually performed in a minimally invasive manner or using so-called "keyhole surgery" (laparoscopic) under general anesthesia. An open surgery, in which the surgeon removes the gallbladder through an abdominal incision, is only used in rare cases today, e.g. severe inflammation or if a tumor is suspected. In addition to the procedure, antibiotics are usually used to treat bacterial inflammation, and antispasmodic drugs can also relieve the pain.

If the patient has had gallbladder symptoms for more than three days, surgery is usually not performed for safety reasons. Instead, the affected person also receives antibiotics and antispasmodic and analgesic medication. In addition, to relieve the gallbladder, food should be completely avoided for at least one day and nothing greasy or fried should be eaten for the following days. After the acute phase of the disease has subsided, the gallbladder should also be removed in order to remain symptom-free in the long term. The procedure is considered to be largely risk-free and usually patients can leave the hospital after only a few days.

If organic causes for the biliary pain have been excluded, the treatment of the so-called “irritable gall bladder” (biliary dyskinesia) often consists in learning suitable relaxation methods in order to reduce the personal stress level. Depending on your personal taste, there are various relaxation methods and techniques such as Progressive muscle relaxation according to Jacobson or meditation in question, traditional Asian exercises or martial arts such as Qigong and Tai-Chi have also been enjoying increasing popularity in recent years.

Other methods of promoting relaxation such as exercise, a walk in the fresh air or a soothing bath can often help to alleviate the stress-related symptoms. Nutrition also plays an important role. Greasy and sumptuous meals and alcohol should be avoided to relieve the gallbladder. Instead, a low-meat or vegetarian whole food diet is recommended, and it is also important to drink enough at all times. If possible, obesity should be reduced, as this exerts pressure on the abdominal cavity and can therefore increase the symptoms. It can be helpful to use certain spices, e.g. Use turmeric, ginger and curry as they help with digestion and stimulate bile flow.

Naturopathy and home remedies for biliary pain

Outside the acute stage, biliary problems can also be alleviated using various home remedies and naturopathic procedures. From the field of herbal medicine come e.g. Greater celandine, yarrow, verbena and marigold, which have proven particularly effective in disturbed bile flow. A tea made from peppermint, artichoke or bitter clover is also suitable for gallstones, and an infusion of bearberry, chamomile or marigold can be helpful for gallbladder infections.

From the area of ​​the Schüssler salts, salt No. 7 (Magnesium phosphoricum) can help to relieve the pain in the bile. The number 10 - Sodium Sulfuricum - is generally considered in naturopathy as a supportive agent for the liver and bile. Homeopathy offers, among other things, the remedy Colocynthis for severe complaints - especially if the pain radiates to the back and subsides with light movement. However, if only absolute immobilization brings an improvement in the situation, homeopaths usually recommend Bryonia alba (D6 - D12). If the pain occurs as a result of excitement, anger and rage and the tension during the colic increases, Chamomilla vulgaris can be the treatment of choice.

If stress is the cause (biliary dyskinesia), it is also important to critically and unrestrainedly question personal stress and to develop effective strategies for psychological relief. Short-term complaints due to inner restlessness can often be alleviated by a warm grain pillow or a soothing tea. Chamomile or lemon balm are particularly suitable here, and other home remedies for abdominal pain, such as vinegar wrap, have also proven effective for an irritable gall bladder. For this, a towel is immersed in hot vinegar water (1 tablespoon per liter of water), wrung out and placed on the aching belly for about 20 minutes. Herbal medicine with valerian, hops or lavender also offers valuable "first aid" care so that you don't "get your bile up" with anger, anger or tension.

In addition to this, however, the cause of the stress-related bile pain should always be researched and therefore also dealt with possibly uncomfortable questions. "What disturbs me so much?", "What worries do I eat into myself?", "Who or what always makes me so angry that I would prefer to spit poison and bile?". Various methods and techniques for reducing stress, such as autogenic training, yoga or breathing exercises, can be valuable support. Because these help the person concerned to concentrate on their own person and to find the inner balance again. In order to be able to deal with deeper conflicts, traumas etc. and to understand the motives for your own behavior, psychotherapeutic treatment can also be very useful in some cases. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch

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Video: Gall Bladder Stones - Causes, Symptoms u0026 Treatment. Dr. Rajesh Sinha (November 2022).