Pay Attention To Pain

You probably know by now that aches and pains during pregnancy are pretty typical -- and by the time it's all over, you'll know that it is all worth it. However, one kind of pain can cause problems not only during pregnancy, but also follow you into the postpartum period. After the birth of a child, many women find themselves with stabbing pains and other intestinal discomforts. What is it? No, it's not your uterus returning to its pre-pregnant size, and we don't mean heartburn -- we're talking about the pain caused by gallstones.

Jennifer Newton Reents


In fact, some women have such tremendous pain that their gall bladders are removed during pregnancy, though removal soon after pregnancy is more common.

Second to appendicitis, gall bladder removal is the most common surgical condition encountered during pregnancy, says Dr Christy Dibble, director of the Gastrointestinal Endoscopy Service Program in Women's Digestive Disorders at Women and Infants Hospital in Providence, Rhode Island. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that women between the ages of 20 and 60 are twice as likely to develop gallstones as are men.

Pregnancy, as well as estrogen and birth control use, put us at a higher risk for developing gall bladder problems. In fact, Dibble says two to four percent of pregnant patients are found to have gallstones during their pregnancy ultrasounds.

Your gall bladder and gallstones
So just what does a gall bladder do? This small organ sits below the liver and houses bile, a fluid breakdown of old red blood cells and digestive enzymes. Dr David Bowen, who heads the surgery department at Ochsner Hospital in New Orleans, explains that bile is needed for digestion. Normally, bile remains in your intestines until you eat, and the gall bladder then squeezes bile into intestines to mix with the food as it makes its way down.

Gallstones form for a number of reasons. Typically, the materials that make up bile -- cholesterol, bile salts and lecithin -- get out of balance and begin to form crystals, says Bowen. Those crystals then stick together and grow larger and harder.

"The hormonal milieu, circulating estrogen and progesterone levels, affect the gallbladder's ability to contract and excrete bile," says Dibble. "Higher levels of these hormones result in a slowdown of the gallbladder wall and promote gallstone formation. When these gallstones leave the gallbladder and become lodged in the ducts of the gallbladder or pancreas, they can be [extremely] painful."

Cindie Scott of Dallas, Georgia, experienced symptoms of gallstones following both her pregnancies. "I had my first baby in January of 1999. About two months later, I started having severe pains in my abdomen," she says. "It usually occurred late at night after I had eaten spicy food like Italian or Mexican. This happened about once a month for about four or five months, and then I noted no more symptoms."

About a month after her second child in 2001, she again experienced severe pain. "This was by far the worst episode -- extreme pain and pressure in my abdomen and side, along with a high fever," Scott says. "The pain lasted anywhere from two to six hours. Nothing that I tried would relieve the pain." Six weeks postpartum, an ultrasound revealed a gall bladder full of stones. The organ was removed a few months later. Along with pregnancy and the influence of female hormones, other risk factors include obesity, ethnicity (in particular, Native American and Mexican American), diabetes and rapid weight loss, according to the NIDDK.

Symptoms are often called a gallstone "attack" because they occur suddenly -- often following fatty meals and during the night. According to the NIDDK, symptoms typically include:

  • Steady pain in the upper abdomen that increases rapidly and lasts 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea or vomiting
  • Abdominal bloating
  • Recurring intolerance of fatty foods
  • Belching
  • Gas and indigestion

If, in addition, you experience any of the following symptoms, you need to see a doctor immediately:

  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish skin or whites of eyes
  • Clay-colored stools

During an attack, the the stone gets in the way, and the gall bladder "pushes against the blockage of the stone, which causes pain. Then the gall bladder relaxes, and the pain goes away," Bowen says. "After a while, if the gall bladder continues to be inflamed, the patient may get intermittent episodes of abdominal discomfort causing nausea, belching, etc. Then the gall bladder is scarred and inflamed even further. [It] gets worse over time."

Diane Fahy of Sacramento, California, compared her pain to that of childbirth. "I thought that I was dying. It hurts as much as childbirth, but unlike contractions, the pain doesn't go away," she says. "It continues and continues. There was excruciating pain in my stomach region that couldn't be relieved." She says most of her attacks were set off by fatty foods. And though she says it took six weeks to diagnose her condition, her gall bladder was eventually removed.

For Sandie Reverski of Delaware City, Delaware, the pain felt as though "someone was running a red hot poker back and forth through the right side of my abdomen. At first, it just felt like a stomachache or gas. As time wore on, my back ached with shooting pains, and I felt like I was being ripped apart from the inside out." She had her gall bladder removed about five months after her baby was born.

Surgery to remove the gall bladder (cholecystectomy) is the most common treatment for stones; more than 500,000 Americans undergo the procedure each year. (Those who have gallstones but no symptoms usually do not need treatment.)

Most commonly, the surgery is done with a laparoscope, using a procedure that can be performed during pregnancy. The surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. Outside of pregnancy and when a laparoscope can't be used, a large incision across the abdomen is necessary. This is called "open surgery," and is required in only about 5% of gall bladder operations.


Melanie Walenciak of Tulsa, Oklahoma, says she found relief in having her gall bladder removed. "The pain is gone. My lifestyle and diet have not changed at all, although they probably should," says Walenciak, who had more than 300 stones in her gall bladder. "I have read books on natural medicine stating that the gall bladder should not be removed. It serves a purpose, and your body will miss it. I admit this alarmed me at first, but it has been eight years since my gall bladder was removed and I have had no digestive problems at all." Once the gallbladder is removed, bile flows out of the liver and goes directly into the small intestine, instead of being stored in the gall bladder. Other treatments such as radio frequency and oral medications are available, Bowen says, but they are not always effective.

Avoiding problems
Dibble says that, along with hormonal fluctuations, genetics may play a role in gall bladder disease -- and surgery may be the only option to end the pain. "While following a healthy diet high in fruits and vegetables and limiting saturated fats may help limit episodes, surgical management may be unavoidable," she says. The good news is that we can live without our gall bladders without even changing our diets. Now that is something we can stomach!


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