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What is the gallbladder?
The gallbladder is a small, sac-shaped organ that sits just beneath the liver. Its purpose is to store bile, a substance that helps digest fats. As food enters the small intestine from the stomach, the gallbladder receives a signal to start contracting and release bile into the intestine.
Bile is composed of water, bile salts, and cholesterol, among other things. If the bile contains too much cholesterol and not enough bile salts, or the gallbladder doesn't empty properly, the gallbladder can form deposits, known as stones or gallstones. These stones are one form of gallbladder disease, but you can have stones and not notice any symptoms.
The term "gallbladder disease" covers inflammation, infection, stones, and blockage of the gallbladder.
What is biliary colic?
Biliary colic is the result of a blockage in the ducts of the gallbladder. If the bile is unable to exit the gallbladder, perhaps because of a gallstone, it can lead to inflammation or infection. And since the bile isn't entering the small intestine, the fat in the diet doesn't get broken down during digestion, and this can cause pain in the upper abdomen and back, as well as nausea and vomiting.
Biliary colic creates a sharp pain in the upper part of the abdomen that appears one to two hours after a meal that's high in fat. (Because dinner is usually the heaviest meal, the pain is more likely to occur at night.) The pain can last from a few minutes to several hours.
Some people also have pain between the shoulder blades or underneath the right shoulder. In addition to pain and nausea, biliary colic can cause gas, abdominal bloating, sweating, chills, or fever.
How does pregnancy affect the gallbladder?
Pregnancy hormones, particularly progesterone, cause muscular tissue throughout the body to relax, and this affects the gallbladder as well. The release of bile slows, and bile that doesn't get released can lead to the development of gallstones. Pregnant women who already have gallstones run a higher risk that these stones will block the release of the bile.
The problem in detecting the beginning of gallbladder disease during pregnancy is that the symptoms may be confused with morning sickness. However, if symptoms persist beyond the first trimester, or if you or your doctor suspects gallbladder-related problems, your doctor will likely recommend an ultrasound. Ultrasound is the most effective way to diagnose a gallbladder condition.
Of course, if you've had gallbladder problems before, let your doctor know so he can monitor you during pregnancy and prevent the disease from getting worse.
Am I at risk for gallbladder disease?
Women are far more likely to develop gallbladder disease than men are. You're more likely to develop gallbladder disease if you have a family history of the disease, are overweight (even if only moderately), have a high fat or high cholesterol diet, have diabetes, or are of Mexican or Native American origin.
Gallbladder disease used to be known as an older woman's affliction. But with more obesity among younger women, more younger women are being diagnosed with gallbladder disease.
Symptoms of gallbladder disease are more common in the third trimester or after delivery, but those at higher risk can develop the symptoms earlier in pregnancy.
Will gallbladder disease affect my baby?
Deposits or stones have no direct effect on your baby. However, your baby could be affected by the consequences of the disease. For instance, if you develop an infection, inflammation, or nausea and vomiting, these conditions can hinder your ability to nourish yourself and pass along adequate nutrition to your developing baby.
How is gallbladder disease treated during pregnancy?
In general, the goal of treatment during pregnancy is to reduce the symptoms and complications, and then treat the disease itself after pregnancy.
The first step in treating an inflamed gallbladder is to change your diet and eat fewer fatty foods. This means that the gallbladder will have to work less. For many women this step alone may be enough to relieve the symptoms. Regular exercise can also be helpful.
If your doctor prescribes a drug for a gallbladder problem and it doesn't provide adequate relief, he'll evaluate the effects of the disease and the risks of surgery. Given the risks, any surgery during pregnancy is generally avoided. But if the inflammation is severe, if there's an infection, or if the colic is acute, an operation may be necessary to prevent more serious complications.
If you need gallbladder surgery, it will probably be done laparoscopically. The surgeon makes two small abdominal incisions, inserting surgical instruments and a laparoscope. The laparoscope has a tiny camera that transmits a picture of the organs to a video monitor.
The gallbladder can then be removed without having to create a large incision. This means less pain and an easier recovery.
Can I develop gallbladder problems after pregnancy?
It's not uncommon for gallbladder disease symptoms to appear two to four months after delivery. This may be because pregnancy hormones aggravated the problem during the preceding nine months. Changes in your hormone levels after delivery may also be the culprit.
Gallbladder problems may also result from rapid weight loss after delivery. When you burn fat quickly, extra cholesterol accumulates in the bile, which can lead to gallstones.
To reduce your risk of developing gallstones after pregnancy, eat a high-fiber diet that includes plenty of fruit, vegetables, and whole grains. Try to keep your postpartum weight loss to no more than 2 pounds a week. And get plenty of exercise.
If you had gallbladder disease that was controlled during pregnancy and no surgery was required, it's important to have a follow-up evaluation. Symptoms can occur in the postpartum period or later in life, so have an evaluation when you're not in pain. Your doctor may recommend that you have the gallbladder removed to avoid an emergency situation later.