A gallstone passing through the bile duct typically causes pain lasting 20 minutes to a few hours per episode. The total time from when a stone leaves the gallbladder to when it reaches the small intestine varies widely, from hours to weeks, depending on the stone’s size and whether it gets stuck along the way. About 73 percent of stones that enter the common bile duct will pass on their own without complications.
What Happens When a Gallstone Passes
Gallstones form inside the gallbladder, a small organ tucked beneath the liver that stores bile. Most gallstones sit quietly in the gallbladder and never cause problems. The trouble starts when a stone slips out of the gallbladder and into the cystic duct, the narrow tube that connects the gallbladder to the common bile duct. From there, the stone needs to travel through the common bile duct and out through a tiny muscular valve at the entrance to the small intestine.
The common bile duct is only about 6 to 8 millimeters wide in most people, roughly the diameter of a pencil. That means stones smaller than about 5 millimeters have the best chance of passing through without getting lodged. Larger stones can wedge into the duct and block the flow of bile entirely, which creates a more serious situation that often requires medical intervention.
How Long the Pain Lasts
The pain caused by a gallstone moving through or temporarily blocking a bile duct is called biliary colic. A single episode lasts anywhere from 20 minutes to a few hours. The pain usually hits suddenly, often after a fatty meal, and settles in the upper right side of the abdomen or in the center just below the breastbone. It can radiate to the right shoulder blade or back.
What makes biliary colic distinct from other abdominal pain is its pattern. It builds to a steady, intense ache rather than coming in sharp waves. It doesn’t get better with changing position, antacids, or passing gas. Once the stone either passes through the narrowed area or falls back into a wider section of the duct, the pain fades. You might have a single episode, or you might have repeated episodes over days or weeks as the stone works its way through.
Factors That Affect Passage Time
Stone size is the biggest factor. Stones under 5 millimeters generally pass within hours to days. Stones between 5 and 8 millimeters may take longer and have a higher chance of getting stuck. Stones larger than 8 millimeters rarely pass on their own because they exceed the diameter of the bile duct.
The shape and composition of the stone matters too. Smooth, round stones move more easily than irregular or jagged ones. Cholesterol stones, which make up the majority of gallstones, tend to be smoother than pigment stones. The tone of the muscular valve at the end of the bile duct also plays a role. In some people, this valve opens more readily, allowing stones to pass with less resistance.
Age can indirectly affect things as well. The common bile duct tends to widen slightly with age, and people who have had their gallbladder removed often have a duct that dilates up to 10 millimeters. A wider duct gives stones more room to pass.
When Stones Get Stuck
A stone that lodges in the bile duct and doesn’t move creates a blockage. This is different from biliary colic, where the stone shifts and the pain resolves. A stuck stone causes persistent pain, and the backup of bile can lead to jaundice (yellowing of the skin and eyes), dark urine, and pale stools. If bile becomes infected behind the blockage, it can cause a serious infection called cholangitis, which brings fever, chills, and worsening pain.
A stone can also get stuck at the point where the bile duct and pancreatic duct share an opening into the small intestine. When this happens, it can block the pancreas from draining its digestive enzymes, triggering acute pancreatitis. This is one of the main reasons doctors take bile duct stones seriously even when they’re expected to pass.
What Happens if a Stone Won’t Pass
If a stone remains lodged in the bile duct, doctors can remove it using a procedure called ERCP. A flexible scope is passed through the mouth, down through the stomach, and into the small intestine, where the opening of the bile duct is widened to extract the stone. Recovery from this procedure is typically quick, with most people going home the same day or the next.
For stones still sitting in the gallbladder, the standard treatment is surgical removal of the gallbladder itself. This is one of the most common surgeries performed, and most people recover within a week or two. Removing the gallbladder eliminates the source of future stones rather than waiting for them to cause repeated problems.
What You Can Expect During an Episode
If you’re in the middle of passing a gallstone, the pain will typically peak within the first hour and then gradually ease over the next one to three hours. Nausea and sometimes vomiting are common during the worst of it. You might find that lying still is more comfortable than moving around. Over-the-counter pain relief and a heating pad can help take the edge off during a mild episode.
If the pain lasts more than five or six hours without any sign of letting up, that suggests the stone is stuck rather than passing. Fever, persistent vomiting, or yellowing skin alongside the pain are signs the situation has moved beyond simple biliary colic. These warrant prompt medical evaluation because a blocked bile duct can escalate quickly from painful to dangerous.
After a stone passes successfully, you may feel sore for a day or two, but the intense pain resolves. Keep in mind that having one episode of biliary colic means there are likely more stones in the gallbladder. About two-thirds of people who have a first episode will have another within two years, which is why surgery is often recommended even after a stone passes without complications.