If you’re living with sickle cell disease (SCD) and have suddenly started having abdominal pain, gallstones could be behind this new symptom. With SCD, though, abdominal pain can have more than one cause. It’s important to find out what’s causing it and get the appropriate medical care.

Even if you’ve had your pain dismissed or questioned by healthcare providers before, abdominal pain can have different causes and deserves careful evaluation. It may help to understand why gallstones are more common with SCD, what they can feel like, and when to call your doctor or seek emergency care.

🗳️ Do you typically experience abdominal pain during a sickle cell pain crisis?

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Why Are Gallstones More Common With SCD?

Normal red blood cells are flexible, round, and live for about 120 days. When they reach the end of their lifespan, they break down and produce bilirubin. Bilirubin is a yellow waste product processed by the liver.

In people with SCD, red blood cells contain an abnormal form of a protein called hemoglobin. This can cause the cells to lose their round shape and become rigid and sickle-shaped. These cells are also more fragile, so they break down faster than usual.

Sickled red blood cells typically live only 10 to 20 days.

This rapid breakdown of red blood cells, called hemolysis, causes the body to produce more bilirubin than usual. The liver processes this extra bilirubin and sends it into bile, which is stored in the gallbladder. When bilirubin builds up in bile, the excess can contribute to the formation of pigment gallstones.

Because people with SCD experience chronic hemolysis, gallstones may develop earlier than they do in people without SCD. Gallstones can sometimes develop during early childhood, and the risk increases with age.

If you have SCD, talk with your healthcare provider about your risk of forming gallstones.

Signs and Symptoms of Gallstones

If they don’t cause symptoms, you can have gallstones for years without knowing they’re there. Doctors call these asymptomatic or “silent” gallstones.

When a gallstone moves into or blocks a duct leading from the gallbladder, it can cause symptoms. Symptoms may come and go or persist and can include:

• Sudden, severe pain in the upper right or center of your abdomen
• Pain that spreads to your back, arm, chest, or right shoulder (referred pain may be more common in females, according to Cleveland Clinic)
• Nausea or vomiting

Gallstone pain may be constant, may occur after eating a fatty meal, and may continue for several hours, making it hard to go about your daily activities.

Because gallstone pain can resemble pain from a sickle cell pain crisis or other medical conditions, it can be difficult to know what’s causing it.

If you have new or unusual abdominal pain, contact your healthcare provider, especially if the pain persists or gets worse.

Gallstones vs. Pain Crisis

Because a sickle cell pain crisis and a gallbladder problem can both cause severe abdominal pain, it isn’t always easy to tell them apart.

The table below highlights some differences that may help you recognize what you’re experiencing.

Even if you think you can tell what’s causing your pain, talk with your healthcare provider for an assessment and proper diagnosis.

How Are Gallstones Diagnosed?

A healthcare provider may start by asking where the pain is, when it started, what seems to bring it on, and whether you have a history of “silent” gallstones.

They may also press gently under your right ribcage while you breathe in to check for tenderness. Pain during this test, known as Murphy’s sign, can point to inflammation of the gallbladder.

They’ll also check your skin and eyes for signs of increased jaundice (yellowing of the skin or whites of the eyes), which can indicate a problem with bile flow. On brown or black skin, this yellowing can be harder to see. Red blood cell breakdown can also increase bilirubin, so you may have yellowing of the eyes without gallstones or notice that the yellowing increases during a pain crisis.

Your healthcare provider may then order blood tests to look for signs of inflammation, infection, or problems affecting your liver or bile ducts. They will also check your bilirubin level and compare it with your usual level.

Imaging tests can help your healthcare provider check your gallbladder and bile ducts. An abdominal ultrasound is often the first imaging test used to check for gallstones.

If an ultrasound doesn’t give a clear answer and your symptoms continue, your healthcare provider may order other tests, such as:

• Magnetic resonance cholangiopancreatography (MRCP) — An MRI scan that creates detailed images of the bile and pancreatic ducts to look for stones
• Endoscopic retrograde cholangiopancreatography (ERCP) — A procedure that can find and remove stones from your bile ducts

If your symptoms and test results suggest gallstones, your healthcare provider can explain what this means to you and whether you need treatment.

Treatment for Gallstones

When gallstones need treatment, surgery to remove the gallbladder is common. Because stones often recur if the gallbladder remains, removing it is the most dependable long-term treatment.

Surgery to remove the gallbladder is called a cholecystectomy. Most gallbladder removals are performed using laparoscopic cholecystectomy, a minimally invasive procedure that uses small incisions and a camera to remove the gallbladder. ERCP can be used to remove stones from the bile ducts, but it does not remove the gallbladder.

Your healthcare provider may also prescribe antibiotics if a bacterial infection is present.

If treatment is needed, surgery isn’t always the only option. Medications can sometimes dissolve gallstones, but they aren’t commonly used and typically work only for smaller cholesterol stones without complications. They may take months to years to work.

If you have gallstones and SCD, your healthcare provider can help you decide which treatment option is right for you and work with your sickle cell care team to plan your care.

Do Gallstones Always Need Treatment?

Not always. If gallstones aren’t causing symptoms or complications, your healthcare provider may recommend monitoring them rather than treating them right away.

Whether you or someone you care for needs treatment can depend on:

• Pain and other symptoms
• A blocked bile duct caused by a gallstone
• Complications, such as an infection or inflammation of the gallbladder

In some children with SCD, though, a healthcare provider may consider gallbladder removal even without symptoms to help prevent future complications.

When Should You Get Medical Care for Gallstone Symptoms?

Contact your healthcare provider if you have new or worsening abdominal pain. Seek prompt medical care for severe pain.

Seek medical care right away if you also experience:

• Worsening jaundice
• Clay-colored stools (pale gray or white stools)
• Vomiting that doesn’t stop
• Fever or chills, with or without sweating

These symptoms can mean a gallstone is blocking a bile duct or causing an infection.

If symptoms feel different from your usual sickle cell symptoms or pain, or they’re getting worse, your healthcare provider can determine what’s going on and what type of treatment (if any) is needed.