Pain After Gallbladder Surgery: What Is Normal and What Is Not

Some pain after gallbladder surgery is normal: soreness around the incisions, a deeper ache inside the belly and gas pain in the belly or shoulder are usually worst in the first two to three days and fade over one to two weeks after keyhole surgery. Pain that builds instead of easing, or comes with fever, vomiting or yellowing skin, is not normal and is a reason to call your surgeon.

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Most people have some pain after gallbladder surgery, and how much varies a great deal. Some find the first week easier than they feared; others find it harder than their gallbladder attacks.

The more useful question is which way the pain is heading. This guide covers normal pain, the signs that are not normal, pain medicine and pain that lingers.

What Pain After Gallbladder Surgery Is Normal?

Normal pain after keyhole gallbladder surgery is soreness around the incisions, a deeper ache inside the abdomen and pain from leftover surgical gas [1, 2]. Pain overall is most intense in the first two to three days [3]. In a Danish study of 150 people followed through the first week, incision pain was the most common and the strongest, followed by deep abdominal pain and then shoulder pain, with large differences between individuals [1]. By day 4, most people report no severe pain, and pain from the incisions is usually gone in 7 to 10 days [4].

Normal pain	When it is usually worst	When it usually eases
Soreness at the incisions	Days 1 to 3	Mostly gone in 7 to 10 days
A deep ache inside the belly	The first days	Over the first week or so
Shoulder pain from surgical gas	The first day or two	Several days to a week
Gas pain in the belly	The first few days	Several days to a week

Gas pain should ease over several days to a week [2, 5]. A sore throat from the breathing tube and some nausea are expected in the first days too [2]. Constipation, a common short-term side effect of pain medicine [5], can add discomfort of its own, but sudden constipation with cramps and no gas or stool passing needs a call to your provider right away [6].

What makes all of this normal is the direction. Each day should feel a little better than the one before. Our gallbladder removal recovery guide covers the rest of the week.

What Pain After Gallbladder Surgery Is Not Normal?

Pain that gets worse instead of better, pain your medicine does not touch, and pain with fever, vomiting or yellowing of the skin are not normal after gallbladder surgery and are reasons to call your surgeon promptly [4, 5, 2]. Changes at an incision belong on that list too: swelling, redness that spreads beyond the edge of the incision, warmth, discoloration, bleeding, or discharge that is thick, smelly or increasing are reasons to call, not signs to wait out [5, 4, 2].

Not normal	When it tends to appear	What to do
Pain that eased, then builds again	Any time in the first weeks	Call your surgeon
Fever over 101°F, or chills	Any time in the first weeks	Call your surgeon
Swelling, spreading redness, warmth or thick or smelly discharge at an incision	The first weeks	Call your surgeon
Vomiting that will not stop, or being unable to eat or drink	Any time	Call your surgeon
Yellow skin or eyes, dark urine, or gray or pale stools	Days to years after surgery	Call your surgeon or doctor
Pain not helped by your pain medicine	Any time	Call your surgeon
No bowel movement two to three days after surgery	The first week	Call your surgeon
A bulge at an incision that grows when you strain	Usually months later	Book a visit with your surgeon

A bile leak affects about 0.5 percent of people after keyhole gallbladder surgery [7], and a leak or duct injury can show up from about a week to six months after the operation with fever, pain, jaundice or bile leaking from an incision [4]. Bile duct stones can cause pain with fever or jaundice from days to years later [8, 9]. A hernia at an incision usually appears months after surgery, most often at the belly button [10], and one that turns painful, cannot be pushed back, changes color or comes with vomiting or fever needs care right away [11]. Our guide to complications after gallbladder removal has more.

When Should You Go to the Emergency Room?

Call 911 or go to the emergency room for chest pain, sudden trouble breathing, a fast or irregular heartbeat, coughing up blood or fainting, because after surgery these can be signs of a blood clot in the lungs [12]. Swelling, pain, warmth or redness in one leg can be a clot there and needs a doctor as soon as possible [12].

How Long Does Pain Last After Gallbladder Surgery?

After keyhole surgery, pain is usually most intense for two to three days [3], incision pain is mostly gone within 7 to 10 days, and most people take one to three weeks to return comfortably to normal activity [4].

How long does shoulder pain last after gallbladder surgery?

Days, for most people: in one study of 100, 62 had shoulder pain in the first 12 hours after surgery, and 9 still had it on the tenth day [13]. It comes from the carbon dioxide used to inflate the abdomen, which irritates the diaphragm and is felt in the shoulder [14]. Walking is one of the non-medicine ways to ease pain [4], and many people also use a heating pad.

Shoulder pain is different when it comes with chest pain, shortness of breath, light-headedness or pain in the jaw, neck or arms, because those can be signs of a heart attack and need 911 [15].

Laparoscopic vs open surgery: does recovery pain differ?

Yes. Recovery from open surgery takes about four to eight weeks rather than one to two [5, 16]. In randomized trials, people who had keyhole surgery left the hospital about three days sooner and returned to normal activity about three weeks sooner than those who had open surgery [17].

Where Does Pain After Gallbladder Removal Usually Show Up?

1. Right side

A deep ache inside the abdomen is common in the first week; in one study, this deep abdominal pain was the second most common kind after incision pain [1]. Weeks or months later, pain in the upper right or upper middle abdomen that comes in episodes of 30 minutes or more is more typical of a bile duct problem such as a stone [18, 9], and worth having checked.

2. Left side

Pain on the left side is less typical of the bile ducts, whose pain tends to be felt on the right or in the middle [18]. Early on, many people find that trapped gas, constipation from pain medicine [5] or a strained muscle explains it.

3. Back pain

Pain from the bile ducts can spread to the back or under the right shoulder blade [18, 9]. Back pain on its own, with no pain in the upper belly, does not fit the usual pattern of bile duct pain [18].

4. Joint pain

Joint pain is not a recognized effect of gallbladder removal. One hospital study in China found that people with knee osteoarthritis had more often had their gallbladder removed [19], while a small study of women over 40 found past gallbladder removal unrelated to arthritis spreading to new joints [20]. A link like that does not show cause, and both conditions are more common with age and extra weight. New joint pain with swelling, redness or fever deserves its own check.

What Can I Take for Pain After Gallbladder Surgery?

The American College of Surgeons says pain after gallbladder surgery can be controlled with acetaminophen and ibuprofen, taken as your surgeon advises, alongside ice, a pillow held against the belly and walking, and that an opioid may be needed for severe pain that keeps you from moving and sleeping [4]. European anesthesia recommendations likewise advise acetaminophen with an anti-inflammatory around the time of keyhole surgery, unless one is unsuitable, with opioids as a backup [21].

1. Acetaminophen (Tylenol)

When pain is hard to ignore, the American College of Surgeons suggests taking non-opioid medicine on a regular schedule [4]. The acetaminophen label warns that severe liver damage may occur above 4,000 mg in 24 hours, with other medicines containing acetaminophen, or with three or more alcoholic drinks a day, and says to ask a doctor first if you have liver disease; Extra Strength directions allow no more than 6 caplets (3,000 mg) in 24 hours unless a doctor says otherwise [22]. Some prescription pain pills also contain acetaminophen [23], and one such label notes that most cases of liver injury involved more than 4,000 mg a day, often from more than one acetaminophen-containing product [24].

2. Ibuprofen and other NSAIDs

Anti-inflammatories such as ibuprofen and naproxen ease pain and swelling [4]. The ibuprofen label warns that stomach bleeding is more likely if you are 60 or older, have had ulcers, take a blood thinner, a steroid or another NSAID, or have three or more drinks a day, and that NSAIDs raise the risk of heart attack and stroke [25]. It says to ask a doctor first if you have high blood pressure, heart disease, liver cirrhosis, kidney disease or past stomach problems [25].

3. Opioids for the first few days

If you are given an opioid, the American College of Surgeons advises taking it for a few days and cutting back or stopping as soon as you can [4]. Opioid labels warn that combining them with alcohol or other sedating medicines can cause extreme drowsiness and slowed breathing that can be fatal [24, 26, 27]. The Percocet label also cautions against driving until you know how the medicine affects you and warns of constipation [24, 28]. Take unused pills to a drug take-back site; the Percocet label says to flush them if no take-back option is readily available [24].

Why Do I Still Have Pain After Gallbladder Removal?

Most people do not: in a Dutch study of 820 people, biliary colic had resolved in about 95 percent six months after surgery [29]. When the same Danish team followed 150 patients for a year, 132 had no chronic pain, and of the 16 with moderate or severe pain who were examined, 8 had a cause that could be found [30]. Another study found unexplained pain at 12 months in 9 of the 100 people enrolled, more often after a lot of deep abdominal pain in the first week [31].

Some lasting pain may never have come from the gallbladder. In a large trial of people with gallstones and abdominal pain, about 63 percent of those who had surgery were pain-free five years later [32]. Doctors often use the label post-cholecystectomy syndrome while they look for the specific cause [33], and the common causes are:

• a stone left in, or newly formed in, the bile duct [8]
• a sphincter of Oddi problem, where the muscle at the end of the bile duct does not relax properly [18]
• a hernia at an incision [10]
• reflux, a stomach ulcer, irritable bowel syndrome or pancreatitis [33], and bile reflux in particular [34]

Pain fixed in one small spot of the belly wall can also come from the abdominal wall itself, from a trapped nerve or from a small scar, including a keyhole scar, and it is often mistaken for a functional complaint [35]. A procedure to cut the sphincter is no longer offered to people whose tests are normal, after a trial found it no better than a sham [36, 18]. To find the cause, doctors usually start with blood tests and an ultrasound, then MRCP or an endoscopic ultrasound if those point to the bile ducts [33, 37]. See also gallstones without a gallbladder, bile reflux, elevated liver enzymes and our questions to ask your doctor.

What About Digestion Once the Pain Has Settled?

Fats and heavier meals tend to be harder for the first month or so [5], and less bile is on hand at the start of a fatty meal without a gallbladder [38]. Smaller, more frequent meals are the usual first step [39], and our guides to diet after gallbladder removal and bloating after gallbladder surgery go further.

For heaviness after richer meals, some people add bile support. Dr.Primal's TUDCA is made for life after gallbladder removal and taken with meals, when your body calls on bile the most. It is a hydrophilic, or water-loving, bile acid that occurs naturally in small amounts in human bile [40], used to support healthy bile flow and fat digestion.

In Summary: Pain After Gallbladder Surgery

Pain after keyhole gallbladder surgery is normal in the first days: incision soreness, a deep ache inside the belly and shoulder gas pain are most intense over two to three days and mostly fade within one to two weeks, while open surgery takes four to eight weeks. Pain that builds, fever over 101°F, vomiting, yellowing skin and swelling or discharge at an incision are reasons to call your surgeon.

Pain that lasts for months is uncommon, and worth checking for a cause. Our guide to the side effects of gallbladder removal gives the wider view. If your digestion still feels unsettled once you have healed, our short digestion quiz is a quick way to put your symptoms and habits in order, so you know what to focus on next.

This article is for general education and is not a substitute for advice from your doctor. TUDCA is sold as a dietary supplement. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.