Batu hempedu (gallstones) are small, hard stones that form in the gallbladder (pundi hempedu). They are common, especially in women and people over 40, and most people who have them never get symptoms. If a stone blocks a bile duct, it can cause severe pain in the upper right or middle of the tummy that lasts more than 30 minutes, often after a heavy meal. Gallstones without symptoms usually need no treatment; if they cause pain or complications, the main treatment is keyhole surgery to remove the gallbladder, and most people live normally without it. A healthy, varied diet, regular meals and steady weight loss can help lower the risk. This guide explains the signs, causes, tests, treatment and what to eat.
Apa itu batu hempedu?
Gallstones are hard, pebble-like pieces of material, usually made of cholesterol or bilirubin (a pigment in bile), that form in your gallbladder (NIDDK). They can range from the size of a grain of sand to a golf ball, and you can have one large stone, hundreds of tiny ones, or both (NIDDK). Doctors sometimes call gallstones cholelithiasis.
In Malay, hempedu means bile, and the gallbladder is called pundi hempedu, although many people simply say "hempedu". The gallbladder is a small, pear-shaped organ in the upper right part of your tummy, below the liver. Your liver makes bile, the gallbladder stores it, and when you eat, the gallbladder squeezes bile into the gut to help digest fat (NIDDK).
There are 2 main types of gallstones (MedlinePlus):
- cholesterol stones, the most common type. MedlinePlus notes that they are not related to the cholesterol level in your blood; for blood cholesterol, see our guide to kolesterol tinggi;
- pigment stones, made of bilirubin, which can happen when too many red blood cells are broken down.
Gallstones are different from kidney stones, which form in the urinary system. See our guide to batu karang for a side-by-side comparison.
Tanda dan simptom batu dalam hempedu
The NHS says gallstones are common and often do not cause symptoms. These "silent" gallstones are often found by chance during a scan for another health issue, and they usually do not need treatment (NIDDK, NHS).
If a gallstone blocks a bile duct (a small tube that connects the gallbladder to the liver and other organs), it can cause tummy pain called biliary colic, or a gallbladder attack. The NHS says the pain may:
- feel severe and be constant;
- last longer than 30 minutes, and up to several hours;
- be in the middle of your tummy, or just under your ribs on the right side;
- make you feel sick or vomit.
NIDDK says gallbladder attacks often follow heavy meals and usually happen in the evening or during the night. The pain usually stops when the stone moves and no longer blocks the duct, but if you have had one attack, more attacks are likely.
Gallstone symptoms can be similar to other conditions, such as appendicitis, stomach ulcers, pancreatitis and acid reflux, which should also be checked by a doctor (NIDDK). Pain under the ribs can also come from the stomach; see our guide to gastrik.
When to get urgent help
The NHS advises seeing a doctor urgently if you have pain in your tummy that lasts longer than 30 minutes.
Call 999 or go to the emergency department (NHS) if:
- you have sudden, severe pain in your tummy;
- you have pain that spreads from your tummy to your back, and are being sick;
- your temperature is very high, or you feel hot, cold or shivery;
- your skin or the whites of your eyes look yellow (jaundice).
NIDDK also lists tea-coloured pee and light-coloured poo as warning signs during or after a gallbladder attack. These can be signs of a serious infection or inflammation of the gallbladder, liver or pancreas.
One complication is acute cholecystitis, inflammation of the gallbladder. The NHS says its main symptom is a sudden, sharp pain in the upper right side of the tummy that spreads towards the right shoulder, does not go away within a few hours and may be worse when you breathe deeply. It usually needs treatment in hospital. Right shoulder pain has many other causes too; see our guide to sakit bahu dan leher.
Punca batu dalam hempedu and who is at risk
NIDDK says gallstones may form if bile contains too much cholesterol, too much bilirubin or not enough bile salts, or if the gallbladder does not empty completely or often enough. Researchers do not fully understand why these changes happen. You may be more likely to get gallstones if:
| Risk factor | What the sources say |
|---|---|
| Being a woman | Women are more likely to get gallstones than men; extra oestrogen from pregnancy, hormone replacement therapy or birth control pills may raise the risk (NIDDK). |
| Age over 40 | The chance of gallstones rises as you get older (NHS, NIDDK). |
| Obesity | Especially in women (NIDDK). |
| Losing weight quickly | For example after weight loss surgery or a very low-calorie diet (NHS, MedlinePlus). For safer approaches, see our guide to weight loss. |
| Diet | A diet high in fat, calories and refined carbohydrates and low in fibre (NHS, NIDDK). |
| Health conditions | Diabetes and insulin resistance, metabolic syndrome, high triglycerides, low HDL cholesterol, Crohn's disease, cirrhosis and conditions where red blood cells are broken down (NIDDK). |
| Family history | People with a family history of gallstones have a higher risk (NIDDK). |
Fatty liver shares several of these risk factors, such as obesity and diabetes; see our guide to hati berlemak.
Batu hempedu in women and in Malaysia
Because women are more likely to get gallstones, this condition matters for many Malaysian women. MedlinePlus says the gallbladder is more likely to have trouble emptying bile properly during pregnancy, and the Cambridge University Hospitals dietitians list pregnancy among the things that increase the risk. If you are pregnant and have pain under your right ribs, see a doctor; for early pregnancy signs, see our guide to tanda-tanda mengandung.
Malaysian studies also show differences between women and men:
- A Malaysian study of 213 people whose gallstones were found without symptoms (data from a government hospital and two private clinics) found that 10.8% developed pain over an average of about 4 years. Women were about 3 times more likely than men to go on to have symptoms, and the estimated lifetime risk was about 22% for women and 6% for men.
- An older study of 133 people with acute pancreatitis at a Malaysian hospital (1994 to 1999) found that gallstones were the most common identified cause in Malay and Chinese patients, and that gallstone pancreatitis was mainly seen in women.
If you have been told you have gallstones but have no symptoms, ask your doctor what signs to watch for and whether you need follow-up.
How gallstones are diagnosed
A doctor will ask about your symptoms, your health and family history, and examine your tummy (NIDDK). Tests may include (NHS, NIDDK, MedlinePlus):
- an ultrasound scan of the tummy, which NIDDK says is the best imaging test for finding gallstones;
- blood tests, such as liver function tests, a full blood count and pancreatic enzymes, to look for infection, inflammation or blockage;
- a CT or MRI scan (MRCP), which can show stones in the bile ducts or complications;
- a HIDA scan (cholescintigraphy), to check how the gallbladder empties or whether a duct is blocked;
- ERCP, a camera test passed through the mouth, used mainly to remove a stone stuck in the common bile duct.
Rawatan batu dalam hempedu
The NHS says you might not need any treatment if your gallstones are not causing symptoms, although you may need follow-up appointments. You may need treatment if:
- you have symptoms of gallstones;
- you have complications from gallstones;
- gallstones are found in the common bile duct.
| Treatment | What it involves |
|---|---|
| Gallbladder removal (cholecystectomy) | The main treatment for gallstones that cause problems (NHS). Most people have keyhole (laparoscopic) surgery. |
| ERCP | Used to clear stones from the common bile duct; the opening of the duct is widened so the stones can pass (NHS). |
| Painkillers while waiting for surgery | Such as paracetamol and ibuprofen, with stronger painkillers for severe pain if needed (NHS). |
| Medicines to dissolve stones | Bile acid medicines such as ursodiol can dissolve small cholesterol stones, but may take 2 years or longer and stones may come back (MedlinePlus). NIDDK says non-surgical treatments are used only in special situations, such as when a serious medical condition prevents surgery. |
| Shock wave lithotripsy | Breaks stones into small pieces; used rarely because gallstones often come back (NIDDK, MedlinePlus). |
NIDDK says that if you have a gallbladder attack, contact your doctor even if the pain goes away, because the symptoms may come back. Ask your doctor before trying any remedy that claims to flush out or dissolve gallstones.
Buang hempedu: surgery and recovery
The NHS says gallbladder removal is a common and safe procedure, often recommended if gallstones cause problems such as severe or frequent tummy pain. NIDDK says the gallbladder is not an essential organ, so you can live normally without it. After it is removed, bile flows directly from the liver into the gut instead of being stored.
The operation. It is done under general anaesthetic and usually takes about 1 hour (NHS). Most people have keyhole surgery through a few small cuts. Open surgery, with one larger cut, is used if the gallbladder is very inflamed or keyhole surgery is not possible; recovery takes longer (NHS, NIDDK).
Recovery. The NHS says you can usually go home on the same day, although some people stay overnight. It advises having someone stay with you for the first 24 hours, taking painkillers, eating a normal healthy diet (small meals may be easier at first), building up activity gradually and not driving until you can do an emergency stop without pain. Many people return to work 1 to 2 weeks after surgery, depending on their job.
Kesan buang hempedu (after-effects). Some people have feeling sick, indigestion, tummy pain or diarrhoea after the operation, sometimes called post-cholecystectomy syndrome; the NHS says these usually improve soon, but contact your doctor if they continue. NIDDK says changes in bowel habits are usually temporary. Serious complications are rare, but the NHS advises asking for an urgent appointment if you have severe or worsening pain, pus or redness around your wounds, yellow skin or eyes, leg swelling or pain, or a very high temperature.
Makanan untuk pesakit batu hempedu
There is no single "gallstone diet", but these tips come from NIDDK and the dietitians at Cambridge University Hospitals (an NHS hospital trust):
- eat a healthy, varied diet, with plenty of fruit and vegetables, wholegrains such as brown rice and oats, beans and peas, and protein such as fish, eggs, tofu and lean meat;
- choose unsaturated oils, such as vegetable or olive oil, in small amounts; NIDDK says healthy fats help your gallbladder contract and empty regularly;
- limit deep-fried foods, fried snacks, pastries and pies, refined carbohydrates and sugar;
- eat regular meals, including breakfast; the Cambridge dietitians say missing meals and fasting reduce gallbladder emptying, which increases the risk of stones forming or getting bigger;
- if large meals cause discomfort, try smaller, more frequent meals;
- try steaming, boiling or grilling instead of frying, and remove the skin and visible fat from meat and poultry;
- if particular foods trigger your symptoms, you could try avoiding them to see if it helps.
Is a low-fat diet needed? The NHS says you may be advised to eat a low-fat diet while waiting for surgery. However, the Cambridge dietitians say a low-fat diet does not help everyone and there is little evidence for it, and cutting out fat can lead to rapid weight loss or nutritional deficiencies. They recommend moderate amounts of fat as part of a balanced diet. After gallbladder removal, they say you do not need to follow a low-fat diet.
Weight loss. If you are overweight, gradual weight loss can lower your risk of gallstones, but the Cambridge dietitians advise against losing more than about 1 kg (2 lb) a week or yo-yo dieting, which may increase the risk. They also recommend 150 minutes of moderate activity a week. Talk to your doctor before making big changes to your diet (NIDDK).
Frequently asked questions (FAQ)
Apa itu batu hempedu (what are gallstones)?
Gallstones (batu hempedu or batu dalam hempedu) are hard, pebble-like pieces, usually made of cholesterol or bilirubin, that form in the gallbladder (pundi hempedu), a small pear-shaped organ under the liver that stores bile. They can be as small as a grain of sand or as large as a golf ball. Gallstones are common, and most people who have them do not get symptoms.
Apa tanda batu dalam hempedu (what are the symptoms of gallstones)?
Most gallstones cause no symptoms. If a stone blocks a bile duct, it can cause sudden, severe and constant pain in the middle of the tummy or just under the ribs on the right side, lasting longer than 30 minutes and up to several hours, and it may make you feel sick or vomit. These attacks often follow heavy meals and usually happen in the evening or at night. Get urgent help if you also have a fever or chills, yellow skin or eyes, or tea-coloured pee and pale poo.
Apa punca batu dalam hempedu (what causes gallstones)?
Gallstones may form if bile contains too much cholesterol, too much bilirubin or not enough bile salts, or if the gallbladder does not empty completely or often enough. You are more likely to get them if you are a woman, over 40, living with obesity, have lost weight quickly, eat a diet high in fat or refined carbohydrates and low in fibre, have diabetes, are pregnant or take hormone medicines such as birth control pills, or have a family history of gallstones.
Perlukah buang hempedu jika ada batu (do gallstones always need surgery)?
No. Gallstones that do not cause symptoms usually do not need treatment. If they cause pain or complications, or are found in the common bile duct, the main treatment is surgery to remove the gallbladder (cholecystectomy), usually by keyhole surgery. You can live normally without a gallbladder. Talk to your doctor about what is right for you.
Apa makanan untuk pesakit batu hempedu (what should I eat if I have gallstones)?
A healthy, varied diet is recommended: plenty of fruit and vegetables, wholegrains, beans, fish and other lean protein, and small amounts of unsaturated oils. Limit deep-fried foods, fried snacks, pastries and sugary foods, eat regular meals including breakfast, and try smaller meals if large meals cause discomfort. A low-fat diet may help some people while waiting for surgery, but cutting out all fat is not recommended.
Apa kesan buang hempedu (what happens after gallbladder removal)?
Most people recover well. You can often go home on the same day, and many people return to work in 1 to 2 weeks. Bile then flows straight from the liver into the gut. Some people have nausea, indigestion, tummy pain or diarrhoea afterwards; these usually improve soon, but tell your doctor if they continue. You do not need a special low-fat diet after the operation.
Bolehkah batu hempedu hilang tanpa pembedahan (can gallstones go away without surgery)?
Pain from a gallstone attack often stops when the stone moves, but the stones usually stay, and if you have had one attack, more attacks are likely. Medicines can slowly dissolve some small cholesterol stones, but this can take 2 years or longer and the stones may come back, so it is used only in special situations. Ask your doctor before trying any remedy that claims to flush out gallstones.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Gallstones — NHS
- Why gallbladder removal is done — NHS
- How gallbladder removal is done — NHS
- Recovering from gallbladder removal — NHS
- Complications of gallbladder removal — NHS
- Acute cholecystitis — NHS
- Definition and facts for gallstones — National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- Symptoms and causes of gallstones — NIDDK
- Diagnosis of gallstones — NIDDK
- Treatment for gallstones — NIDDK
- Eating, diet and nutrition for gallstones — NIDDK
- Gallstones — MedlinePlus Medical Encyclopedia, US National Library of Medicine
- Dietary advice for patients with gallstones — Cambridge University Hospitals NHS Foundation Trust
- Sood S, et al. Natural history of asymptomatic gallstones: differential behaviour in male and female subjects. Med J Malaysia. 2015;70(6):341-5
- Kandasami P, et al. Acute pancreatitis in a multi-ethnic population. Singapore Med J. 2002;43(6):284-8
