Gallstones and Diarrhea in Pregnancy
Gallstones do not cause diarrhea in pregnant women. The typical presentations of gallstone disease in pregnancy are biliary colic (episodic right upper quadrant pain), acute cholecystitis, pancreatitis, or cholangitis—none of which include diarrhea as a characteristic symptom 1, 2.
Classic Presentations of Gallstone Disease in Pregnancy
The symptoms you should expect from gallstones are:
- Biliary colic: Episodic, colicky right upper quadrant or epigastric pain that radiates to the back or right shoulder, typically triggered by high-fat meals 1
- Acute cholecystitis: Persistent right upper quadrant pain with fever and signs of systemic inflammation 1
- Gallstone pancreatitis: Severe epigastric pain radiating to the back with nausea and vomiting 1
- Cholangitis: Right upper quadrant pain with fever and jaundice (Charcot's triad) 1
Why This Matters Clinically
If a pregnant patient presents with diarrhea, you should look elsewhere for the cause rather than attributing it to known gallstones. The differential diagnosis for diarrhea in pregnancy is broad and includes:
- Hyperemesis gravidarum (which can affect 0.3%–2% of pregnant persons and may present with gastrointestinal symptoms, though typically nausea and vomiting rather than diarrhea) 3
- Infectious gastroenteritis
- Dietary intolerances
- Inflammatory bowel disease
- Other pregnancy-related gastrointestinal conditions
Important Diagnostic Pitfall
Do not be misled by the presence of gallstones on imaging when evaluating diarrhea. Gallstones are extremely common in pregnancy, occurring in up to 10% of pregnancies overall 1, and biliary sludge develops in up to 30% of pregnant women 4. The coexistence of gallstones and diarrhea is likely coincidental rather than causal.
When Gallstones Are Actually Symptomatic
Gallstone-related disease complicates only 0.5% to 0.8% of pregnancies despite the high prevalence of stones 1. When symptomatic, 60% of conservatively managed patients develop recurrent biliary symptoms requiring multiple hospitalizations 1, 2. These recurrent symptoms remain pain-focused, not diarrhea.
If your pregnant patient has both gallstones and diarrhea, investigate the diarrhea as a separate entity and manage the gallstones based on whether they are causing typical biliary symptoms (pain, fever, jaundice) rather than attributing gastrointestinal symptoms to the stones 1, 2.