Pigment stones can be black or brown and often form in the gallbladders of people with hemolytic anemia or cirrhosis. Patients may also have a mixture of pigment and cholesterol gallstones. On average, symptoms take about eight years to develop. The reason for the decline in incidence after ten years is not known, although some physicians suggest that younger, smaller stones may be more likely to cause symptoms than larger ones. Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating, often waking the patient during the night.
Biliary colic produces a steady pain, which can be quite severe.
The patient may have a fever and experience nausea or vomiting. Biliary colic typically disappears after one to five hours. The pain begins abruptly. Severe pain and tenderness in the upper right abdomen are the most common complaints. The discomfort is intense and steady and can last for up to days.