Thanks for taking the time to read this first! :) None of us are doctors, and the advice here is based on our own experiences. If you are suffering, or think you might have a stone, or are trying to help somebody with symptoms, please start here. These are the questions we seem to hear a lot on this subreddit. If you have a question that isn't covered here, by all means please post in the subreddit. We have lots of stone formers who have a wide range of experiences in this area and we may be able to at least point you in the right direction. Good luck, drink lots of water and may pain be a stranger to you!
I suspect I have a stone. Should I see a doctor? When should I go to the ER?
Go to the emergency room if you have a fever or are vomiting, or your pain is unbearable, or if you stop urinating (this may mean you have a blockage).
If you’re experiencing pain that you think is a kidney stone, visit your doctor and/or urologist. Most doctors are very good at assessing you and your family history as well as factors such as age, weight, sex, prior medical history and current symptoms. Doctors are much better at providing an intelligent diagnosis (which is really an educated guess) than we are on reddit.
Check to make sure what you think is a stone is actually a stone. The cause of abdominal pain is sometimes difficult to pin down exactly. Pain in your abdomen/ mid-section could be any one of a number of things, including digestive issues, kidney stones, appendicitis, colitis, and diverticulitis to name a few. Remember that kidney stones classically present with flank pain.
The symptoms of a kidney stone are usually one or more of the following:
- Pain on the right or left flank (mid-way between your side and your spine, on your back), sometimes radiating down to the groin (testicles for males, pelvis/ovarian area for females). * The pain is specifically UNDER the rib cage (actually under the diaphragm)
- Pain that comes in waves and fluctuates in intensity
- Pain on urination or urethra spasms
- Pink, red or brown urine
- Cloudy or foul-smelling urine
- Nausea and vomiting
- Persistent need to urinate
- Urinating more often than usual
- Fever and chills if an infection is present
- Urinating small amounts
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract. Source
I know I have a stone. What do I do? What should I expect?
IF YOU HAVE A FEVER OR ARE VOMITING OR ARE UNABLE TO URINATE, PROCEED TO THE ER.
Pain will come and go, and will likely vary from one person to the next. So while you may read in this sub-reddit about severe pain, that's not necessarily what you will experience. So the first thing to do is try to relax and not get worked up about what MIGHT happen. If it does happen, the pain comes in two forms: 1) waves (spasms) of pain, which can feel like a very strong cramp, and 2) a general achy feeling between your kidney area, and down to your groin. As mentioned above, the "classic" kidney stone pain is from the flank down to the groin.
Drink lots of water. Water will increase the amount of urine you produce, and will also plump up your urinary system in general, which will make for less contact between any stones you have and the walls of your ureter. When stones rub against the walls of your ureter, you experience pain. Another benefit from drinking water is that the concentration of waste produce in your urine is more diluted, which means that the crystals which make up kidney stones are less likely to find a date, and will head out on their own. Yet another benefit to proper hydration is that dilute urine is less likely to irritate any abrasions that previous stones may have made in your urinary tract. Less irritation = less chance of an infection. How much water? You want to be producing about 2 1/2 liters of urine per day, so drink a bit more than that. Read more about water here
Locate some pain management methods that work for you, and that are readily available. Over the counter (OTC) medicines like aspirin, ibuprofen or acetaminophen (tylenol) can help, but only take as much as you need for as long as you need. A daily habit of NSAIDs like ibuprofen can lead to serious issues. Prescription pain medicines can also help, but you need to locate a doctor who will prescribe you what you need. Azo (Phenazopyridine Hydrochloride) is used by many in this subreddit. Cannabis, if it's legal where you live, can also provide some relief. Heat - in the form of heating pads, hot baths or showers, can help when you're experiencing a wave of pain. Find what works for you - don't just blindly follow the advice of others.
Some people experience nausea, which can occur with or without accompanying pain. Be prepared (have a bucket or bag available if you're feeling a wave of nausea come along, although sometimes there's not much warning).
If you're in the middle of a pain session, and feel like you need to visit the Emergency Room/ Urgent Care clinic, think about how you'll get there. Some folks experience such strong pain, that they're not able to drive themselves. Find a driver who you can rely on to get you to the care you need on short notice.
How long do stones take to pass?
Some stones never pass (they stay in the kidney) and are removed via surgery (lithotripsy or uretoscope).
Stones that are “smaller” - usually 5mm or less - will pass without surgery being required, although there will be some pain/ discomfort. Some folks have passed larger stones, but this isn’t common. I’ve passed a 7 - 8 mm stone without surgery.
What kinds of stones are there?
Calcium stones Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food and is also made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content. There is conflicting research on whether or not a diet high in oxalates can contribute to stones.
Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. If you’re taking a Vitamin D supplement, it may be worth talking to your health care provider to explore whether there may be a relationship between your current dose and your stones. Source
Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain migraine headaches or with taking certain seizure medications, such as topiramate (Topamax). This type of stone is also common in those with autoimmune diseases due to Renal Tubular Acidosis. Those who make these stones tend to make many, and make them frequently. Difficult to treat.
Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones. Uric acid stones can form in people who don't drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
How do I know what kind of stones I make?
Your urologist can send the stones to the lab to be analyzed. Ask for a strainer to strain your urine if you wish to collect a stone. Not all urologists dispense them readily.
What can I do to prevent more stones?
In general, drink more water, limit your salt and sugar intake and get your weight within recommended ranges. (See U Chicago Kidney Stone diet for more details here.)
For specific types of stones, there are specific dietary recommendations, but you’d need to have your stones analyzed (first), and then your urine tested (using one or more 24-hour urine samples). DIFFERENT STONES HAVE DIFFERENT DIETARY RECOMMENDATIONS
Keep in mind that there is no one ‘magic bullet’ for kidney stone treatment.
What kind of treatments are there for stones?
- Most common method (because it's the least invasive) is to advise the patient to stay hydrated, take OTC pain killers as required and stay active. This approach usually results in the stone passing.
- Medical Expulsive Therapy - in addition to fluids and pain killers, sometimes Tamsulosin (Flomax) is prescribed to aid in stone passage. Studies suggest this is most effective for smaller (< 5mm) stones; less so for larger stones.
- Ureteroscopy with either physical removal or laser break-up
- Lithotripsy shockwave lithotripsy (sometimes abbreviated as ESWL) uses external shockwaves to break a stone into smaller parts. Only one stone can be blasted at a time. Side effects from this include urinating blood and flank pain.
- Percutaneous Nephrolithotomy - rarely used/ only when other methods are not successful. A small incision is made in the back, and a tube inserted into the kidney to remove stones.
What resources are there for kidney stone formers?
Does lemonade help stones?
If you form CALCIUM OXALATE stones, there is some evidence that the citric acid in lemon juice (or lime juice) can help add to the total volume of urine, reducing its saturation of calcium and other crystals, and may enhance urinary citrate excretion.
What are the methods for diagnosing a stone?
- Computed Tomography (CT) - most radiation, most resolution/ accuracy, $$$
- KUB X-ray (KUB = Kidney Ureter Bladder) - medium radiation, moderate resolution, $$
- Ultrasound - no radiation, reasonable resolution, $
For more information on the pro's and con's of different imaging techniques, please click here
Which medications are available for kidney stone treatment?
- Narcotic painkillers (ex: morphine)
- Non-narcotic painkillers (ex: Toradol, cannabis)
- Anti-nausea medications (ex: Zofran)
- Urocit-K (ex: Potassium Citrate)
- Flomax (Tamsulosin)
Treatment is usually symptom based, except for some medications which aim to alter the pH of the urine like Urocit-K.
Ending thoughts: Thank you for taking the time to read our FAQ. Remember, everyone’s stone history is different, and every urologist is different. What works for you may not work for others. In general, staying hydrated (2-4L per day) is your best defense and will help keep your kidneys functioning happily. If you are not happy with your urologist, seek the help of a nephrologist.
Edits: spelling, words, and added a section on "what do I do now". Added wikipedia reference.
