Kidney Stones Symptoms, Causes, Treatment and How to Prevent Them

Kidney stones symptoms usually begin with severe pain in the side of your tummy or lower back that can spread to the groin and comes and goes in waves. You may also feel sick, need to pee often, or notice cloudy, bad-smelling or bloody urine. Small stones often pass without any symptoms, but severe pain, fever or being unable to pass urine needs urgent medical help.

What are kidney stones?

Kidney stones are hard lumps that form in one or both kidneys when chemicals that are normally found in your urine build up, according to the NHS. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes them as solid, pebble-like pieces that form when urine contains high levels of certain minerals. The good news: the NIDDK says kidney stones rarely cause permanent damage if they are treated by a health professional.

Stones come in very different sizes. According to the NIDDK's definition and facts page, they can be as small as a grain of sand or as large as a pea, and rarely as big as a golf ball. A small stone may travel out through the urinary tract on its own with little or no pain. A larger stone can get stuck on the way, block the flow of urine and cause severe pain or bleeding.

In Pakistan most people simply call it "pathri".

Kidney stones symptoms: what to look out for

Small kidney stones are common and often cause no symptoms at all. You may pass them when you pee without ever noticing. Larger stones are a different story. The NHS says kidney stone pain:

• usually starts in the side of your tummy (abdomen) or lower back
• may spread to the top of the inner thigh (groin), the testicles, or the area around the opening of the vagina
• comes and goes, with spells when it is very severe and spells when it eases or goes away

Other symptoms listed by the NHS and on the NIDDK's symptoms and causes page include:

• pink, red or brown blood in your urine
• needing to pee often, or pain while peeing
• being unable to pee, or only passing a small amount
• cloudy or bad-smelling urine
• feeling sick (nausea) or being sick (vomiting)
• a high temperature, chills, or feeling hot, cold or shivery

The NIDDK advises seeing a health professional right away if you have any of these symptoms, because they can point to a kidney stone or to a more serious condition.

Types of kidney stones and what causes them

The NIDDK explains that stones form when there are high levels of calcium, oxalate and phosphorus in the urine. There are four main types of stone, and treatment usually depends on a stone's size, location and what it is made of.

Who is more likely to get kidney stones?

According to the NHS and the NIDDK, you are more likely to get kidney stones if you:

• do not drink enough water or other liquids
• are male (men get them more often than women)
• have a close family member who has had kidney stones
• have had a kidney stone before (stones can come back)
• have certain conditions, such as gout, obesity, repeated urine infections, metabolic syndrome, an overactive parathyroid gland (hyperparathyroidism), long-lasting bowel inflammation or cystic kidney disease
• eat a high-protein, low-fibre diet, or are inactive or bed-bound
• take certain medicines, which the NHS says include aspirin, antacids, diuretics (water pills) and antibiotics

If you take any of these medicines, do not stop them on your own. Ask the doctor who prescribed them whether they matter for you.

Why hot weather and not drinking enough water matter

Not drinking enough water to stay hydrated is one of the main reasons the NHS gives for kidney stones forming. The NIDDK explains why: drinking enough liquid keeps your urine diluted and helps flush away the minerals that might otherwise clump together into stones.

This matters in Pakistan, where summers are long and hot. The NIDDK notes that the amount you need to drink depends on the weather and how active you are. If you live, work or exercise in hot weather, you may need more liquid to replace the fluid you lose through sweat. People who work outdoors, travel in the heat or cook in a hot kitchen can easily fall behind on fluids without realising it.

A simple check from the NHS: look at the colour of your pee. If it is dark, you are dehydrated and need to drink more.

How kidney stones are diagnosed and treated

Tests a doctor may order

The NHS says a doctor can usually diagnose kidney stones from your symptoms. They may also ask about other conditions, the medicines you take, your diet, and whether you or anyone in your family has had stones before. Sometimes you will need urine or blood tests, which can usually be done at a local lab.

According to the NIDDK's diagnosis page, a urine test can show blood in the urine and minerals that form stones, and white blood cells or bacteria in the urine can mean an infection. Blood tests can show high levels of certain minerals that can lead to stones. Imaging helps find the stone itself. The NHS says that if you are in severe pain, you may be sent to hospital for a CT scan if you are an adult, or an ultrasound scan if you are pregnant or the patient is a child under 16. The NIDDK adds that an abdominal x-ray can show where a stone is, though not every stone shows up on an x-ray.

Treatment options

Treatment depends on the size and type of stone, and your doctor will decide what suits you. Here is what the sources describe in general terms:

• Treatment at home. The NHS says most kidney stones can be treated at home with medicine. They can still be painful and may take a few weeks to pass. You will usually be advised to drink lots of water, and a doctor may offer painkillers, anti-sickness medicines, or medicines to help the stone come out in your pee.
• Catching the stone. You may be asked to collect the stone when you pass it so a lab can find out what type it is.
• Hospital care. The NIDDK's treatment page says larger stones, stones that block the urinary tract, or stones causing great pain may need urgent treatment. If you are vomiting and dehydrated, you may need fluids through a drip in hospital.
• Procedures to break up or remove stones. These include shock wave treatment from outside the body that breaks the stone into small pieces you can pass; passing a long, thin tube up the urethra (the tube urine comes out of) to find and remove or break the stone; and, for larger stones, removing the stone through a small cut in the back under general anaesthetic. A urologist (a kidney and bladder specialist) can carry these out.

After a stone has passed or been removed, the NIDDK says you may be asked to collect your urine over 24 hours so your doctor can see how much urine you make and check its mineral levels. Depending on the type of stone, a doctor may also prescribe medicine to help prevent new ones.

How to prevent kidney stones

Kidney stones can come back. These are the prevention steps the NHS and the NIDDK describe:

• Drink plenty of water. The NHS advises adults to drink 2.5 to 3 litres of water each day, and children 1 to 2 litres. Drink more in hot weather or when you sweat a lot. If you have kidney failure or another health problem that makes it hard to drink this much, talk to your doctor first, as the NIDDK advises.
• Add fresh lemon juice to water. The NIDDK explains that citrus drinks contain citrate, which helps stop crystals turning into stones.
• Cut down on fizzy, caffeinated and alcoholic drinks. The NHS advises avoiding drinking lots of these.
• Do not cut out calcium. The NHS says to make sure you get enough calcium in your diet. The NIDDK explains that, in the right amounts, calcium from food can block other substances in the gut that may cause stones.
• Keep salt down. The NHS says adults should have less than 6g of salt a day. The NIDDK notes that sodium is found in many canned, packaged and fast foods, condiments, seasonings and meats.
• Watch animal protein if your doctor advises it. The NIDDK's eating, diet and nutrition page says eating animal protein, such as beef, chicken, organ meats, eggs, fish and dairy, may raise the chance of stones. Beans, dried peas and lentils (daal) are plant-based foods high in protein and low in oxalate.
• Ask about high-oxalate foods. If you have had calcium oxalate stones, the NIDDK says you may want to avoid foods such as nuts, peanuts, spinach (palak), rhubarb and wheat bran.
• Keep a healthy weight. The NIDDK says being overweight increases the risk, and that the DASH eating plan can reduce the risk of stones. It is the same eating pattern used for blood pressure, which we explain in our guide to high blood pressure numbers.

The NHS also says: do not make changes to your diet without speaking to your doctor, because the right diet depends on your type of stone.

When to see a doctor, and when it is an emergency

See a doctor if you think you might have a kidney stone, if you notice blood in your urine, or if you have had stones before and want a plan to stop them coming back. The NHS says to get urgent medical help if you have kidney stones that are causing symptoms.

Go to a hospital emergency department, or call 1122 if you cannot get there safely, if you have:

• severe pain in your side, back, tummy or groin
• a high temperature, or you feel hot, cold or shivery, together with stone pain
• difficulty passing urine, or you can only pass a small amount
• vomiting along with signs of dehydration, such as very dark urine

Do not wait to see if these settle on their own. The NIDDK warns that untreated kidney stones can lead to urinary tract infections, including kidney infections, and loss of kidney function. Getting help early means these problems are rare.

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Sources

• NHS: Kidney stones
• NIDDK: Kidney stones
• NIDDK: Definition and facts for kidney stones
• NIDDK: Symptoms and causes of kidney stones
• NIDDK: Diagnosis of kidney stones
• NIDDK: Treatment for kidney stones
• NIDDK: Eating, diet and nutrition for kidney stones

Medical note: This guide is for general information and is not a substitute for advice from a doctor who can examine you.