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FAQs About Stones

Question markAll the questions below have been submitted by patients to the Stone Disease Advisory Group.

The answers have been carefully prepared by the Executive Committee of the Endourology Section of BAUS. This body includes patient representatives, urologists and general practitioners, and they can be contacted directly by e-mail.

What is happening to me?

Your body is trying to eliminate a stone from the kidney down the normal urinary passages. The pain itself is caused by powerful muscle contractions and the release of chemicals within the kidney.

If the stone is too large to pass by itself, or if the surface of the stone is "spiky", this can cause the stone to get stuck and the muscle contraction becomes more powerful. It is this which causes the severe pain.

Powerful pain-killers may be needed to relieve the pain.

Sometimes an infection occurs in the urine behind the stone and this, too, can make you feel unwell with a high temperature. Stones at the lower end of the ureter (close to the bladder) can often irritate the bladder and cause symptoms very similar to cystitis (a constant desire to pass urine, pain on urination, blood in the urine & passing small amounts of urine only).


Why am I in so much pain?

It is your body's way of letting you know that there is a problem. The pain can be extremely severe and very frightening when you first experience it.

As a general rule, the pain usually reaches a point where it does not get any worse. The level of pain, however, does not indicate the size of the problem. Patients in acute pain may have stones the size of a grain of sand, whereas some patients with large kidney stones may experience very little pain. Fortunately, the majority of stones are less than 2mm in size.

Women often say that the pain of renal colic is worse than the pain of childbirth. It can, however, be relieved with simple injections, suppositories or tablets so that you are comfortable.

The first episode of renal colic is often the worst. If you are unfortunate enough to suffer repeated episodes, the pain is often less severe on subsequent occasions. This is probably because you know what the pain is, and you are less concerned that it is something life-threatening.


Is it life-threatening?

No. Symptoms can be very severe but they can usually be relieved, relatively simply, by a variety of measures and the condition is not life-threatening. However, if a patient continually neglects his / her health over many years, kidney stones can cause renal failure and this, in itself, can be life-threatening.

If you have a severe infection with blood poisoning (septicaemia) as a result of your stone(s), this can also be dangerous. In this situation, it is important that you seek urgent medical advice and are treated promptly with powerful antibiotics.

Very rarely, you may have stones blocking the outflow of urine from both kidneys and this, too, requires urgent treatment to re-establish drainage from the kidneys.


Why do I constantly have a high temperature?

A high temperature is a simple message from your body to say that you have an infection. This message should not be ignored and you should seek medical advice promptly.

Obstruction to the flow of urine from the kidney may result in infection in the urine. This can produce typical symptoms of urinary infection (frequency, pain on passing urine, blood in the urine, pain in the bladder area) or it may just produce discomfort in the kidney area with a raised temperature.

The combination of blockage (by a stone) and infection can damage a kidney quickly and should, therefore, be treated promptly with antibiotics. The presence of infection may also prompt early surgical treatment to remove the stone or drain the kidney to relieve the blockage.


Is it an infection which can be passed on?

No. Infection in the urine cannot be passed on to your family or sexual partners under normal circumstances.


Why do I feel so tired all the time?

Tiredness can be caused by several issues (including an inadequate diet) but ongoing pain and/or infection often causes you to feel tired, lacking in energy and unwell.

This should improve within a few days, once treatment has been given for any infection, and after your pain has been relieved. As with any health problem, you are advised to rest if needed and to avoid over-tiring yourself, but you should try to remain mobile (and not "take to your bed").

Antibiotics usually resolve the tiredness caused by infection within a few days but, if they do not, you should contact your GP as soon as possible.


Why don't the doctors explain anything to me?

When you are first reviewed, your doctor may not be clear about the diagnosis. This means that he/she cannot always tell you exactly what is going on.

Although your GP may suspect a kidney stone as the cause of your symptoms, this can only be confirmed by an X-ray or CT scan at hospital.

Until the diagnosis has been confirmed, it is difficult for any doctor to give you accurate advice. Once a scan or X-ray has been performed, your doctor will tell you what it shows and will then try to give you a more accurate idea of what treatment (if any) is needed.


What are the doctors going to do for me?

First, they will relieve your symptoms, then establish a definite diagnosis and, finally, decide on the best treatment and try to find out why you have formed stones.

Your pain will be relieved by injections, suppositories or tablets. An X-ray or CT scan will usually confirm the diagnosis of stones. Blood and urine tests are usually performed to discover whether there is an underlying reason why you have formed stones.


Will I be in hospital for long?

If your stone is small and your pain settles, you may be discharged very quickly but, if surgery is needed, you will be in hospital longer.

Most of your time in hospital will, inevitably, be spent waiting for specialist tests to be carried out and ensuring that you are free of infection. As soon as this is confirmed and all the results are available, the doctors can then decide on the best course of action for your problems.

They will, of course, discuss this with you and will then make treatment plans depending on your individual circumstances.

The best thing you can do is to rest and relax, making use of the time to recover.


How can people help when I am in severe pain?

By giving you painkillers as soon as your pain begins (do not wait for it to become severe), keeping you well-hydrated and helping you to remain mobile.

A stone patient should be kept as relaxed and comfortable as possible, in a comforting atmosphere at home. Painkillers (suppositories or tablets) should be available when needed. Remaining mobile actually encourages small stones to pass more quickly.


Will I need dialysis or a kidney transplant?

It is extremely unlikely. It is very rare for stones to result in kidney failure requiring dialysis or transplantation, although a temporary reduction in kidney function may occur

Kidney failure can occur if you only have one kidney, or if one kidney is already irreversibly damaged for any reason, and you then develop severe blockage to the other kidney due to stones.

One rare form of stone disease (primary hyperoxaluria) is due to an inborn deficiency of an enzyme produced by the liver and may result in end-stage kidney failure; it is sometimes treated by combined kidney and liver transplantation. Fortunately, this is extremely rare.


Would I ever need a "bag"?

It is highly unlikely that you would need a permanent drainage bag although it is not unusual to have temporary drains after some types of surgery. For example, you may need a temporary drainage "bag" if your kidney needs to be drained with a nephrostomy tube and you may also have a temporary bladder catheter inserted if you undergo surgery.

These temporary drains are usually removed shortly after the procedure.


Can I eat & drink anything or do I need a special diet?

At this early stage, it may be difficult to advise you on a suitable diet but this will be assessed in more detail after your tests.

Maintaining a high fluid intake (enough to keep your urine colourless) will reduce your risk of further stones. Water or squash are best; you can drink tea and coffee but in restricted amounts. There is some evidence that drinking the diluted juice of fresh lemons can reduce your risk of stones even further, by raising the levels of natural stone inhibitors in your urine.

For many years, conventional advice was always that you should avoid dairy produce (e.g. milk, butter, cheese & eggs). We now know that this is not desirable because it can, in fact, increase your risk of further stones. You should, however, reduce your intake of protein, salt and oxalate-containing foods and you should avoid Vitamin C or D supplements (including fish-oil preparations).

In summary, a normal-calcium, low-salt, low-protein diet can reduce your risk of stone formation by half. Keeping your urine colourless by increasing your fluid intake will reduce the risk by a further one third.

For more detailed advice on dietary recommendations, with examples of "stone-friendly" menus, click here to download an information leaflet (PDF) about stone prevention.


Should I stop drinking alcohol?

As a general rule, no. Small amounts of alcohol do no harm but large quantities can cause dehydration which is not desirable in patients with stones.

As we all know, alcohol can worsen some medical conditions and may reduce the effectiveness of some tablets or lead to side-effects.

"Moderation" is the key word but you should refrain from alcohol if you are advised to do so.


Are stones caused by hard water?

No. The calcium & magnesium salts which result in "hard" water are not usually absorbed to any significant degree and do not, therefore, play a major part in stone formation. People have been known to suffer from kidney stones for thousands of years, all over the world, and local water issues have little bearing on this.

Drinking tap water is the best way to reduce your risk of further stone formation. Many people drink mineral or spring waters, in the belief that these are healthier. Whilst some are, indeed, low in mineral content, some contain higher levels of calcium and magnesium than tap water (together with other potentially harmful chemicals) in a form which can be absorbed and may not, therefore, be suitable for patients with stones.

A water softener is unnecessary because, although it supplies you with soft water for washing & bathing, your drinking supply (usually the cold tap in your kitchen) is not connected to the softener. It is, therefore, of no benefit in preventing stone recurrence.

A water filter may improve the taste of "hard" tap water but there is no evidence that it is any more helpful in reducing stone recurrences than unfiltered tap water.


Does stone formation run in families?

In most cases, no. Some types of stone, however, do run in families (e.g. cystine stones) and families who live together are, of course, often subject to the same factors (e.g. diet, dehydration etc).  

If you suffer from cystinuria, click here to go to a website specifically for cystinurics.


Why am I the only one in my family affected?

Stones can run in families but this is rare.

Stones usually form because of specific factors (e.g. dehydration, dietary excesses, urinary infection) which often exist only in individual patients. Each person's diet is different; we all eat and drink at different times. Your doctors may suggest in-depth studies of your dietary / fluid intake once you have returned home and are on your normal diet.

If stones do run in your family or these types of stone are found after further tests, you need special treatment to prevent further stone formation. In addition, other members of the family may need to be screened for the same inherited abnormality.