Do you sometimes feel nauseous with a sharp pain in your lower back, just below your ribs? Do you feel like you have to urinate and it hurts, sometimes you have to urinate a little, and the pain spreads to your stomach? If so, you may have a condition called " ureteral stones." Let's talk about this in a little more detail today, just like talking to a friend.
What are Ureteral Stones?
Simply put, a ureteral stone is an irregularly shaped solid object that gets stuck in one of your ureters, the two thin tubes that carry urine from your kidneys to your bladder (where urine is stored). They look like small pebbles. Did you know that each of our kidneys has one ureter?
These stones can form in either the left or right side of the urethra. An adult's urethra is usually between 10 and 12 inches long. These stones can become lodged in the upper part of the urethra, near the kidney, or in the lower part, near the bladder.
Most of the time, these urinary stones are very small. Some of them are not even visible to the naked eye. They are washed out with urine, so they do not cause any problems.
However, if a kidney stone is large enough, it can block the flow of urine from the kidneys to the bladder. That's when severe pain occurs. These stones are formed when minerals and salts in your urine clump together. They first form as small crystals, then they grow into larger stones.
"So, are these ureteral stones the same as kidney stones?" Yes, a ureteral stone is actually a stone that forms in a kidney and breaks free and becomes lodged in the ureter.
What are the main types of urinary stones?
There are four main types of urinary stones:
- Calcium stones : These are the most common type. There are two types of these: `(Calcium oxalate)` stones and `(Calcium phosphate)` stones.
- Uric acid stones: These types of stones form when the amount of uric acid in your urine increases.
- Struvite stones: These stones can sometimes form after a urinary tract infection ( UTI ). They are mainly composed of magnesium ammonium phosphate (struvite) and calcium carbon-apatite.
- Cystine stones: These cystine stones are caused by a genetic condition called ``Cystinuria.`` This disease causes the amino acid cystine to accumulate in the urine before it leaves the kidneys.
Who is at higher risk of developing urinary stones?
Anyone can develop kidney stones, but the following people are at a slightly higher risk:
- For men.
- For white people (this is according to data from foreign countries).
- For people between the ages of 40 and 60.
- For those who have previously developed urinary stones.
- If someone in the family has developed kidney stones.
- For those who drink less water.
- For those with diabetes (Diabetes Mellitus).
- For people with polycystic kidney disease.
This situation can be seen among us in Sri Lanka as well. In particular , things like drinking less water and working in an environment that causes excessive sweating can have an impact.
How common are these urinary stones?
According to data from the United States, about one in 1,000 adults is hospitalized every year due to urinary stones. It is also said that there is a 1 in 8 chance of developing a stone in a lifetime. This situation is not insignificant in Sri Lanka either.
What are the symptoms of these urinary stones?
If you have very small urinary stones, they can pass through your urinary system without any symptoms.
However, if the stones are large enough to block your urinary tract, you may experience symptoms such as:
- Severe pain: This is intermittent pain that is not constant. It usually starts in the lower back, under the ribs. It can feel like a knife stabbing.
- Spreading pain: This pain can spread to the lower abdomen, and sometimes to the genital area.
- Pain or burning when urinating.
- Feeling nauseous.
- Vomiting.
- Blood in the urine or discoloration: Urine may be brown, pink, or red.
- Cloudy pee.
- The need to urinate frequently.
- Little urine leakage.
Imagine, one night, Nilanthi suddenly felt a severe pain in her back. She couldn't even imagine what had happened. The pain was so bad that she couldn't even stand up straight. It was only when she went to the hospital that she learned that a stone was stuck in her urethra.
Why do these urinary stones form?
The main reason for the formation of kidney stones is the increase in the amount of stone-forming substances in your urine. Normally, these substances pass through the urinary system without any problems. But this does not happen because your body does not produce enough urine to dissolve or wash out these substances. Most often, this is due to the fact that you do not drink enough water. Then these substances gradually accumulate and begin to form stones.
The main materials used to make this stone are:
- Calcium
- Oxalate
- Uric acid
- Phosphate
- Cystine
- Xanthine
How long can a stone stay in the urethra?
This is something that varies from person to person. Because your body is different from someone else's, the time it takes for you to pass a stone may vary. Sometimes, you may not be able to pass the stone at all.
For most people, a stone smaller than 4 millimeters can pass within a week or two.
Once a stone in the urethra reaches the bladder, it usually passes within a few days.
How does a doctor diagnose this?
A doctor will first ask you about your symptoms and perform a physical exam. They may then order tests such as these to confirm whether you have kidney stones:
- Urinalysis: This checks the urine for signs of infection and the levels of substances that can cause stone formation.
- Blood test: This checks how well the kidneys are working, whether there are infections, and whether there are other problems that could lead to stone formation.
- Ultrasound scan: Uses sound waves to check for blockages in the urinary tract.
- CT scan (Computed Tomography - CT scan): This helps your doctor determine the exact size, location, and hardness of your urinary stone.
How do you remove these urinary stones? (Treatment)
The method of removing urinary stones depends on the size of the stones, their location, and the material they are made of. Depending on the size and location of the stone, your doctor can give you a good idea of whether you can simply pass it or not.
If you have large kidney stones or a blockage in your urinary system, a urologist may recommend treatments such as:
- Shock Wave Lithotripsy (SWL): This involves using high-energy sound waves to break up stones in the urinary tract. The small pieces are then easily passed out in the urine. This is the least invasive treatment, but it is not suitable for everyone.
- Ureteroscopy: This involves inserting a long, thin tube (ureteroscope) through the urethra. It has a camera attached to the end. The tube is passed through the bladder and into the urethra to find the stone. It is then removed or crushed with a laser.
- Percutaneous Nephrolithotomy (PCNL): In this procedure, your doctor makes a small incision in your back and inserts a scope directly into your kidney to find and remove the stone. This treatment is only recommended if the stone is very large or has an irregular shape.
- Ureteral stents: These are thin, flexible, temporary tubes that help keep the urethra open, allowing urine to flow around a stone that is blocking it.
- Medical Expulsive Therapy (MET): This is most effective for small stones in the lower urinary tract. It uses medications such as alpha-blockers, calcium channel blockers, corticosteroids, and phosphodiesterase-5 inhibitors (PDE5).
Special medications for certain types of stones
These types of medications can be given to people who develop certain types of urinary stones, especially:
- For calcium stones:
- Potassium citrate: This makes the urine more alkaline and reduces acidity.
- Diuretics: These help to remove excess fluid and calcium from the body through urine.
- For struvite stones:
- Antibiotics: These are medicines that fight bacterial infections.
- Acetohydroxamic acid: This helps prevent the accumulation of ammonia in the urine.
- For cystine stones:
- Tiopronin (mercaptopropionyl glycine): This helps prevent kidney stones in people with cystinuria.
- `Potassium citrate`.
How do I take care of myself/manage symptoms?
It is very important to drink plenty of fluids, such as water. Drinking at least 2 to 3 liters of fluid a day can help pass small urinary stones.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased at the pharmacy for mild pain or discomfort. The most commonly used NSAIDs are aspirin, ibuprofen, and naproxen. Not everyone can take these NSAIDs, so it's a good idea to ask your doctor or pharmacist before using them.
How long does it take to recover after treatment?
Most people feel better within a few days of treatment. However, you may experience some side effects until the last stone is passed from your body.
How do you prevent the formation of urinary stones?
There are many ways to prevent the formation of urinary stones:
- Drink more fluids: It's a good idea to drink at least 2 to 3 liters of fluids a day. Water is best, but other fluids like lemonade and orange juice are also good.
- Limit animal protein: Animal protein like meat, eggs, and fish increases the amount of uric acid in your body. Lentils, beans, green peas, seitan, and tofu are good sources of protein that do not increase uric acid levels.
- Reduce sodium in your diet: Consuming less than 1,500 milligrams of salt per day can reduce the risk of developing kidney stones. You can replace salt with salt substitutes, spices, lemon juice, and flavored vinegar.
- Limit foods high in oxalate: Oxalate is a nutrient found in foods like spinach, almonds, cashews, and potatoes. However, calcium-rich foods and drinks can help prevent oxalate stones.
Sometimes your doctor will tell you to urinate into a special strainer or filter until your stone passes. The stone is then removed and its chemical composition is analyzed. Based on that information, your doctor can develop a treatment plan to prevent stones from forming again.
What can I expect if I have kidney stones?
If diagnosed correctly, the prognosis for people with kidney stones is good. However, there is a chance that you will develop kidney stones again.
Many people pass small kidney stones without treatment. For larger stones, treatment can break up the stone and allow you to pass it yourself, or a doctor can remove it. Medications can also help to remove kidney stones and prevent them from forming again.
If you have had more than one urinary stone, your doctor can help you find the cause. After that analysis, you can make changes to your lifestyle to prevent stones from forming again.
When should I see a doctor?
If you experience symptoms of kidney stones, see a doctor immediately. If your pain is unbearable, he or she may prescribe medication for pain and nausea/vomiting.
If you have a kidney stone, a doctor can find its location and give you the right treatment.
What questions should you ask your doctor?
- How do you tell if I have a kidney stone?
- If I don't have a kidney stone, what other medical condition could I have?
- What type of kidney stone do I have?
- How big is my urinary stone?
- Which urethra is my stone in?
- How many urinary stones do I have?
- Will I be able to just pass this kidney stone, or do I need treatment?
- What is the best treatment for me to remove my urinary stone?
- How can I prevent urinary stones from forming again?
- What changes should I make to my diet?
- Do I need to take any medication to prevent kidney stones from forming again?
Finally, a take-home message:
Having kidney stones is a really annoying and painful thing. However, this is a temporary condition. Your doctor can help you prevent your symptoms from getting worse. Therefore, it is wise to see a doctor as soon as you notice the symptoms of kidney stones. He/she will also give you the necessary instructions to prevent the formation of kidney stones again. Don't worry, this condition can be well managed with proper treatment and lifestyle changes!
` Urinary stones, kidney stones, urinary tract, pain, urinary tract infections, treatment, prevention
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