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Bladder stonesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/bladder-stones/DS00904
Bladder stones are hard masses of minerals in your bladder. Bladder stones develop when urine in your bladder becomes concentrated, causing minerals in your urine to crystallize. Concentrated, stagnant urine is often the result of not being able to completely empty your bladder.
Bladder stones don't always cause signs or symptoms and may be discovered during tests for other problems. When symptoms do occur, they can range from abdominal pain to blood in your urine.
Small bladder stones sometimes pass on their own, but you may need to have others removed by your doctor. Left untreated, bladder stones can cause infections and other complications.
Some people with bladder stones have no problems — even when their stones are large. But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms can develop. These include:
- Lower abdominal pain
- In men, pain or discomfort in the penis
- Painful urination
- Frequent urination
- Difficulty urinating or interruption of urine flow
- Blood in your urine
- Cloudy or abnormally dark-colored urine
Bladder stones generally begin when your bladder doesn't empty completely. The urine that's left in your bladder can form crystals that eventually become bladder stones. In most cases, an underlying condition affects your bladder's ability to empty completely.
The most common conditions that cause bladder stones include:
- Prostate gland enlargement. An enlarged prostate, or benign prostatic hyperplasia (BPH), can cause bladder stones in men. As the prostate enlarges, it can compress the urethra and interrupt urine flow, causing urine to remain in your bladder.
- Damaged nerves (neurogenic bladder). Normally, nerves carry messages from your brain to your bladder muscles, directing your bladder muscles to tighten or release. If these nerves are damaged — from a stroke, spinal cord injury or other health problem — your bladder may not empty completely.
Other conditions that can cause bladder stones include:
- Inflammation. Bladder stones can develop if your bladder becomes inflamed. Urinary tract infections and radiation therapy to your pelvic area can both cause bladder inflammation.
- Medical devices. Occasionally, bladder catheters — slender tubes inserted through the urethra to help urine drain from your bladder — can cause bladder stones. So can objects that accidentally migrate to your bladder, such as a contraceptive device or stent. Mineral crystals, which later become stones, tend to form on the surface of these devices.
- Kidney stones. Stones that form in your kidneys are not the same as bladder stones. They develop in different ways and often for different reasons. But small kidney stones occasionally travel down the ureters into your bladder and, if not expelled, can grow into bladder stones.
In developing nations, bladder stones are common in children — often because of dehydration, infection and a low-protein diet. In other parts of the world, bladder stones occur primarily in adults, especially in men age 30 and older.
Conditions that contribute to your risk of bladder stones include:
- Bladder outlet obstruction. Bladder outlet obstruction refers to any condition that blocks the flow of urine from your bladder to the urethra, the tube that carries urine out of your body. Bladder outlet obstruction has many causes, but the most common is an enlarged prostate.
- Neurogenic bladder. Stroke, spinal cord injuries, Parkinson's disease, diabetes, a herniated disk and a number of other problems can damage the nerves that control bladder function. Some people with neurogenic bladder may also have an enlarged prostate or other type of bladder outlet obstruction, which further increases the risk of stones.
Bladder stones that aren't removed — even those that don't cause symptoms — can lead to complications, such as:
- Chronic bladder dysfunction. Left untreated, bladder stones can cause long-term urinary problems, such as pain or frequent urination. Bladder stones can also lodge in the opening where urine exits the bladder into the urethra and block the passage of urine from your body.
- Urinary tract infections. Recurring bacterial infections in your urinary tract may be caused by bladder stones.
Preparing for your appointment
If you have signs and symptoms of bladder stones, you're likely to start by seeing your family doctor or a general practitioner. However, you may be referred to a doctor who specializes in treating disorders of the urinary tract (urologist).
What you can do
To get ready for your appointment, make a list of:
- Any symptoms you're experiencing, including any that may seem unrelated to your condition
- Key personal information, including any major stresses or recent life changes
- All medications you're taking, as well as any vitamins or other supplements
- Questions to ask your doctor, in order of importance
- Be aware of any pre-appointment restrictions. Ask if there's anything you need to do in advance, such as restrict your diet.
- Ask a family member or friend to come with you. Someone who accompanies you may remember information that you missed or forgot.
For bladder stones, some basic questions to ask your doctor include:
- Can bladder stones pass on their own?
- If not, do they need to be removed, and what's the best method?
- What are the risks of the treatment you're proposing?
- What will happen if the stones aren't removed?
- Is there any medication I can take to eliminate bladder stones?
- How can I keep them from coming back?
- I have other health conditions. How can I best manage these conditions together?
- Are there any dietary restrictions that I need to follow?
- Will the stones come back?
- Do you have any printed materials that I can have? What websites do you recommend?
Don't hesitate to ask additional questions that may come up during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Have you had a fever or chills?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Tests and diagnosis
Reaching a diagnosis of bladder stones may involve:
- A physical exam. Your doctor will likely feel your lower abdomen to see if your bladder is enlarged (distended) and, in some cases, perform a rectal exam to determine whether your prostate is enlarged. You should also discuss any urinary signs or symptoms that you're having.
- Analysis of your urine (urinalysis). A sample of your urine may be collected and examined for microscopic amounts of blood, bacteria and crystallized minerals. A urinalysis also helps determine whether you have a urinary tract infection, which can cause or be the result of bladder stones.
- Spiral computerized tomography (CT) scan. A conventional CT scan combines multiple X-rays with computer technology to create cross-sectional images of your body. A spiral CT speeds up this process, scanning more quickly and with greater definition of internal structures. Spiral CTs can detect even very small stones and are considered one of the most sensitive tests for identifying all types of bladder stones.
- Ultrasound. An ultrasound, which bounces sound waves off organs and structures in your body to create pictures, can help your doctor detect bladder stones.
- X-ray. An X-ray of your kidneys, ureters and bladder helps your doctor determine whether stones are present in your urinary system. But some types of stones aren't visible on conventional X-rays.
- Special imaging of your urinary tract (intravenous pyelogram). An intravenous pyelogram is a test that uses a contrast material to highlight organs in your urinary tract. The material is injected into a vein in your arm and flows into your kidneys, ureters and bladder, outlining each of these organs. X-ray pictures are taken at specific time points during the procedure to check for stones. Spiral CT scans are generally done instead of an intravenous pyelogram.
Treatments and drugs
Generally, bladder stones should be removed. If the stone is small, your doctor may recommend that you drink a lot of water each day to help the stone pass. However, because bladder stones are often caused by the inability to empty the bladder completely, spontaneous passage of the stones is unlikely. Almost all cases require removal of the stones.
Breaking stones apart
Bladder stones are often removed during a procedure called a cystolitholapaxy (sis-toe-lih-THOL-uh-pak-see). A small tube with a camera at the end (cystoscope) is inserted through your urethra and into your bladder to view the stone. Your doctor then uses a laser, ultrasound or mechanical device to break the stone into small pieces and flushes the pieces from your bladder.
Before the procedure, you'll likely have anesthesia that numbs the lower part of your body (regional anesthesia) or that makes you unconscious and unable to feel pain (general anesthesia). Complications from a cystolitholapaxy aren't common, but urinary tract infections, fever, a tear in your bladder or bleeding can occur. Your doctor may give you antibiotics before the procedure to reduce the risk of infections.
About a month after the cystolitholapaxy, your doctor will likely check to make sure that no stone fragments remain in your bladder.
Occasionally, bladder stones that are large or too hard to break up are removed through open surgery. In these cases, your doctor makes an incision in your bladder and directly removes the stones. Any underlying condition causing the stones, such as an enlarged prostate, may be corrected at the same time.
No studies have confirmed that herbal remedies can break up bladder stones, which are extremely hard and usually require a laser, ultrasound or other procedure for removal.
Always check with your doctor before taking any alternative medicine therapy to be sure it's safe and that it won't adversely interact with other medications you're taking.
Bladder stones usually result from an underlying condition that's hard to prevent, but you can decrease your chance of developing bladder stones by following these tips:
- Ask about unusual urinary symptoms. Early diagnosis and treatment of an enlarged prostate or another urological condition may reduce your risk of developing bladder stones.
- Drink plenty of fluids. Drinking more fluids, especially water, may help prevent bladder stones because fluids dilute the concentration of minerals in your bladder. How much water you should drink depends on your age, size, health and level of activity. Ask your doctor what's an appropriate amount of fluid for you.
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