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Bladder stonesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/bladder-stones/DS00904
Bladder stones are usually small masses of minerals that form 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. This may be due to an enlarged prostate, nerve damage or recurring urinary tract infections.
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, especially during the night
- 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 be a cause of 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.
- Weakened bladder wall. Bladder diverticula are weakened areas in the bladder wall that bulge outward in pouches, and allow urine to collect.
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, 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 — but in other parts of the world, bladder stones occur primarily in older men. If you live in an industrialized country, these factors increase your risk:
- Your sex. Bladder stones occur primarily in men.
- Your age. In industrialized countries, bladder stones tend to occur in people age 30 and older, although younger people may also develop stones.
- Bladder outlet obstruction. The most common cause of bladder stones in men, 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.
- Frequent bladder infections. Inflammation from chronic bladder infections can lead to the formation of bladder 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 then be referred to a doctor who specializes in treating disorders of the urinary tract (urologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications you're taking, as well as any vitamins or supplements.
- Ask a family member or friend to come with you. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. 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 is 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?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask 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. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you had a fever or chills?
Tests and diagnosis
Tests used to make a diagnosis of bladder stones may include:
- A physical exam. Your doctor will likely feel your lower abdomen to see if your bladder is distended and, in some cases, perform a rectal exam to determine whether your prostate is enlarged. You may also discuss any urinary signs or symptoms that you've been 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 is also helpful for determining 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 rather than the overlapping images produced by regular X-rays. 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. This is an inexpensive and easy test to obtain, 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. More recently, helical 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 an increased amount of water each day to help the stone pass. However, because bladder stones are usually 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. 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.
You'll likely have regional or general anesthesia prior to the procedure to make you comfortable. Complications from a cystolitholapaxy aren't common, but urinary tract infections, fever, a tear in your bladder and 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.
For centuries, some people have tried to use herbs to treat and prevent stones that form in the kidneys and bladder. Traditional herbs for bladder stones include gravel root (also called kidney root, queen of the meadow and Joe Pye), stone root (also called citronella and colinsonia) and hydrangea (wild or mountain hydrangea).
These herbs are used alone or in various combinations and drunk as tea or taken in tincture form. Some herbal formulas add marshmallow (the plant, not the confection), which is said to coat the fragments so that they can be eliminated painlessly. No studies, however, have confirmed that herbs can break up bladder stones, which are extremely hard and usually require a laser, ultrasound or other procedure for removal.
For prevention, parsley leaf is reported to have a diuretic effect and may be helpful for preventing bladder stones.
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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