Brief overview
- Symptoms: Small bladder stones often cause no symptoms. Colicky lower abdominal pain, pain when urinating, and blood in the urine are typical with larger stones.
- Treatment: In most cases no treatment is necessary, small stones wash out by themselves. In the case of larger stones, the stones are initially dissolved or reduced in size by medication, crushed by shock waves, removed by endoscope and cystoscopy. Only rarely is open surgery necessary.
- Causes: Disruption of urinary flow, prostate enlargement, urinary tract infections, metabolic disorder, excessive intake of certain minerals in the diet
- Risk factors: Unbalanced diet with too much fat, proteins and salts, foods rich in oxalic acid, insufficient fluid intake, one-sided diets, prostate enlargement in older men, osteoporosis, vitamin deficiency, urinary bladder catheter or surgical sutures in the bladder.
- Diagnosis: Examination by a specialist (urologist), urine laboratory values, ultrasound and X-ray examination possibly with contrast medium, computer tomography, cystoscopy.
- Prognosis: Mostly the stone goes away by itself, otherwise small interventions are often successful. Without prevention, bladder stones often develop several times.
What are bladder stones?
Urinary stones are solid, stone-like formations (concrement) in the draining urinary tract. If a urinary stone is located in the urinary bladder, the doctor refers to this concretion as a bladder stone. The urinary bladder, as a reservoir, collects urine and, through special muscles, allows it to be released at will.
Bladder stones either form in the urinary bladder itself (primary bladder stones) or they form in the kidney or ureters and eventually enter the urinary bladder with the steady flow of urine (secondary bladder stones). The urinary stone symptoms are the same for both forms.
A bladder stone develops when certain stone-forming salts crystallize in the urine. This usually occurs when the salt in question is present in too high a concentration in the urine and thus exceeds the solubility threshold. If the salt forms a solid crystal (concretion), more and more layers are deposited on it over time, so that the initially small concretion becomes an increasingly large urinary calculus.
Depending on the type of salt from which the stone forms, physicians distinguish:
- Calcium oxalate stones (75 percent of all urinary stones)
- “Struvite stones” made of magnesium ammonium phosphate (10 percent)
- urate stones made of uric acid (5 percent)
- Calcium phosphate stones (5 percent)
- Cystine stones (rare)
- Xanthine stones (rare)
In many cases, bladder stones do not cause any symptoms and are flushed out of the body on their own with the urine. However, if the urinary stones block the exit to the urethra or are too large to pass through the urethra on their own, the urinary stone is removed medically.
What are the symptoms?
People with bladder stones often have no symptoms. Whether bladder stones cause symptoms depends primarily on exactly where the stone is located and how large it is. If it lies freely in the bladder, the outflow of urine into the urethra is not disturbed. Specific symptoms do not occur in this case.
If, on the other hand, it attaches itself firmly to the lower bladder wall and its size blocks the exit of the bladder to the urethra, symptoms develop. The symptoms are caused on the one hand by the irritation of the mucous membrane caused by the bladder stone, which is often sharp-edged, and on the other hand by the urine, which often backs up to the kidney.
Typical bladder stone symptoms are sudden onset of colicky lower abdominal pain, sometimes radiating to the flanks. In addition, there is pain during urination, the urine stream suddenly breaks off, and blood in the urine is also possible. A common symptom is a constant urge to urinate, associated with a small amount of urine during urination (pollakiuria).
In the event of a complete blockage of the urethra, there is a buildup of urine in the bladder, which often extends through the ureters to the kidneys. This situation, in which affected persons are no longer able to pass urine, is referred to by doctors as urinary retention or ischuria.
In addition to these symptoms, many sufferers show an increasing restlessness to move. This is because they unconsciously search for a body position in which the pain will subside. They constantly change from lying to a standing position or walk around. In addition, nausea and even vomiting sometimes occur as a result of the pain.
If you notice pain when urinating or unusual, cramping pain in the lower abdomen, it is best to see a doctor immediately and have the cause clarified. If urine backs up to the kidneys, kidney damage is possible.
Men are statistically more likely to be affected by bladder stones. Urinary stone symptoms in men and women are the same.
How can bladder stones be treated?
The size and location of the bladder stone determine whether the doctor removes it or waits for a spontaneous discharge. In most cases, no special treatment is needed for a bladder stone. Small stones (up to five millimeters) and those lying freely in the bladder are excreted by themselves through the urethra in about nine out of ten cases.
Sometimes certain medications (for example, the active ingredient tamsulosin) facilitate elimination if, for example, an enlarged prostate constricts the urethra. In the case of some stones (urate stones, cystine stones), the doctors also try to dissolve or reduce the size of the urinary stones by means of a chemical reaction (chemolitholysis).
In any case, it is recommended that you drink plenty of fluids to facilitate stone passage.
If pain occurs (which often happens when the urinary stone slips through the urinary tract), painkillers, for example with the active ingredient diclofenac, usually help.
If the stone is too large to pass spontaneously, if the stone obstructs the urethra, and if there is evidence of severe infection (urosepsis), the attending physician must surgically remove the stone. He attempts to crush smaller urinary stones with forceps or remove them directly during a cystoscopy.
How long you stay in the hospital after the procedure depends on how large the removed stone was and whether there were any complications during the procedure. As with any surgery, there are risks associated with cystoscopy. Generally, there is a risk of germs entering the urinary bladder through the instruments and causing it to become inflamed. In addition – although very rarely – organ walls are injured or even punctured with the instrument used.
For some years now, the majority of all procedures have involved the use of pressure waves to break up the stones. This procedure is called extracorporeal shock wave lithotripsy (ESWL). During ESWL, larger stones are destroyed by shock waves, allowing affected individuals to simply excrete the debris through their urine.
If patients still have pain after the bladder stone is removed, this may be an indication of inflammation of the urinary bladder (cystitis). This is treated with antibiotics if necessary.
Today, an open surgical method is only used in very rare cases. It is necessary, for example, if the doctor cannot reach the bladder with the endoscope during cystoscopy because the stone or another structure is blocking the urethra or the entrance to the bladder.
If the bladder stones were caused by a disturbance in the emptying of the bladder, the treating physician’s main priority after stone removal is to treat the cause. In men, prostate enlargement often leads to urethral drainage disorders and subsequent stone formation.
In such a case, the doctor first tries to treat the prostate enlargement with medication. However, in the case of a severely enlarged prostate or repeated urinary stones, surgical intervention is advised in order to eliminate the trigger of the stone formation. In most cases, a so-called transurethral prostate resection (TURP) is recommended. In this procedure, the prostate is removed through the urethra.
Dissolving bladder stones with home remedies
If you experience symptoms such as colicky pain or bloody urine, be sure to see a doctor.
Home remedies to get rid of bladder stones can help with small stones with no or only minor symptoms. Most home remedies for urinary stones are also effective for prevention, such as drinking plenty of fluids and eating a balanced diet.
Anything that stimulates the formation of urine can be helpful for flushing out small stones with urine. Such home remedies include.
- Herbal teas
- Drinking plenty of water
- Climbing stairs
- Lots of exercise in general
Home remedies have their limits. If the symptoms persist for a long period of time, do not improve or even get worse, you should always consult a doctor.
Homeopathic treatment of bladder stones
In homeopathy, preparations of Berberis aquifolium, Berberis, Camphora, Coccus cacti (common mahonia, barberry, camphor and cochineal scale) in dilutions D6 to D12 as drops, tablets or globules are said to be effective against bladder stones.
The concept of homeopathy and its specific efficacy are controversial in science and not clearly supported by studies.
Causes and risk factors
Bladder stones consist of mineral salts, very rarely proteins, which are normally dissolved in urine and flushed out of the body with it. Under certain circumstances, these salts dissolve from the urine (they are “precipitated”) and settle in the urinary bladder. The initially small formations often grow steadily due to the accumulation of further salts.
Doctors distinguish between primary and secondary bladder stones. Primary bladder stones form in the bladder itself, while secondary bladder stones form in the upper urinary tract organs such as the kidney or ureters and are flushed into the bladder with the urine. Primary bladder stones are much more common than secondary bladder stones.
Typical causes of urinary retention include prostate enlargement or bladder emptying dysfunction due to neurological damage. Benign prostatic hyperplasia (BPH) is very common in older men.
Bladder stones are also possible in neurological diseases such as multiple sclerosis or paraplegia due to outflow obstruction. In these diseases, the contraction of the bladder muscles and thus urination (micturition) is often impaired.
In the case of a urinary tract infection, bacteria often alter the chemical composition of the urine, increasing the risk of precipitation of certain substances. For example, experts attribute struvite stones consisting of magnesium ammonium phosphate to urinary tract infections with certain bacteria.
In Germany, an unfavorable diet high in animal fats, proteins and foods containing oxalic acid is considered a risk factor for the development of bladder stones. Oxalic acid is found, for example, in nuts, coffee, cocoa, rhubarb, beet and spinach.
Stone-forming substances such as oxalate, calcium, phosphate, ammonium and uric acid (urate) only dissolve in the urine in a certain amount. If the amount ingested with food exceeds a certain limit, this may lead to precipitation.
Other risk factors for bladder stones include:
- Too little fluid intake (concentrated urine)
- Unbalanced diet with too much meat and dairy products
- Increased intake of vitamin D3 (for example, vitamin capsules)
- Lack of vitamin B6 and vitamin A
- Osteoporosis with an increased release of calcium from the bones into the blood
- Parathyroid hyperfunction (hyperparathyroidism) due to the associated increased calcium level in the blood
- Excessive magnesium intake
Bladder stones occur in people of all ages. However, older and overweight people are more prone to bladder stones. According to statistics, men are more often affected than women. In them, benign enlargement of the prostate (BPH) predominates as a cause.
Bladder stones: examination and diagnosis
If bladder stones are suspected, a specialist in diseases of the urinary tract (urologist) is the right person to contact. In large cities, there are usually many urologists in private practice, while in rural areas urologists can often only be found in hospitals. First, the attending physician will take your medical history.
In doing so, you will describe your current complaints and any previous illnesses to the doctor. Then the doctor will ask further questions such as:
- Where exactly do you have pain?
- Do you have problems urinating?
- Are you (men) known to have an enlarged prostate?
- Have you noticed blood in your urine?
- Are you taking any medications?
The anamnesis is followed by a physical examination. The doctor listens to the abdomen with a stethoscope, for example, and then gently palpates it. The physical examination helps the doctor to determine the possible causes of the abdominal pain and which further examinations are necessary for clarification.
Further examinations
If bladder stones are suspected, further examinations are usually necessary. For this purpose, if the patient does not have urinary retention despite the bladder stone, the urine is examined in the laboratory for crystals, blood and bacteria. In addition, the doctor takes a blood sample, which is used to estimate kidney function and determine the uric acid level by means of a blood test.
A blood count and blood clotting provide clues to possible accompanying inflammation in the urinary bladder. If there is inflammation in the body, the level of white blood cells (leukocytes) and the so-called C-reactive protein (CRP) in the blood are greatly increased.
In this procedure, the practitioners inject a contrast medium into a vein. This is distributed throughout the body and makes it possible to visualize the kidney and the draining urinary tract with any stones. In the meantime, computed tomography (CT) has largely replaced urography. With a CT scan, all types of stones and any urinary obstruction can be detected safely and quickly.
Another examination method is cystoscopy. In this procedure, a rod-like or catheter-like instrument with an integrated camera (endoscope) is inserted into the bladder. This allows stones to be seen directly on the transmitted live images. The advantage of cystoscopy is that smaller stones can be removed during the examination. In addition, the physician can also detect other causes for a blockage of the urine outflow from the bladder, such as tumors.
Course of the disease and prognosis
About 90 percent of bladder stones smaller than five millimeters are washed out on their own with the urine. Meanwhile, pain often occurs when the bladder stone “migrates” through the urethra. As a rule, all urinary stones that do not go away on their own can be removed with an interventional or surgical procedure.
Successful bladder stone removal is no guarantee that urinary stones will never recur thereafter. Doctors repeatedly point out that urinary stones have a high recurrence rate. This means that people who once had bladder stones are at risk of developing them again.
How to prevent bladder stones
You reduce the risk of bladder stones by making sure you get regular exercise and eat a balanced diet that is high in fiber and low in animal proteins. Especially if you have had bladder stones before, it is recommended that you eat foods containing purine and oxalic acid only in small amounts.
These foods include, for example, meat (especially offal), fish and seafood, legumes (beans, lentils, peas), black tea and coffee, rhubarb, spinach and chard.
In addition, you should make sure to drink at least 2.5 liters per day, as this will flush the urinary tract well, reducing the risk of mineral salts settling. However, there is no sure way to avoid bladder stones in principle.
