Understanding Kidney Stones: A Urologist's Guide to Symptoms, Treatment, and Prevention
A few days ago, this guy comes limping into my clinic holding his lower back. His wife drove him because he couldn’t handle sitting behind the wheel. Turns out he had a stone wedged right at the bottom of his ureter. Once we took care of it, he looks at me and goes, “Doc, what the heck caused this?”
I hear that question every single day. People have all these ideas about kidney stones – some think it’s from drinking too much milk, others blame it on hard water. Most of what folks believe comes from stories they’ve heard, not from actual medicine. That’s why I figured it was time to set the record straight.
The Reality of Kidney Stones
Here’s how I break it down for my patients. You know when you make coffee and forget to drink it? Hours later, there’s that ring of dried coffee around the mug. Your kidneys work the same way when you’re not staying hydrated.
Your kidneys filter waste from your blood, and normally there’s plenty of water to keep everything dissolved. But when you get dehydrated, or when there’s just too much waste compared to water, crystals start forming. Calcium binds with oxalate, uric acid clusters together, and you end up with a stone in your kidney.
The sneaky part is that stones can hang out in your kidney for ages without bothering you. I’ve spotted stones on scans that patients never knew they had. Problems start when a stone decides to take a trip down the ureter. That’s the tube that drains your kidney, and it’s ridiculously narrow – about the width of a thin straw.
When Stones Become a Problem
Kidney stone pain is brutal – there’s no other way to put it. Patients describe it as some of the worst pain they’ve felt. Usually starts in your back, somewhere between your ribs and hip, then can spread around to your belly and down toward your groin.
Stone pain comes and goes in waves. You’ll hurt something awful for twenty minutes, then get a break where you think maybe it’s over. Then boom – another wave hits you. Your ureter keeps squeezing, trying to push that stone through, which is what causes those waves.
Here’s something that always surprises people – when you’re dealing with kidney stone pain, you can’t get comfortable. I’ve had patients tell me they tried lying down, standing up, pacing around the house at 3 AM. Nothing helps. It’s totally different from back pain where you might find relief by changing positions.
You might notice your pee looks different too – sometimes pink or red. Don’t panic if you see this. It’s just the stone scraping things up a bit as it moves through. Usually not serious, but it’s definitely something to mention when you call the doctor.
UNDERSTANDING DIFFERENT TYPES OF STONES
Most stones I see are made of calcium oxalate. These show up in people who don’t drink enough water or eat lots of high-oxalate foods. I’ve got patients who drink gallons of iced tea – tea’s loaded with oxalates – and they keep making stones until we figure out the connection.
Uric acid stones are tricky because they’re basically invisible on regular X-rays. I see these more in people who eat a lot of meat or have gout. Sometimes we don’t catch them until we do a CT scan.
Then there are struvite stones, which form when you’ve got a urinary tract infection. These suckers can get huge if we don’t catch them early. The infection part makes them more serious – we can’t just wait around with these.
Figuring Out What's Going On
Honestly, most of the time I know what’s happening before we even do any tests. After twenty years of this, you recognize the story. The way someone describes the pain, how it started, where it hurts – I’ve heard it a thousand times.
But we still need pictures to know exactly what we’re dealing with. CT scans are my go-to because they show me everything – how big the stone is, where it’s sitting, and what it’s made of. This stuff matters because it tells me whether we can wait it out or need to jump into action.
I always check their urine too. Blood in the urine is pretty common with stones, even if you can’t see it. And if there’s any sign of infection along with the stone, that changes everything – we need to move fast because infected stones can get dangerous quickly.
Treatment Isn't Just About This Stone
Here’s something I make sure every patient understands: dealing with kidney stones isn’t just about getting rid of the one that’s bothering you right now. It’s about making sure you don’t keep making new ones. How I handle your stone depends on a bunch of things – its size, where it’s stuck, how much pain you’re in, and how well your kidneys are working.
If we’re talking about a small stone – say, under 5mm – I usually suggest we try the wait-and-see approach first. That means managing your pain and drinking tons of water. I’ll often give you a medication called tamsulosin. It’s actually a prostate drug, but it relaxes the muscles in your ureter and can help stones pass easier.
Waiting it out can drive people crazy. I get that. I tell all my patients to strain their urine through a coffee filter when they go to the bathroom. Sounds gross, but when that stone finally comes out, we can analyze it and figure out how to prevent the next one.
When stones get bigger than 6-7mm or just won’t quit causing problems, that’s when we need to do something more active. Shock wave lithotripsy is pretty neat – we use sound waves to break up the stone from outside your body. You lie on a table, we focus these waves on the stone, and it crumbles into pieces small enough to pass. Most people go home the same day.
For stones that are lower down, closer to the bladder, I like doing ureteroscopy. Basically, I go up through your natural plumbing with a tiny camera and either grab the stone or blast it with a laser. The equipment keeps getting better – these scopes are incredibly small now and much easier on patients.
With really large stones that just won’t move, I sometimes have to go in through the back to reach the kidney directly. I know it sounds intimidating, but for big stones it’s often the quickest path to getting you better rather than trying other approaches that might fail.
Stopping Stones Before They Start
After treating kidney stones for years, I can tell you that stopping them before they form is way better than dealing with them after the fact. The prevention strategies really aren’t complicated either.
Water is your best friend. I tell patients all the time to drink enough so their urine stays light yellow – think pale lemonade, not dark apple juice. Dark, concentrated urine is where crystals love to form. That’s the basic chemistry of it.
Now, diet – that’s where people get confused. Everyone thinks they need to cut out calcium, but that’s actually backwards. The calcium in your food can help prevent stones by grabbing onto oxalates in your gut before they get to your kidneys. It’s the calcium pills that can cause problems.
What really matters is cutting back on salt. I see it all the time – patients who live on fast food and processed stuff keep making stones because all that sodium makes their kidneys dump calcium into their urine.
For patients who keep getting stones, I might have them do a 24-hour urine test. It’s a pain to do, but it shows us exactly what’s going on chemically so we can fix the root cause.
wHAT TO EXPECT GOING FORWARD
I’m straight with my patients about kidney stones. Statistics show that about half the people who get one stone will develop another within ten years. I don’t tell people this to scare them – I want them to understand why prevention matters so much.
Some patients get paranoid after their first stone. Every little backache has them worried it’s happening again. I understand the anxiety, but most people who’ve been through it learn to tell the difference between regular back pain and stone pain pretty quickly.
The upside is that we’ve got great options for treatment these days. Most stones can be handled with procedures that don’t require major surgery, and serious complications are pretty rare when we catch things early.
Bottom Line
You’d be surprised how many people end up dealing with kidney stones – I see about one in every ten patients develop them during their lifetime. The pain is absolutely brutal, no question about it, but the good news is we can fix the problem.
Here’s what I tell all my patients: the vast majority of kidney stone issues can be avoided with the right approach. Stay well-hydrated, keep sodium intake reasonable, and be smart about supplements. I’ve seen these three changes make all the difference for my patients.
If you’ve got terrible back or side pain, throwing up, or notice blood in your urine, don’t wait around. I’ve seen too many people suffer needlessly because they thought it would just go away on its own.
Every patient responds differently, and what works for your neighbor might be completely wrong for you. That’s why I tell people to stick with their urologist and follow the specific plan we work out together.
