How to Get Rid of Kidney Stones at Home or With Surgery

Most kidney stones smaller than about 5 millimeters will pass on their own with nothing more than fluids, pain medication, and patience. Larger stones, or those causing infection or a complete blockage, usually need medical or surgical intervention. The line between “wait it out at home” and “call the urologist” depends mostly on the stone’s size and where it sits in the urinary tract, though your pain level and overall health play a role too.

Size and Location Determine Whether a Stone Can Pass

Stone width is the single strongest predictor of whether it will leave your body without help. In a study tracking nearly 400 ureteral stones, those 3 mm or smaller passed on their own about 98% of the time, while stones 5 mm wide passed roughly 65% of the time. Once a stone hits 6 mm, the spontaneous passage rate drops to around a third, and stones 6.5 mm or larger passed only about 9% of the time.¹ An older but widely cited study found a similar pattern, with passage rates falling from around 87% for 1 mm stones to about 25% for stones over 9 mm.²

Location matters too. A stone that has already traveled down to the lower ureter, near the bladder, is much more likely to pass than one lodged high up near the kidney. That same study reported passage rates of about 48% for stones in the upper ureter versus roughly 79% for stones sitting right at the junction where the ureter meets the bladder.² So a 4 mm stone near the bladder has much better odds than the same-sized stone stuck near the kidney.

Managing Pain While You Wait

The pain from a kidney stone, often called renal colic, can be excruciating. It tends to come in waves as the ureter spasms around the stone. For most people, non-steroidal anti-inflammatory drugs like ibuprofen, naproxen, or ketorolac are the best first-line option. A Cochrane review found that patients given NSAIDs had lower pain scores than those treated with opioids in the majority of the trials examined, needed rescue medication less often, and experienced significantly less vomiting.³ A later meta-analysis confirmed that NSAIDs offered a small edge over opioids for initial pain relief and caused far fewer side effects, particularly vomiting.⁴

If you’re managing a stone episode at home, over-the-counter ibuprofen or naproxen is a reasonable starting point. Acetaminophen (paracetamol) can be added alongside for extra relief, since it works through a different mechanism and doesn’t clash with NSAIDs. Opioids are sometimes prescribed for breakthrough pain but tend to cause nausea and constipation, which make the whole experience worse.

Hydration and Home Strategies

Drinking plenty of fluids is probably the most repeated piece of kidney stone advice, and it holds up. A systematic review covering two decades of research confirmed that higher fluid intake leads to greater urine output and reduced stone formation.⁵ The goal during an active stone episode is to keep urine dilute so the stone has an easier path and so crystal growth slows. Aiming for enough fluid to produce at least two liters of urine per day is a common clinical target.

That said, the advice is easier to give than to follow. A study of recurrent stone formers who were repeatedly told to drink more found that their urine volume stayed stubbornly lower than non-recurrent patients, and the improvement over time was significantly smaller.⁶ If you’ve had stones before, making a conscious effort to carry a water bottle and track intake is worth the annoyance.

Lemon juice is a popular home remedy, and there’s a reasonable scientific basis for it. Citrate in lemon juice can be excreted unchanged in the urine, where it helps prevent calcium oxalate from crystallizing. Research on fresh lemon juice supplementation showed it raised urinary citrate without increasing oxalate levels, which is the ideal combination.⁷ Orange juice, by contrast, can raise urinary oxalate, making it a less useful choice. This doesn’t mean lemon water will dissolve an existing stone, but it can help with prevention and possibly slow growth during an active episode.

Dietary Calcium and a Common Misconception

Many people with calcium-based stones assume they should cut calcium from their diet. This is backwards. Dietary calcium actually binds oxalate in the gut before it can be absorbed, reducing the amount of oxalate that reaches the kidneys. Research on women’s dietary patterns found that calcium from food was associated with lower stone risk, while calcium supplements taken between meals didn’t have the same protective effect, likely because the timing didn’t align with oxalate-containing foods.⁸ The takeaway: eat calcium-rich foods with your meals, especially meals that contain spinach, nuts, chocolate, or other high-oxalate items.

Medications That Help Stones Pass

For stones in the 5 to 10 mm range that aren’t causing an emergency, your doctor may prescribe an alpha-blocker like tamsulosin (often known by the brand name Flomax). These drugs relax the smooth muscle in the ureter wall, reducing spasms and widening the path for the stone. Alpha-1 receptors are found in high density in the lower third of the ureter, which is why these medications work best for stones in that region.⁹ Beyond helping the stone move, alpha-blockers also seem to decrease the pain signals triggered by ureteral spasms.¹⁰

Tamsulosin has consistently shown higher stone expulsion rates and shorter times to passage compared with watchful waiting alone. In one trial comparing tamsulosin with other agents, the tamsulosin groups had significantly better expulsion rates and faster passage times for distal ureteral stones.¹¹ A nomogram study of patients with acute ureteric colic also found that medical expulsive therapy with alpha-blockers independently improved the odds of spontaneous passage.¹²

Dissolving Uric Acid Stones Without Surgery

Not all kidney stones are created equal. About 80% of stones are calcium-based, but roughly 10% are made of uric acid, and these have a special property: they can sometimes be dissolved entirely with medication. Uric acid stones form because the urine is persistently too acidic. Taking oral potassium citrate or potassium bicarbonate raises the urine pH enough that existing uric acid crystals can dissolve over weeks to months.¹³ This approach requires monitoring your urine pH at home with test strips and regular check-ins with your doctor, but it’s one of the few situations where you can genuinely get rid of a kidney stone without either passing it or having it surgically removed.

Uric acid stones are often invisible on standard X-rays (they’re “radiolucent”), so a CT scan is usually needed to diagnose them. If your doctor suspects a uric acid stone based on imaging and your urine chemistry, dissolution therapy is typically tried before any surgical option.

When You Need Surgery

If a stone is too large to pass, is causing a complete obstruction, has led to infection, or simply hasn’t budged after a reasonable waiting period, surgical options come into play. The three main procedures used today are shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.

Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) uses focused sound waves generated outside the body to shatter a stone into small fragments that can then pass naturally. It’s completely non-invasive and doesn’t require general anesthesia in many cases, which is a major advantage. However, it doesn’t work equally well on all stones. A study found that only about 37% of treated stones were completely fragmented, and the stone’s density on CT scan, its location, and whether there were multiple stones all affected the outcome.¹⁴ Very hard or very large stones are poor candidates for ESWL.

Ureteroscopy With Laser Lithotripsy

Ureteroscopy involves threading a thin, flexible scope up through the urethra, bladder, and into the ureter to reach the stone directly. Once the scope reaches the stone, a holmium laser breaks it into tiny fragments, which are either extracted with a small basket or left to pass on their own.¹⁵ This procedure works for stones in the ureter and in the kidney, and it can handle harder stones that ESWL would struggle with. Flexible ureteroscopy has even been used successfully for kidney stones 2 cm and larger, though those cases require experienced surgeons and often need a temporary ureteral access sheath.¹⁶

Percutaneous Nephrolithotomy

For very large stones, including staghorn calculi that fill the entire collecting system of the kidney, percutaneous nephrolithotomy (PCNL) is considered the gold standard.¹⁷ This procedure involves making a small incision in the back and creating a tract directly into the kidney, through which the surgeon can break up and remove stone material. It’s the most invasive of the three main options, but it’s also the most effective for very large stone burdens. Staghorn stone cases do carry higher complication rates: a global study found that postoperative fever, bleeding, and the need for blood transfusion were all more common with staghorn stones, and the stone-free rate was lower at about 57% compared with around 83% for simpler stones.¹⁸

Dealing With Stent Discomfort After Surgery

After ureteroscopy or PCNL, surgeons usually place a temporary internal stent (a thin plastic tube) in the ureter to keep it open while swelling resolves. These stents are effective at preventing obstruction, but they come with a well-documented downside: stent-related symptoms affect over 80% of patients and can include frequent urination, urgency, bladder pain, flank discomfort, and blood in the urine.¹⁹ Many people describe the stent as more bothersome than the stone itself.

If you’re dealing with stent symptoms, alpha-blockers are again helpful. A systematic review found clear support for alpha-1 blockers in reducing stent-related discomfort, with anticholinergic medications providing additional benefit either alone or in combination.²⁰ A more recent Bayesian network meta-analysis identified that a combination of silodosin (an alpha-blocker) and solifenacin (an anticholinergic) was the most effective drug pairing for both urinary symptoms and pain.²¹ Stents are usually removed within one to two weeks via a quick office cystoscopy, and symptoms typically resolve quickly after removal.

How Doctors Decide Which Imaging to Order

When you show up with suspected kidney stone pain, the diagnostic workup usually starts with imaging. CT scan without contrast is the gold standard for accuracy, but ultrasound is increasingly used as the first step because it involves no radiation. A large trial published in the New England Journal of Medicine found that starting with ultrasound instead of CT led to significantly lower radiation exposure with no meaningful difference in missed serious diagnoses, adverse events, pain scores, or hospital readmissions.²²

That doesn’t mean ultrasound is always sufficient. It’s less accurate overall, and a comparative analysis found that CT scan had a slight advantage over ultrasound in patients with low to moderate pre-test probability of stones, though the two were comparable when clinical suspicion was already high.²³ In pediatric patients, low-dose CT delivers roughly a third of the radiation of a standard-dose scan while maintaining high accuracy, making it a good middle ground when ultrasound is inconclusive.²⁴

Kidney Stones During Pregnancy

Kidney stones in pregnancy present a tricky management challenge because several standard tools, including CT scans and certain medications, carry risks for the developing baby. Ultrasound is the primary imaging choice, with MRI as a second-line option if more detail is needed.²⁵

Conservative management is the default first approach. This means hydration, anti-nausea medication, and pain relief with acetaminophen throughout pregnancy, with NSAIDs considered safe only in the first and second trimesters.²⁶ Spontaneous passage rates in pregnant patients range widely, from about 23% to 84% depending on the study and stone characteristics.²⁷ When conservative treatment fails, the usual options are placing a ureteral stent or a percutaneous nephrostomy tube to drain the kidney until the stone can be dealt with more definitively after delivery. Ureteroscopy during pregnancy has become more common in experienced centers, though ESWL is contraindicated because the shock waves could harm the fetus.

When to Go to the Emergency Room

Most kidney stone episodes, however painful, are not true emergencies. But there are clear situations where you should seek immediate care:

Fever with stone pain: This combination suggests a urinary tract infection behind an obstructing stone, which can escalate to life-threatening sepsis within hours. An infected, obstructed kidney needs emergency drainage.
Complete inability to keep fluids down: Persistent vomiting leads to dehydration, which concentrates the urine and makes everything worse. You may need IV fluids.
Pain that doesn’t respond to anything: If over-the-counter NSAIDs aren’t touching the pain, you need stronger medication and possibly urgent intervention.
Only one functioning kidney: A stone blocking your only kidney can cause acute kidney failure. This requires immediate action.

Infection stones, made of struvite, are a particular concern because they form specifically due to urease-producing bacteria and can grow rapidly into large, branching staghorn shapes. These stones always require treatment because the underlying infection won’t resolve while the stone remains.

Preventing the Next Stone

If you’ve had one kidney stone, your risk of having another within five to ten years is substantial. Prevention starts with understanding what your stones are made of, which is why your doctor should send any passed or extracted stone for laboratory analysis. Beyond that, a 24-hour urine collection is the standard tool for diagnosing the specific metabolic abnormalities that drove your stone formation.²⁸ This test measures things like calcium, oxalate, citrate, and uric acid levels in your urine over a full day, and the results guide targeted dietary changes or medications.

General prevention advice applies to almost everyone: drink enough to produce at least two liters of urine daily, eat calcium-rich foods with meals, limit sodium and animal protein, and keep oxalate intake moderate. For people with specific abnormalities, doctors may prescribe thiazide diuretics (for high urine calcium), potassium citrate (for low citrate or uric acid stones), or allopurinol (for high uric acid). These treatments have been studied for decades and can cut recurrence rates significantly when patients actually follow them.

The Gut Bacteria Connection

An emerging area of research involves a gut bacterium called Oxalobacter formigenes, which feeds on oxalate in the intestine and breaks it down before it can be absorbed into the bloodstream. A case-control study found that colonization with this bacterium was associated with roughly a 70% reduction in the risk of being a recurrent calcium oxalate stone former.²⁹ The catch is that antibiotics readily kill off O. formigenes, and once lost it may not recolonize easily. This finding has prompted interest in probiotic supplements containing oxalate-degrading bacteria, though commercial products are not yet well validated. It’s another reason to avoid unnecessary antibiotic courses if you’re a stone former.

Kidney Stones in Children

Pediatric kidney stones have been rising in frequency over the past two decades, and management in children requires extra caution around radiation exposure and anesthesia. Treatment decisions weigh the same factors as in adults, including stone size, location, and composition, but with additional emphasis on minimizing CT scans and general anesthesia whenever possible. A thorough metabolic workup is especially important in children because underlying metabolic abnormalities are more common in pediatric stone formers than in adults, and identifying these early can prevent years of recurrent episodes. Treatment choices range from observation with supportive care to medical expulsive therapy and surgery, with the goal of clearing the stone while limiting harm from the workup and treatment process itself.