Kidney stones are hard deposits of minerals and salts that form inside the kidneys. When they move into the narrow tubes of the urinary tract, they cause intense pain, often called renal colic. This discomfort signals the stone is attempting to pass from the kidney down the ureter toward the bladder. While small stones may exit without intervention, larger ones require strategic management to expedite passage and control pain. Understanding the steps you can take at home and when to seek emergency intervention is paramount to safely managing this condition.
Immediate Steps for Aiding Stone Passage at Home
The primary action to encourage stone passage is aggressive fluid intake, which increases the volume and flow of urine. Aim to drink enough water daily to produce at least two liters of light-colored urine, helping to flush the stone out of the ureter and into the bladder. Consuming citrus juices, particularly lemon juice, is also beneficial because they contain high levels of citrate, which binds to calcium and may prevent the stone from growing larger.
Moderate physical activity can promote stone movement through the urinary tract. Gentle activities like walking, light jogging, or climbing stairs use gravity and body motion to encourage the stone to dislodge. Avoid over-exertion, which could increase discomfort. Pain management is often achieved with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and ease the pain caused by the stone irritating the ureter wall.
It is necessary to capture the stone once it passes, as composition analysis is essential for preventing future occurrences. Patients are typically instructed to urinate through a specialized strainer to collect the stone or any fragments. This allows a healthcare provider to determine the stone type (e.g., calcium oxalate or uric acid), guiding dietary and medical preventative measures.
Medical Treatments to Facilitate Natural Passage
For stones causing significant pain or those slightly larger than a few millimeters, a healthcare professional may prescribe medication. Alpha-blockers, such as tamsulosin (Flomax), are commonly used in medical expulsive therapy. This class of drug works by relaxing the smooth muscles in the wall of the ureter, the tube connecting the kidney and bladder.
The relaxation and widening of the ureter’s lumen make it easier for the stone to travel through the narrow passage. Studies suggest that alpha-blockers significantly increase the stone passage rate, particularly for stones between 5 and 10 millimeters. By accelerating expulsion, these medications reduce the time a patient experiences pain and may decrease the need for powerful pain relievers. Prescription pain management, often involving stronger NSAIDs or narcotics, is also used to make the passage tolerable.
Recognizing Signs of Serious Complications
While many stones pass naturally, certain symptoms indicate a serious complication requiring immediate medical attention. Uncontrolled pain that cannot be managed by prescribed medication suggests the stone may be causing a complete obstruction. The presence of fever and chills alongside the pain is especially concerning, as it signals a urinary tract infection that has progressed to the kidney. This combination of obstruction and infection can rapidly lead to a life-threatening condition called urosepsis.
Another sign of an emergency is the complete inability to urinate or severely diminished urine output, suggesting a total blockage of the urinary tract. Persistent nausea and vomiting that prevents the patient from keeping down fluids or medication also necessitates emergency care. Immediate evaluation in an emergency setting is necessary if these severe symptoms occur to prevent severe dehydration, ensure pain control, and avoid potential kidney damage.
Procedures for Stones That Require Removal
When a stone is too large (typically greater than 10 millimeters) or irreversibly lodged in the ureter, it will not pass naturally and requires procedural intervention. One non-surgical option is Extracorporeal Shock Wave Lithotripsy (ESWL). This procedure uses focused sound waves directed from outside the body to break the stone into tiny, passable fragments. ESWL is most effective for stones in the kidney or upper ureter that are visible on X-ray, and recovery is often rapid, allowing patients to resume normal activities quickly.
Alternatively, Ureteroscopy (URS) involves passing a thin, flexible scope through the urethra and bladder up into the ureter to visualize the stone directly. Once located, the stone can be grasped with a basket-like device or broken into smaller pieces using a laser fiber. Following URS, a temporary ureteral stent is often placed to keep the ureter open, allowing urine to drain and reducing swelling while the passage heals. This technique is generally more successful than ESWL for hard or larger stones in the lower ureter, and the stent is later removed in a quick office procedure.