What Can You Do for a Kidney Stone: Treatment Tips

Most kidney stones smaller than about 5 or 6 millimeters will pass on their own with enough fluids and pain control, while larger or stubbornly lodged stones need medical or surgical intervention. The specifics of what you should do depend on the stone’s size, location, and composition, along with how much pain you’re in and whether complications like infection or blockage are developing. What follows covers the full range, from riding out a small stone at home to the procedures used for bigger ones, and then the dietary and medication strategies that keep new stones from forming.

Managing the Pain

Renal colic, the intense flank-to-groin pain a stone causes as it moves through the ureter, is often described as one of the most severe pains people experience. The first priority is getting that pain under control, and the evidence consistently points to anti-inflammatory painkillers (NSAIDs like ibuprofen, ketorolac, or diclofenac) as the best first choice. NSAIDs work especially well for stone pain because they don’t just block the pain signal; they also reduce the swelling and pressure buildup inside the kidney and ureter that drive much of the discomfort.¹

A large meta-analysis pooling data from thousands of patients found that NSAIDs provided a small but real edge over opioids for initial pain relief at 30 minutes, with the added benefit of fewer people needing rescue pain medication and substantially less vomiting.² Opioids still have a role when NSAIDs aren’t enough or can’t be used (for example, if you have kidney disease or a stomach ulcer), but the trend in urology has shifted firmly toward trying to avoid opioids as the default.³

A simpler option that sometimes gets overlooked is heat. A randomized trial testing a local heat patch on people with stone pain found it offered meaningful relief as a non-drug add-on.⁴ A heating pad or hot water bottle on your flank won’t replace medication for severe colic, but it can take the edge off and is worth trying while you wait for pills to kick in.

Helping a Small Stone Pass

If imaging shows your stone is small enough that spontaneous passage is realistic, the game plan is straightforward: drink plenty of fluids and manage pain while you wait. Staying well hydrated increases urine output, which helps push the stone along and also corrects any dehydration from vomiting or not being able to keep fluids down.⁵ A common target is around two to three liters of water per day, though your doctor may adjust that based on your situation.

You may also be prescribed tamsulosin, a medication originally developed for prostate enlargement that relaxes the smooth muscle in the ureter. For stones in the lower ureter, tamsulosin can improve the odds of passing the stone without surgery. One randomized trial focused on larger lower-ureteral stones (10 to 15 mm) found that tamsulosin significantly increased the spontaneous passage rate compared to placebo, though it didn’t eliminate the need for procedures in most of those patients since the stones were on the bigger side.⁶ For smaller stones, the benefit is more meaningful, and the medication is generally well tolerated. Its main side effects are mild dizziness and occasionally a drop in blood pressure when standing.

How long should you wait? Most urologists give it two to four weeks for a stone to pass, depending on size. If the stone hasn’t moved, or if you develop fever, worsening pain, or signs of infection, that waiting period gets cut short and intervention becomes necessary.

When You Need a Procedure

Stones that are too large to pass, stones that get stuck, or stones causing complications like infection or kidney damage need to be removed. Three main procedures dominate modern urology, each suited to different situations.

Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL or SWL) uses focused sound waves from outside the body to break a stone into small fragments that can then pass naturally. It’s typically the go-to for kidney stones around 20 mm or smaller and for upper ureteral stones.⁷ The appeal is that it’s noninvasive: no incisions, no scope threaded through your urinary tract. A large study of nearly 3,000 patients found an overall stone-free rate of about 87% at three months, with success depending heavily on stone size, location, and patient factors.⁸

The downside is that SWL doesn’t always finish the job in one session, and some patients need follow-up procedures. A head-to-head randomized trial comparing SWL to ureteroscopy for ureteral stones found that about 22% of SWL patients needed further treatment, compared to roughly 10% of those who had ureteroscopy.⁹ Hard stones, like those made of calcium oxalate monohydrate or cystine, resist fragmentation more than softer ones. And for patients with a higher body mass index, the shock waves have a harder time reaching the stone effectively.

Ureteroscopy

Ureteroscopy involves passing a thin, flexible scope up through the urethra and bladder into the ureter (or kidney) and using a laser to fragment the stone directly. It’s more invasive than SWL but tends to clear stones more reliably in a single session, especially for ureteral stones. A cost-utility analysis found that ureteroscopy produced slightly better quality-of-life outcomes than SWL, though at a higher overall cost.¹⁰ In children with upper urinary tract stones over 1 cm, ureteroscopy achieved a stone-free rate of about 97%, compared to roughly 76% for SWL.¹¹

The trade-off is that ureteroscopy usually requires general anesthesia, and a temporary ureteral stent is often placed afterward to keep the ureter open while swelling subsides. That stent is, frankly, the most-complained-about part of the whole process.

Percutaneous Nephrolithotomy

For very large stones, including staghorn calculi that branch into multiple parts of the kidney’s drainage system, percutaneous nephrolithotomy (PCNL) is the standard. The surgeon creates a small tunnel through the back directly into the kidney and uses a scope to break up and remove the stone. PCNL is the most invasive of the three common approaches, but it’s the only realistic option for big or complex stones.¹² It often requires a hospital stay of a day or two and carries a higher complication rate than SWL or ureteroscopy.

A comparative study of large staghorn stones found an interesting pattern: the more invasive the procedure, the higher the one-session stone-free rate but the greater the loss of kidney function afterward. PCNL preserved the most kidney function among the options studied, but its single-session clearance rate for large staghorns was lower, meaning more follow-up procedures and higher total costs.¹³

Living With a Ureteral Stent

If you have ureteroscopy (and sometimes after other procedures), you’ll likely wake up with a ureteral stent, a thin plastic tube running from your kidney to your bladder. Stents are effective at preventing dangerous blockages from swelling or stone fragments, but they come with a well-documented set of unpleasant symptoms: urinary frequency, urgency, burning during urination, blood in the urine, and flank discomfort, especially during physical activity. These symptoms tend to be worst in the first couple of days and remain elevated the entire time the stent is in place.¹⁴

A 10-year clinical review confirmed that stent-related symptoms hit hardest around seven days after placement, with frequency, urgency, and pain all significantly worse than baseline. Encouragingly, quality of life bounced back toward normal within about two weeks of stent removal.¹⁵ Individual experiences vary widely, though. Some people barely notice their stent; others find it nearly as miserable as the stone itself. Alpha-blockers like tamsulosin are sometimes prescribed to ease stent symptoms, and staying well hydrated tends to help reduce the irritation.

Dietary Changes That Actually Matter

Once a stone has been dealt with, the question shifts to prevention. About half of people who form one calcium stone will form another within five to ten years without changes, so prevention matters. The most impactful dietary change is also the simplest: drink more water. A large analysis of urinary risk factors found that urine volume was one of the three most important factors for stone formation, alongside calcium excretion and citrate levels.¹⁶ Aiming for urine output of at least two liters per day, which typically means drinking about three liters of fluid, dilutes the substances that crystallize into stones.

Cutting back on sodium is the next big lever. High salt intake drives calcium into the urine and simultaneously lowers citrate, a natural stone inhibitor. Studies have shown that for every 2,300 mg increase in dietary sodium, urinary calcium rises by about 40 mg in normal adults, and the increase is roughly double that in people who already form stones.¹⁷ High sodium also raises urine pH and decreases citrate excretion, compounding the risk.¹⁸

Calcium intake is the area where the common advice gets counterintuitive. Many stone formers assume they should eat less calcium, but for calcium oxalate stones (the most common type), adequate dietary calcium actually helps. When you eat calcium-rich foods with meals, the calcium binds oxalate in the gut before it’s absorbed, reducing the amount of oxalate that reaches your kidneys. A clinical study confirmed that regular calcium supplementation didn’t raise the combined calcium-oxalate product in urine and actually lowered the proportion of oxalate relative to calcium.¹⁹ The key is getting calcium from food or taking supplements with meals, not on an empty stomach.

Citrus, especially lemons, gets a lot of attention as a stone prevention strategy. Citrate binds calcium in urine and inhibits crystal formation.²⁰ A prospective study found that lemon juice increased urinary citrate about 2.5-fold in patients with low citrate levels and also decreased urinary calcium.²¹ However, a randomized trial testing long-term lemon juice supplementation found that it didn’t reliably increase 24-hour urinary citrate, possibly because the kidneys reabsorb the extra citrate. The protective effect may instead come from reduced sodium excretion and lower urine saturation.²² So lemon water is worth trying, but it’s not a guaranteed fix, and the mechanism may be more complicated than simply “more citrate in, more citrate out.”

Medications for Recurrent Stone Formers

When dietary changes alone aren’t enough, several medications have strong evidence behind them. The choice depends on what’s driving your stones, which is where a metabolic workup becomes important.

Thiazide diuretics reduce calcium in the urine and are among the best-studied stone-prevention drugs. A study tracking over 500 patients on low-dose hydrochlorothiazide plus amiloride over five years found a dramatic drop in new stone formation: only 53 stones appeared during the study period, compared to the roughly 916 that would have been expected based on patients’ prior history.²³ A more recent comparison of preventive medications found that thiazides had the lowest stone recurrence rate at about 15%, compared to roughly 21% for allopurinol or alkali citrate, translating to about a third lower odds of a new stone event.²⁴

Allopurinol is used specifically when high uric acid in the urine is contributing to stones, even calcium-based ones (uric acid crystals can act as seeds for calcium oxalate to grow on). One study found that both allopurinol alone and allopurinol combined with a thiazide dramatically cut stone formation, and interestingly, the benefit seemed to persist even after the medications were stopped, suggesting that the medical guidance patients received alongside the prescriptions played its own role.²⁵

Potassium citrate supplements serve double duty: they raise urinary citrate (the stone inhibitor) and alkalinize urine. For uric acid stones specifically, urinary alkalinization is the main treatment strategy, since uric acid crystallizes in acidic urine and dissolves when the pH rises.²⁶ Uric acid stones are actually one of the few stone types that can sometimes be dissolved without surgery, just by raising the urine pH with citrate supplements or a more alkaline diet.

The 24-Hour Urine Test

If you’ve had more than one stone, most guidelines recommend a metabolic evaluation that includes a 24-hour urine collection. This test measures the levels of calcium, oxalate, citrate, uric acid, sodium, and other substances in your urine over a full day, giving your doctor a detailed picture of what’s chemically driving your stone formation.²⁷ The results guide which dietary changes or medications will help you specifically, rather than relying on generic advice.

Despite the clear value, this test is surprisingly underused. A population-based study found that fewer than 5% of kidney stone patients had a 24-hour urine test, and only about 6% of those with recurrent stones did. Just 0.6% had all three recommended measurements completed.²⁸ If you’re a repeat stone former and nobody has offered you this test, it’s worth asking about. Targeted prevention based on your actual urine chemistry is far more effective than guessing.

Special Cases and Less Common Stone Types

Not all stones respond to the same strategies. Cystine stones arise from an inherited condition called cystinuria, where the kidneys leak excessive amounts of the amino acid cystine into the urine. Treatment is aggressive: fluid intake high enough to produce over three liters of urine daily, sodium and protein restriction to decrease cystine excretion, and alkalinization of urine to a pH of 7.0 to 7.5. When those measures aren’t enough, drugs like tiopronin or D-penicillamine bind cystine and prevent it from crystallizing.²⁹ Cystine stones tend to recur frequently and often require repeated surgical interventions, making prevention even more critical than for typical calcium stones.

Struvite stones (sometimes called infection stones) form when certain bacteria that produce an enzyme called urease infect the urinary tract. These bacteria raise urine pH dramatically, allowing struvite crystals to form rapidly and sometimes grow into large staghorn shapes. The treatment is twofold: surgical removal of the stone and eradication of the underlying infection with antibiotics. Without clearing the infection, the stone will simply regrow.

Herbal Remedies and Phyllanthus niruri

Among herbal remedies, Phyllanthus niruri (commonly called “stone breaker” or “chanca piedra”) has the most clinical data behind it. A systematic review and meta-analysis of clinical studies found that P. niruri treatment was associated with significant decreases in both stone size and stone number.³⁰ A separate study found it reduced urinary oxalate in patients with high oxalate levels and decreased uric acid excretion in those with elevated uric acid, with no significant adverse effects on metabolic blood markers.³¹

The research is promising enough to take seriously but not yet strong enough to replace conventional treatment. Most of the existing studies are relatively small, and the supplement industry doesn’t standardize dosing the way pharmaceutical companies do. If you’re interested in trying it, it’s reasonable to discuss with your urologist as an add-on, particularly for prevention, rather than as a substitute for proven approaches. Herbal products also aren’t well-regulated, so quality varies widely between brands.

How Stones Are Diagnosed

If you show up at an emergency department with suspected kidney stone pain, imaging is the first step. CT scans remain the gold standard for accuracy, catching stones that ultrasound misses. A large randomized trial found, however, that starting with ultrasound instead of CT led to lower radiation exposure without differences in missed serious diagnoses, complications, pain control, return visits, or hospitalizations.³² For that reason, ultrasound is increasingly used as the first imaging step, especially for younger patients and those who may need repeated imaging over time.

Ultrasound does have meaningful limitations. Its sensitivity for stone detection is around 77%, and it tends to overestimate stone size, measuring stones as about 3 mm larger on average than CT does. That overestimation is more pronounced for smaller stones and in patients with a higher body mass index, and it can lead to unnecessary surgical interventions in a significant proportion of cases.³³ If your treatment plan depends heavily on exact stone size, a CT scan may still be necessary to get an accurate measurement before deciding between watching and operating.