“It was the worst pain I’ve ever had in my life.”
“Let me tell you a Doc, I would rather have two more babies than deliver one more of these stinking stones.”
“I was sitting there minding my own business and all of a sudden it felt like a pitbull jumped up and grabbed a hold of my back and would not let go.”
Sound familiar? The above are all war stories from some of my patients that have experienced trying to pass a stone.
Kidney stones develop, initially, as just small crystals on the inside of the kidney. Under the right conditions—with the right building blocks in the diet and some dehydration—they grow larger and larger.
As long as these stones remain “attached“ to the inside of the kidney, they really can’t cause any pain. Once the stone gets large enough and the attachment is no longer firm enough, it eventually breaks off of the inside lining of the kidney and becomes free-floating in a “funnel system” called the renal pelvis. This pocket of urine that the kidney makes then funnels down into the ureter—a long tube—which carries the urine from the kidney to the bladder.
Stones can cause pain in one of two ways. Once the stone starts traveling down the ureter, it can be too large to pass easily and eventually can get stuck in the tube. This can then partially or completely block the flow of urine from the kidney past the stone. It’s the degree of blockage that causes the severity of the pain as the kidney continues to make urine even with the ureter blocked off. The urine starts filling up the tube and backs up towards the kidney which makes the kidney swell. This results in intense pain. The ureter can also have sharp edges that can tear the inside lining of the ureter and cause blood in the urine and also results in pain.
Some stones that are small enough and low enough in the ureter can pass spontaneously with or without the addition of a medication called Flomax or tamsulosin. When a stone is too large to pass, we have procedures that are designed to either crush the stone called lithotripsy, or ESWL, and ureteroscopy with laser fragmentation of the stone.
So if you or someone you know has pain suggestive of a stone, you can call my office to make an appointment at the Providence location, if the pain is bearable. Otherwise, you can go to urgent care or the emergency room to determine if the pain is indeed caused by a stone. A CAT scan will be done to determine the size and location of a stone, if present. If you have back pain that is severe and associated with fever, you definitely need to go directly to the emergency room for evaluation as this could be a sign of sepsis.