Bladder Stones

Our body contains several minerals and substances like calcium, potassium, urea and so on. These minerals, acquired from what we eat, move around in the body in the form of crystals. As per the body’s biology, these minerals are meant to be used for the release of energy and then excreted out of the body. However, when these crystals accumulate in a mass inside the body, it results in what is known as a calculus, or stone. This stone normally occurs in the bladder, kidneys, gall bladder, and so on. When the stone occurs in the bladder, it is referred to as a bladder stone. Often times, people who have a bladder stone do not feel any symptoms, however, in some cases a bladder stone could cause immense pain and even result in blood being passed through the urine.

Bladder stones are hard, calcified masses of minerals that form in your urinary bladder.

These stones develop as a result of concentrated, stagnant urine.

The concentrated urine causes crystallization of the minerals present.

Urinary stasis, or stagnant urine, is often the result of anatomic defects, strictures, infections, foreign bodies, or not being able to completely empty your bladder.

Bladder stones sometimes remain asymptomatic until they are discovered through tests performed for other reasons.

If symptoms do occur, they can range from pain in the abdomen to bloody urine (hematuria).

Small bladder stones may pass on their own, but larger stones need surgical removal by a doctor.

Bladder stones can lead to infection and other complications if left untreated.

How Are Bladder Stones Formed?

The bladder is a balloon-shaped organ situated in the pelvic region of the body. The primary function of the bladder is to store the urine that is secreted from the kidneys. The kidneys assist in filtering waste from the body and creating urine; they act as filters for removing toxins and wastes. The wastes are mixed with water, from which urine is generated and excreted from the ureters and then passed on to the bladder. The urine remains in the bladder until one feels the need to urinate, at which time it is released through a narrow tube known as the urethra.

Among the waste products excreted through urine is urea. When urea is in the bladder for a long time, it begins to come together to form a crystal known as calculi, or bladder stones.

Most patients with bladder stones may not have any signs or symptoms, even with larger stones.

The signs and symptoms develop when a stone causes irritation to the bladder wall or blockage to the flow of urine.

These include:

• Pain or pressure in the lower abdomen
• Blood in the urine
• Pain or difficulty while urinating
• Frequent urge to pass urine
• Abnormally colored, cloudy, or dark urine
• In men, pain or discomfort in the external genitalia

Bladder stones are usually caused when you are unable to completely empty the urine collected in your bladder.

The urine that remains in your bladder for a long time becomes concentrated, then crystallizes and eventually develops into bladder stones.

In most cases, another problem in the urinary system may affect your bladder’s ability to empty completely.

The most common underlying conditions that cause bladder stones include:

• Prostate gland enlargement: In men, there exists a tiny gland that is located between the bladder and the penis, around the urethra, called the prostate gland. At a young age, the prostate gland helps in the production of semen, but as men grow older, the prostate gland begins to grow enlarged, which increases the pressure on the urethra and restricts urine flow. Due to this restricted flow, the urea is not completely excreted out of the body, which eventually results in the formation of stones.
• Cystocele: For women, age and several other factors tend to cause the bladder to become weak, and it can often drop into the vagina. This obstructs the normal urine flow as the urine tries to leave the bladder. This strain can cause urea buildup, which eventually results in bladder stones. The weakening of the bladder can occur due to various reasons, including the birthing process, severe constipation, or heavy weightlifting. This condition wherein the bladder drops down to the vagina is known as cystocele.
• Bladder diverticulum: Several pouch-like structures, known as diverticula, can form around the bladder wall. When these pouches become enlarged, they can obstruct the normal urine passage and lead to urea accumulation in the body or the formation of bladder stones. These pouches can occur due to an infection or even as a result of prostate enlargement. In some cases, they exist right from birth.
• Damaged nerves (neurogenic bladder): Normally, nerves carry impulses from your brain to the bladder muscles, directing them to either tighten or relax. If these nerves get damaged — due to a stroke, injury to the spinal cord, or other health problems — your bladder will not empty completely. With a neurogenic bladder condition, a person is unable to completely remove the contents from the bladder, which causes a certain amount of urea to settle back in, resulting in bladder stones.

Other conditions that can cause bladder stones include:

• Bladder augmentation surgery: This surgery is administered to people to treat incontinence and uses a piece of bowel to enlarge the bladder. This condition is common and occurs in almost 5% of patients who undergo the bladder augmentation surgery. It eventually causes the formation of stones.
• Inflammation: Bladder inflammation caused by a urinary tract infection or radiation therapy to your pelvic area can cause the formation of stones in the bladder.
• Medical devices: Sometimes, the urinary bladder catheter (a thin, flexible tube inserted through the urethra to drain urine from your bladder) can cause bladder stones. In addition, objects such as a contraceptive device or stent may accidentally migrate to your bladder. Mineral crystals, which may eventually develop into stones, tend to deposit on the surface of these devices.
• Kidney stones: Small kidney stones may sometimes travel down the ureters to reach your bladder and if they do not pass out through urine, they develop into bladder stones.
• Diet: Although not one of the most common factors, a diet that is high in fat content, salts, and sugars could result in bladder stones.

If you think you have symptoms of bladder stones, you may initially consult your family doctor or a general practitioner to make a diagnosis.

If your condition requires specialized treatment, you will be referred to a doctor who specializes in treating urinary tract disorders or a urologist.

To be ready for your appointment, make a list of:

• The symptoms you are experiencing, including the ones that seem unrelated to your condition
• Key personal information, including any major stressful situations or recent life changes
• All medications you are taking currently, including vitamins or other supplements

For bladder stones, some of the basic questions you can ask your doctor include:

• Do bladder stones pass on their own? If not, is removal necessary, and what is the best method of removal?
• What are the possible risks of the treatment you are proposing?
• What will be the outcome if the stones are not removed?
• Is there any medication that can be taken to eliminate bladder stones?
• Is there any way to prevent their recurrence?
• I have been diagnosed with other health conditions. How can I best manage these together?
• Should I follow any dietary restrictions?

Your doctor is likely to ask you a number of questions, such as:

• When did you first experience your symptoms?
• Do your symptoms appear occasionally or have they been continuous?
• What is the severity of your symptoms?
• Did you have a fever or chills?
• Is there anything that seems to improve or worsen your symptoms?

An accurate diagnosis of bladder stones may be determined by these tests:

• A physical examination: This involves palpation (feeling) of your lower abdomen to check whether there is enlargement of the bladder, and in some cases a rectal examination may be done to check for prostate gland enlargement. You may discuss your urinary symptoms with your doctor.
• Urine tests (urinalysis): A sample of your urine will be collected to be examined for microscopic amounts of blood, bacteria, and crystallized minerals. A urinalysis also indicates the presence of a urinary tract infection, which may cause bladder stones or might have occurred as a result of bladder stones.
• Spiral computerized tomography (CT) scan: A spiral CT scan provides images of internal structures with greater definition. It can detect smaller stones and is considered the most sensitive test for the diagnosis of bladder stones.
• Ultrasound: An ultrasound examination uses sound waves to create pictures of internal organs and can help in the detection of bladder stones.
• X-ray: An X-ray of your kidneys, ureters, and bladder can determine the presence of stones in your urinary tract. Some types of stones cannot be visualized on conventional X-rays.
• Special imaging of your urinary tract (intravenous pyelogram): In this test, a contrast dye is injected into a vein in your arm, which then flows into your kidneys, ureters, and bladder, outlining and highlighting each of these organs. X-ray pictures are taken at specific points of time during the procedure to check for the presence of stones.

Removing bladder stones is the main treatment method.

If the stone is small enough, your doctor may advise you to drink plenty of fluids, especially water, so that the stone can be eliminated through urine.

Since bladder stones often develop as a result of an inability to empty the bladder completely, spontaneous passage of these stones is unlikely.

The most effective medical treatment for bladder stones is achieving urinary alkalization for the dissolution of uric acid stones.

Stone dissolution may be achieved if the urinary pH can be modified to a level greater than or equal to 6.5.

Potassium citrate 60 mEq/day is the drug of choice for stone dissolution.

Surgical Approaches

• Transurethral cystolitholapaxy: In transurethral cystolitholapaxy, a small tube with a camera attached to its end (cystoscope) is inserted through your urethra and into your bladder to visualize the stone. Your doctor then uses an energy source such as a laser, an ultrasound, or a mechanical device (a lithoclast), an electrohydraulic device, a manual lithotrite to fragment the stone into smaller pieces and flush them from your bladder. Before the procedure, an anesthesia that numbs the lower part of your body (regional anesthesia) or that makes you unconscious and unable to feel pain (general anesthesia) is administered. Complications following a cystolitholapaxy rarely happen, but urinary tract infections, fever, a tear in your bladder, or bleeding may occur. Your doctor may prescribe antibiotics to be taken before the procedure in order to decrease the risk of infection. About a month after the cystolitholapaxy procedure, your doctor will make sure that no stone fragments remain in your bladder.
• Percutaneous suprapubic cystolitholapaxy: This is the primary approach used in children, as the percutaneous route allows for the use of shorter- and larger-diameter endoscopic equipment (usually an ultrasonic lithotripter) that performs rapid fragmentation and evacuation of the bladder stones.
• Open suprapubic cystotomy: This approach is used when the bladder stones are too large and hard to be fragmented. These stones are removed intact. Your doctor makes an incision on your bladder and removes the stones directly. This approach is chosen when open prostatectomy or bladder diverticulectomy are indicated at the same time.

Bladder stones are a result of underlying problems that are difficult to prevent.

However, one can decrease his/her chance of developing bladder stones by following these tips:

• Note your unusual urinary symptoms and consult your doctor immediately.
• Prompt diagnosis and treatment of an enlarged prostate gland, urinary tract infections or other urological conditions can decrease your risk of developing bladder stones.
• Drink lot of fluids: Drinking more fluids, especially water, helps in the prevention of bladder stones as the fluids can dilute the mineral concentration in your bladder. The amount of water a person should drink varies and depends on factors such as age, size, health, and level of activity. Ask your doctor about the appropriate amount of fluid recommended for you.

Discuss with your doctor before starting any alternative remedy for bladder stones to ensure it is safe and has no adverse interactions with other medications you are on

However, there are several natural remedies that could help in getting rid of bladder stones. Although the efficacy of these depends upon several factors, some of them may prove to be helpful. However, before you rely on these natural methods, it is important to consult with the treating doctor, as these remedies could take time compared to other medical methods of stone removal.

• Pineapple Juice, Rose Water, and Sugar Candy (misri): Pineapple juice, rose water, and raw sugar candy, or misri, when consumed together are known to bring about immediate relief from the symptoms associated with bladder stones. Mix about 10 ml of pineapple juice, 10 ml of rose water, and about 10g of sugar candy together and let it sit for 10 minutes. The next morning, drink this mixture on an empty stomach to get immediate relief from your bladder stone symptoms.
• Water Therapy: Consuming a lot of water every day is the most effective way of naturally getting rid of bladder stones. Excess water helps in dissolving the stones so that they can pass easily through urine. This, however, only works in cases of small bladder stones and may not work if the stones are very large in size.
• Horse Gram and Radish Juice: It may sound weird and absurd, but this is known to be one of the best ways to treat bladder stones. Boil about 6g of horse gram in about 25 ml of radish juice. Strain this liquid and drink the same day. This natural treatment is highly beneficial in breaking down bladder stones and having them removed from the body with other wastes.
• Cranberry Juice: Cranberry juice is a very effective natural remedy in treating multiple problems associated with the bladder. It helps in clearing out the bacteria that cause urinary infections and also helps in dissolving bladder stones.
• Watermelon Seeds: Watermelon seeds help break down bladder stones into small particles which can be easily passed through urine.
• Nigella Seed Tea: Boil 1 tsp of nigella or kalonji seeds in water for 5 mins. Once the seeds have boiled in the water, filter the mixture and drink it every day to let the bladder stones dissolve and flush out of the body.

There are several risks and complications associated with bladder stones.

Bladder stones are very common among children in developing regions of the world often because of dehydration, infection, and a low-protein diet.

In other countries, bladder stones are common in adults, particularly in men aged 30 and older.

Conditions that contribute to the development of bladder stones include:

• Obstruction of the bladder outlet: Bladder outlet obstruction is a condition in which there is a block in the flow of urine from your bladder to the urethra, the tube that carries urine out of your body. Bladder outlet obstruction occurs due to many reasons, but the most common is an enlarged prostate gland.
• Neurogenic bladder: Nerves that control the functions of the bladder may become damaged due to stroke, spinal cord injuries, Parkinson's disease, diabetes, or a herniated disk. This causes incomplete emptying of the bladder, which further increases the risk of bladder stones.

Bladder stones can lead to other complications if left untreated, such as:

• Chronic bladder dysfunction: Bladder stones can cause chronic urinary tract problems such as pain or the frequent urge to urinate. They may obstruct the opening through which urine passes from the bladder into the urethra, and thereby block the excretion of urine from your body.
• Urinary tract infections: Bladder stones may cause recurrent bacterial infections in your urinary tract.