Stages of Passing a Kidney Stone: Symptoms and Treatments

What Are Kidney Stones?

Kidney stones are small, hard deposits that form in the kidneys. They are composed of salts, calcium, minerals, and other waste chemicals filtered out from the blood. When these substances crystallize and stick together, they form a stone.

Kidney stones form when the balance of fluid, salts, and minerals in urine changes. This can happen due to inadequate water intake, excessive sweating without replacing lost fluids, or a diet high in protein, sodium, or sugar.

Kidney stones are quite common. According to NIDDK, about 11% of men and 6% of women in the United States have kidney stones at least once during their lifetime. Factors like genetics, diet, and certain medical conditions increase the risk of developing kidney stones.

The 4 Stages of Passing a Kidney Stone

Stage 1: Formation

Kidney stones begin to form in the kidneys due to concentrated urine. Insufficient water intake leads to more concentrated urine, which allows minerals and salts to crystallize and stick together, forming stones. This stage usually doesn't cause any pain or noticeable symptoms and stones might only be discovered during routine medical examinations.

Stage 2: Movement into the Ureter

Once a kidney stone forms, it may eventually move from the kidney into the ureter, the tube connecting the kidney to the bladder. This movement can be incredibly painful as the stone can scrape against the walls of the ureter, causing severe discomfort.

• Severe, sharp pain in the back and side, below the ribs.
• Pain that radiates to the lower abdomen and groin.
• Pain that comes in waves and varies in intensity.
• Blood in the urine, which may appear pink, red, or brown.
• Nausea and vomiting due to the intensity of the pain.

Stage 3: Entering the Bladder

As the stone progresses into the bladder, the pain usually subsides, but other symptoms may arise due to the presence of the stone in the bladder.

• Reduced pain compared to Stage 2.
• Increased bladder pressure and a frequent urge to urinate, possibly every few minutes.
• Discomfort or pain in the lower abdomen.
• Potential difficulty in completely emptying the bladder if the stone obstructs the urinary flow.

Stage 4: Exiting the Body

The final stage involves the stone passing from the bladder out of the body through the urethra. This stage usually causes minimal to no pain, but there can be some discomfort as the stone passes.

• Minimal to no pain during the passage.
• A sensation of needing to push to expel the stone.
• Possible mild discomfort or burning sensation during urination.
• Relief from symptoms once the stone is passed.

During any of these stages, experiencing severe symptoms or complications requires medical attention. Use the Symptom Checker to identify symptoms, but always consult a healthcare professional for a proper diagnosis and treatment plan. Remember, online tools are not intended to replace professional medical advice, diagnosis, or treatment. Always consult with a professional before taking any action.

When to Seek Medical Attention

Recognizing when to seek medical attention is crucial in managing kidney stones. Medical attention is especially critical if:

• The pain becomes unbearable and is not relieved by over-the-counter pain medications.
• There is a high fever and chills, indicating a possible infection.
• Persistent nausea and vomiting occur, leading to dehydration.
• There is an inability to urinate or significant difficulty in passing urine.
• Blood is present in the urine.

When contacting healthcare providers, explain the symptoms and severity clearly. During medical visits, expect to undergo diagnostic tests such as urine analysis, blood tests, and imaging studies like an ultrasound or CT scan. These tests help determine the size, type, and location of the kidney stone and the appropriate treatment.

Treatment Options

Conservative Treatments

For small kidney stones that can pass on their own, conservative treatments are often recommended. Staying well-hydrated is essential; drinking plenty of water helps flush out the kidneys and move the stone through the urinary tract.

Dietary changes can also aid in preventing and managing kidney stones:

• Reduce sodium intake to prevent stone formation.
• Limit foods high in oxalates like spinach, nuts, and chocolate if prone to calcium oxalate stones.
• Eat a balanced diet rich in fruits and vegetables.

Medications may be prescribed to manage pain, control nausea and vomiting, and facilitate stone passage. Drugs that relax the muscles in the ureter can help speed up the process of passing a stone and reduce discomfort.

Medical Interventions

For larger kidney stones or stones causing significant symptoms, medical interventions may be necessary. Each treatment option is chosen based on the size and location of the stone and the patient's overall health. 

Here are the most common procedures used to treat such cases:

ESWL is often preferred for medium-sized stones that are too large to pass on their own but small enough for shock wave treatment.

ESWL is a non-invasive procedure that uses high-energy shock waves to break kidney stones into smaller pieces. These smaller fragments can then pass through the urinary tract more easily.

• Procedure: The patient lies on a water-filled cushion, and a machine sends shock waves through the body to the kidney stones. The procedure usually lasts about 45 minutes to an hour.
• Recovery: ESWL is typically done on an outpatient basis, meaning patients can go home the same day. Some discomfort may be experienced as the stone fragments pass.

Ureteroscopy involves the use of a small instrument called a ureteroscope, which is passed through the urethra and bladder into the ureter to locate and treat stones.

Ureteroscopy is suitable for stones in the lower urinary tract. 

• Procedure: The ureteroscope allows the doctor to see the stone and either remove it with a small basket-like device or break it into smaller pieces using a laser.
• Recovery: This procedure is minimally invasive and usually performed on an outpatient basis. Patients might experience minor discomfort and will typically recover quickly.

PCNL is used for very large stones or stones not treatable with ESWL or ureteroscopy. This is a more invasive procedure.

• Procedure: A small incision is made in the patient’s back, and a nephroscope is inserted directly into the kidney to remove the stone. Sometimes, the stone is broken into smaller pieces first.
• Recovery: This procedure usually requires hospitalization for a day or two. Recovery time is longer compared to ESWL or ureteroscopy, and patients may need a few weeks to fully recover.

Additional Treatment

A kidney stent is a small tube inserted into the ureter to help drain urine from the kidney to the bladder, bypassing any obstruction caused by the stone.

• Procedure: The stent is placed using a cystoscope, a device passed through the urethra. The stent helps reduce pain and allows urine to flow normally.
• Recovery: Placement of a kidney stent is usually an outpatient procedure. Some discomfort may occur, but it significantly helps in managing symptoms and preventing complications.

Each treatment option is chosen based on the size and location of the stone and the patient's overall health.