Why is your back hurting?
You’ve been working outside in your yard all day and since it is summer, you probably sweat a lot. You don’t think it’s a big deal because you’ve been hydrating with water. However, later in the evening, you notice that your back is hurting and it is getting worse as time passes. You also notice that when you urinate, it is darker in color than normal. What is causing your back to hurt and your urine to be so dark?
Kidney stones are also known as renal lithiasis or nephrolithiasis. They are hard deposits that form inside your kidneys and are made up of minerals and salts. There are a wide variety of causes and it depends on the type of the stone. Typically, they form because your urine becomes concentrated and this allows the minerals to crystallize causing them to stick together. There are four main types of stones: calcium, struvite, uric acid and cystine. Calcium stones are further divide into two subcategories: calcium oxalate and calcium phosphate. Calcium oxalate are the most common type of kidney stone. Oxalate is made by your liver every day and naturally occurs in foods, such as fruits, vegetables, nuts and chocolate. So, if you have too much oxalate and do not drink enough fluid to dilute it, it can build up in your kidneys. Calcium phosphate stones are usually caused by metabolic conditions or taking certain medications. Struvite stones are formed when your body has an infection, like a urinary tract infection, and can grow quickly, becoming very large. Uric acid stones form when your body has a buildup of uric acid, which is usually due to not drinking enough fluid (especially water), losing too much fluid (ex. sweating significantly), eating a diet that is high in protein or having gout. Cystine stones form in people who have a hereditary disorder that causes their kidneys to get rid of (excrete) too much of the amino acid cystine.
Even though there are several types of kidney stones, they have the same general symptoms. It is important to note that most people do not have any pain until the stone moves around in their kidney or ureter (the tube that connects your kidney to your bladder). As the stone moves through your urinary system, it can cause the pain to move in location and cause other symptoms. The most common symptoms are severe pain in your side/back just below your ribs, pain that radiates to your lower abdomen/groin, pain that varies in intensity, pain while urinating, urine that is pink/red/brown colored, foul smelling urine, cloudy urine, feeling like you need to urinate all of the time even after relieving yourself, urinating more frequently, only being able to urinate small amounts, nausea/vomiting and fever/chills. You should see a doctor if you have any of these symptoms. If you have severe pain to the point to can’t sit still or find a comfortable position, nausea/vomiting/fever/chills with your pain, bloody urine or difficulty passing urine, then you should get immediate medical attention.
Kidney stone treatment depends on the several factors, including the type of stone, size, location and cause. The first part of treatment, usually all that is need for small stones, is to drink plenty of water to help flush the stone out of your urinary system. Typically, it is recommended that you drink enough water to make sure your urine is clear as possible. Your doctor may also recommend taking mild pain relievers like ibuprofen, acetaminophen or naproxen to help with any discomfort you are having. There is a medication that is available to help relax the muscles of your ureter making it easier to pass the kidney stone. Your doctor may prescribe this they feel that it will be beneficial. For stones that are large in size, causing bleeding, damaging your kidneys or you are having an ongoing urinary tract infection, you may need more invasive treatment. If the stones are large, you can have procedure called extracorporeal shock wave lithotripsy (ESWL). During the procedure, sound waves are used to create strong vibrations that break the stone into small pieces that you will then be able to pass in your urine. If the ESWL doesn’t work or the stone is too large, you might need to have it surgically removed via a percutaneous nephrolithotomy, which is when a small telescope and instruments are inserted through a small incision in your back and the stone is removed. Another technique is to use a scope that is inserted to your ureter by passing it through your urethra and bladder. Once the stone is found, it can be removed or broken into pieces that will pass when you urinate. If you have this procedure done, your doctor may leave a stent in place where the stone was found because this reduces swelling, which helps with healing. Regardless of how your stone is removed, the important thing is to have your kidney stone analyzed in order to find out what type it is because this will guide you in preventing further kidney stones from forming.
To prevent kidney stones there are several things that you can do. The most important is to drink plenty of water throughout the day. It is typically recommended that you drink enough water to keep the urine that your body produces as clear as possible. If you have a history of kidney stones, your doctor may have specific guidelines that you need to follow. Another key thing to be aware of is how much oxalate-rich food you are eating. Some examples of oxalate-rich food include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products. If you have a history of calcium stones, your doctor may recommend that you be careful with using calcium supplements. It is significant to note that calcium-rich foods are typically fine to eat without increasing your risk of kidney stones but be sure to check with your doctor first. It is vital to eat a diet that is low in sodium and animal protein. If you have a diet high in sodium, your body has to work harder to filter out the calcium in your bloodstream. Diets high in animal protein increase your chance of developing uric acid stones.
If you have a history of kidney stones and know what type you most commonly develop, then your doctor can prescribe you medication that will help prevent them from forming. For calcium stones, your doctor may prescribe a thiazide diuretic or phosphate-containing preparation. The frequency of uric acid stones can be reduced by taking allopurinol, which helps to reduce the amount of uric acid in your blood/urine, and a medicine to keep your urine alkaline. To prevent struvite stones, the key is to prevent infections that affect your kidneys. If you are prone to urinary system infections, your doctor may try a long-term use of antibiotics for a period of time to see if this helps. Since the formation of cystine stones is caused by a heredity disorder, they can be difficult to treat. Besides drinking plenty of water, you might be given a medication to reduces the level of cystine in your urine.
Kidney stones are definitely an unpleasant thing to experience. By taking steps to prevent them, you will avoid having to deal pain and suffering that accompany them. If you have any questions or concerns, please speak with your doctor. If you would like more information, please visit the National Institute of Diabetes and Digestive and Kidney Diseases’ Kidney Stone page at https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones