Stones in the bladder are hard little masses made up of minerals from your urine. Sometimes, they don’t cause any symptoms and pass out of your body on their own. In such situation, you may never even know you had one.
However, more often, they cause pain or other problems when you pee. Urine is about 95 per cent water with the other five per cent containing minerals such as salt, and waste products, such as protein. When the urine is concentrated, often due to lack of water or dehydration or not being able to completely empty the bladder, the colour of urine can vary from dark amber to brown depending. If a man is unable to completely empty his bladder, this may be due to an enlarged prostate, bladder problems or a urinary tract infection.
Stones can form in the bladder. Experts say they are much more common in men past the age of 50 but are much less common than kidney stones.
Sometimes referred to as urinary tract stones or bladder calculi, they primarily affect men, as 95 per cent of all bladder stones cases are found in men.
According to chairman of Urology and Robotics Surgery, Lenox Hill Hospital, Dr. David Samadi, bladder stones are hard masses of minerals in your bladder.
He said: “The bladder’s job is to collect urine that comes down from the kidneys. As the bladder fill up throughout the day, you will get the urge to empty its contents.
“Generally, the bladder will be completely emptied but there can be certain health issues preventing that from happening. Any urine left in the bladder after urination can develop stones from minerals that crystallise in the concentrated urine.
“Bladder stones are not often heard of as they are not nearly as common as kidney stones. They usually don’t cause complications as they are normally fairly small and can get discharged in the urine. But if the stones become trapped in the neck of the bladder with residue in the urine accumulating, they can grow large enough to cause symptoms.
“It develops when urine in your bladder becomes concentrated, causing minerals in your urine to crystallise. Concentrated, stagnant urine is often the result of not being able to completely empty your bladder. Small bladder stones sometimes pass on their own, but you may need to have others removed by your doctor. Left untreated, bladder stones can cause infections and other complications.”
The expert said stones forming in the bladder when the bladder is not emptied completely could be due to nerve damage that impairs a patient’s ability to urinate, recurrent urinary tract infections or an enlarged prostate.
“The resulting stones may or may not be associated with symptoms, including blood in urine, pain with urination, weakened urinary stream, or abdominal pain,” he said, adding: “Small stones can pass on their own, especially with increased water consumption, but left unattended, they may grow large enough to block the flow of urine, leading to infection or pain.”
Bladder stones can be removed in a variety of manners, from open surgery to minimally invasive endoscopic procedures,” according to Benjamin Breyer, Associate Professor of Urology and Epidemiology.
Prevalence
An expert at the Urologist unit, Department of Surgery, Federal Teaching Hospital, Abakaliki (FETHA), Dr. Charles Odoemene, said giant urinary bladder stones are still a rarity in modern urological practice, causing enormous morbidity when presentation is late.
He said bladder stones account for 44.4 per cent of urinary tract calculi in Nigeria. Incidentally, in the western world, bladder stones account for five per cent of urinary tract stones and 1.5 per cent of urologic hospital admissions.
“The higher proportion of lower urinary tract stone in the developing world has been attributed to increased incidence of urinary tract infections and infestations. Bladder stones are commoner in men than in women with an incidence of 95 per cent,” he said.
Causes
The bladder’s job is to collect urine from the kidneys until you need to pass it out. Once you do, your bladder should be empty. But some health issues can prevent that from happening, and you end up with urine left in your bladder. Then, some of the substances in the urine start to stick together and form crystals until they form a bladder stone.
Bladder stones generally begin when your bladder doesn’t empty completely. In most cases, an underlying condition affects your bladder’s ability to empty completely.
The most common conditions that cause bladder stones include:
Prostate gland enlargement: An enlarged prostate or benign prostatic hyperplasia (BPH) can cause bladder stones in men. As the prostate enlarges, it can compress the urethra and interrupt urine flow, causing urine to remain in your bladder.
Damaged nerves (neurogenic bladder): Normally, nerves carry messages from your brain to your bladder muscles, directing your bladder muscles to tighten or release. If these nerves are damaged from a stroke, spinal cord injury or other health problem your bladder may not empty completely.
Inflammation: Bladder stones can develop if your bladder becomes inflamed. Urinary tract infections and radiation therapy to your pelvic area can both cause bladder inflammation.
Medical devices: Occasionally, bladder catheters slender tubes inserted through the urethra to help urine drain from your bladder can cause bladder stones. So can objects that accidentally migrate to your bladder, such as a contraceptive device or stent. Mineral crystals, which later become stones, tend to form on the surface of these devices.
Kidney stones: Stones that form in your kidneys are not the same as bladder stones. They develop in different ways and often for different reasons. But small kidney stones occasionally travel down the ureters into your bladder and, if not expelled, can grow into bladder stones.
Breyer said: “The primary cause of bladder stones is not completely emptying the bladder of urine. This is when urine will form crystals. Other causes can be some infections or an underlying condition affecting the bladder’s ability to hold, store or eliminate urine.
“Prostate gland enlargement in men or benign prostatic hyperplasia (BPH) is a common cause of bladder stones in men. When the prostate is enlarged, this can obstruct the flow of urine, preventing a complete elimination or emptying of the bladder.”
Signs and symptoms
According to Breyer, the signs or symptoms of bladder stones can vary from severe abdominal pain to blood in the urine. Sometimes there may be no signs of them whatsoever as small bladder stones can pass unnoticed without treatment.
He said: “However, if a stone is irritating the walls of the bladder or is blocking the flow of urine, the symptoms can include: lower abdominal pain. In men, pain or discomfort in the penis or testicles, burning sensation when urinating, frequent urination, difficulty urinating or an interruption of the urine flow and blood in the urine, painful urination and cloudy or abnormally dark-coloured urine.
“Some people with bladder stones have no problems even when their stones are large. But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms can develop.”
Tests and diagnosis
Breyer said to diagnosis bladder stones, “the following procedures may be done: A physical exam. Urinalysis a urine sample will be taken to examine for microscopic amounts of blood, bacteria, and crystallised minerals. This can also help determine if a urinary tract infection is the cause of the bladder stones.”
Reaching a diagnosis of bladder stones may involve:
A physical exam: Your doctor will likely feel your lower abdomen to see if your bladder is enlarged (distended) and, in some cases, perform a rectal exam to determine whether your prostate is enlarged. You should also discuss any urinary signs or symptoms that you’re having.
Analysis of your urine (urinalysis): A sample of your urine may be collected and examined for microscopic amounts of blood, bacteria and crystallised minerals. A urinalysis also helps determine whether you have a urinary tract infection, which can cause or be the result of bladder stones.
Spiral computerised tomography (CT) scan: A conventional CT scan combines multiple x-rays with computer technology to create cross-sectional images of your body. A spiral CT speeds up this process, scanning more quickly and with greater definition of internal structures. Spiral CTs can detect even very small stones and are considered one of the most sensitive tests for identifying all types of bladder stones.
Ultrasound: An ultrasound, which bounces sound waves off organs and structures in your body to create pictures, can help your doctor detect bladder stones.
X-ray: An X-ray of your kidneys, ureters and bladder helps your doctor determine whether stones are present in your urinary system. But some types of stones aren’t visible on conventional X-rays.
Special imaging of your urinary tract (intravenous pyelogram): An intravenous pyelogram is a test that uses a contrast material to highlight organs in your urinary tract. The material is injected into a vein in your arm and flows into your kidneys, ureters and bladder, outlining each of these organs. X-ray pictures are taken at specific time points during the procedure to check for stones. Spiral CT scans are generally done instead of an intravenous pyelogram.
Treatments
Generally, bladder stones should be removed. If the stone is small, your doctor may recommend that you drink a lot of water each day to help the stone pass. However, because bladder stones are often caused by the inability to empty the bladder completely, spontaneous passage of the stones is unlikely. Almost all cases require removal of the stones.
Bladder stones are often removed during a procedure called a cystolitholapaxy (sis-toe-lih-THOL-uh-pak-see). A small tube with a camera at the end (cystoscope) is inserted through your urethra and into your bladder to view the stone. Your doctor then uses a laser, ultrasound or mechanical device to break the stone into small pieces and flushes the pieces from your bladder.
Before the procedure, you will likely have anesthesia that numbs the lower part of your body (regional anesthesia) or that makes you unconscious and unable to feel pain (general anesthesia). Complications from a cystolitholapaxy aren’t common, but urinary tract infections, fever, a tear in your bladder or bleeding can occur. Your doctor may give you antibiotics before the procedure to reduce the risk of infections.
About a month after the cystolitholapaxy, your doctor would likely check to make sure no stone fragments remains in your bladder.
Occasionally, bladder stones that are large or too hard to break up are removed through open surgery. In these cases, your doctor makes an incision in your bladder and directly removes the stones. Any underlying condition causing the stones, such as an enlarged prostate, may be corrected at the same time.
“Most likely, bladder stones will need to be removed, which can be done with a procedure called a cystolitholapaxy. This procedure will help break up stones into pieces small enough to pass in the urine. If a stone is too large or hard to break up, then they can be removed surgically,” says Breyer.
Prevention
An expert said drinking plenty of fluids, especially if you are at risk of stones forming, is best. “If you have an infection or feel like your bladder is not completely empty, try urinating 10 to 20 seconds after you urinate the first time. This is called double voiding.
If diet is related to stones, follow directions on how to eat, get medical help at the first signs of urinary problems,” he said.
Some studies have shown that men with enlarged prostates might empty their bladders more completely if they sit when they urinate.
Lifestyle and home remedies
Bladder stones usually result from an underlying condition that’s hard to prevent, but you can decrease your chance of developing them by following these tips:
Ask about unusual urinary symptoms: Early diagnosis and treatment of an enlarged prostate or another urological condition may reduce your risk of developing bladder stones.
Drink plenty of fluids: Drinking more fluids, especially water, may help prevent bladder stones because fluids dilute the concentration of minerals in your bladder. How much water you should drink depends on your age, size, health and level of activity. Ask your doctor what’s an appropriate amount of fluid for you.
Complications
Bladder stones that are not removed, including those that don’t cause symptoms, can lead to complications, such as chronic bladder dysfunction. Left untreated, bladder stones can cause long-term urinary problems, such as pain or frequent urination. Bladder stones can also lodge in the opening where urine exits the bladder into the urethra and block the passage of urine from your body.
Bladder stones may cause recurring bacterial infections in your urinary tract.