Renal calculi are formed when the urine is supersaturated with salt and minerals such as calcium oxalate, struvite (ammonium magnesium phosphate), uric acid and cystine.60-80% of stones contain calcium.They vary considerably in size from small ‘gravel-like’ stones to large staghorn calculi. The calculi may stay in the position in which they are formed, or migrate down the urinary tract, producing symptoms along the way. Studies suggest that the initial factor involved in the formation of a stone may be the presence of nanobacteria that form a calcium phosphate shell.
The other factor that leads to stone production is the formation of Randall’s plaques. Calcium oxalate precipitates form in the basement membrane of the thin loops of Henle; these eventually accumulate in the subepithelial space of the renal papillae, leading to a Randall’s plaque and eventually a calculus.
Bladder stones (calculi) account for around 5% of urinary tract stones and usually occur because of foreign bodies, obstruction or infection.The most common cause of bladder stones is urinary stasis due to failure of emptying the bladder completely on urination, with the majority of cases occurring in men with bladder outflow obstruction.Approximately 5% of bladder stones occur in women and are usually associated with foreign bodies such as sutures, synthetic tapes or meshes, and urinary stasis, so bladder stones should always be considered in women investigated for irritable bladder symptoms or recurrent urinary tract infections.
Patients with indwelling Foley catheters are also at high risk for developing bladder stones and there appears to be a significant association between bladder stones and the formation of malignant bladder tumours in these patients.
- Differential diagnosis
- Frequently Asked Questions
- Frequently Asked Questions
- Ureteral Stent
- What’s a Ureteral Stent?
- How Long Does a Ureteral Stent Stay In?
- How Is a Ureteral Stent Removed?
- How Can I Help My Child?
- When Should I Call the Doctor?
- Other Qs & As
- Constipation may be a risk factor for kidney disease
- CKD, kidney failure risk up to 13 percent higher with constipation
- More research needed to establish causality
- Patient Blog: Sharing My Story of Bladder Cancer to Help Others
- 7 Things To Know about Kidney Stones
- Renal stones are common, being present at some time in one in ten of the population, although a significant proportion will remain asymptomatic.
- The annual incidence is about 1-2 cases of acute renal colic (or ureteric colic) per 1,000 people and the average lifetime risk around 5-10%.
- Men are more commonly affected than women, with a male:female ratio of 3:1. The difference between the sexes is gradually being eroded. This is thought to be due to lifestyle-associated factors, such as obesity and a Western diet.
- The peak age for developing stones is between 30 and 50 and recurrence is common.
Several risk factors are recognised to increase the potential of a susceptible individual to develop stones. These include:
- Anatomical anomalies in the kidneys and/or urinary tract – eg, horseshoe kidney, ureteral stricture.
- Family history of renal stones.
- Relative dehydration.
- Metabolic disorders which increase excretion of solutes – eg, chronic metabolic acidosis, hypercalciuria, hyperuricosuria.
- Deficiency of citrate in the urine.
- Cystinuria (an autosomal-recessive aminoaciduria).
- Drugs – eg, diuretics such as triamterene and calcium/vitamin D supplements.
- More common occurrence in hot climates.
- Increased risk of stones in higher socio-economic groups.
- Contamination – as demonstrated by a spate of melamine-contaminated infant milk formula.
- Many stones are asymptomatic and discovered during investigations for other conditions.
- The classical features of renal colic are sudden severe pain. It is usually caused by stones in the kidney, renal pelvis or ureter, causing dilatation, stretching and spasm of the ureter. In most cases no cause is found:
- Pain starts in the loin about the level of the costovertebral angle (but sometimes lower) and moves to the groin, with tenderness of the loin or renal angle, sometimes with haematuria.
- If the stone is high and distends the renal capsule then pain will be in the flank but as it moves down pain will move anteriorly and down towards the groin.
- A stone that is moving is often more painful than a stone that is static.
- The pain radiates down to the testis, scrotum, labia or anterior thigh.
- Whereas the pain of biliary or intestinal colic is intermittent, the pain of renal colic is more constant but there are often periods of relief or just a dull ache before it returns. The pain may change as the stone moves. The patient is often able to point to the place of maximal pain and this has a good correlation with the current site of the stone.
- Other symptoms which may be present include:
- Rigors and fever.
- Urinary retention.
- Nausea and vomiting.
- The patient with colic of any sort writhes around in agony. This is in contrast to the patient with peritoneal irritation who lies still.
- The patient is apyrexial in uncomplicated renal colic (pyrexia suggests infection and the body temperature is usually very high with pyelonephritis).
- Examination of the abdomen can sometimes reveal tenderness over the affected loin. Bowel sounds may be reduced. This is common with any severe pain.
- There may be severe pain in the testis but the testis should not be tender.
- Blood pressure may be low.
- Full and thorough abdominal examination is essential to check for other possible diagnoses – eg, acute appendicitis, ectopic pregnancy, aortic aneurysm.
This depends upon the position of the pain and the presence or absence of pyrexia and includes:
- Biliary colic.
- Dissection of an aortic aneurysm: beware the patient who presents with features of renal colic for the first time over the age of 60. This may be dissection of aortic aneurysm leading to ruptured aortic aneurysm.
- Pyelonephritis: very high temperature. Pain is unlikely to radiate to the groin.
- Acute pancreatitis.
- Acute appendicitis.
- Perforated peptic ulcer.
- Epididymo-orchitis or torsion of the testis: very tender testis.
- Sinister causes of back pain: usually tender over vertebrae.
- Drug addiction: there are reports of people with fictitious stories of renal colic, designed to obtain an injection of pethidine. These patients tend to be abusive when offered anything other than pethidine.
- Münchhausen’s syndrome.
- Basic analysis should include:
- Stick testing of urine for red cells (suggestive of urolithiasis), white cells and nitrites (both suggestive of infection) and pH (pH above 7 suggests urea-splitting organisms such as Proteus spp. whilst a pH below 5 suggests uric acid stones).
- Midstream specimen of urine for microscopy (pyuria suggests infection), culture and sensitivities.
- Blood for FBC, CRP, renal function, electrolytes, calcium, phosphate and urate, creatinine.
- Prothrombin time and international normalised ratio if intervention is planned.
- Non-enhanced CT scanning is now the imaging modality of choice and has replaced intravenous pyelogram (IVP).Ultrasound scanning may be helpful to differentiate radio-opaque from radiolucent stones and in detecting evidence of obstruction.
- Plain X-rays of the kidney, ureter and bladder (KUB) are useful in watching the passage of radio-opaque stones (around 75% of stones are of calcium and so will be radio-opaque).
- The European Association of Urology’s guidelines on urolithiasis recommend stone analysis for:
- All first-time stone formers.
- All patients with recurrent stones who are on pharmacological preventing therapy.
- Patients who have had early recurrence after complete stone clearance.
- Late recurrence after a long stone-free period (stone composition may change).
Encourage the patient to try to catch the stone for analysis. This may mean urinating through a tea strainer, a filter paper such as a coffee filter or a gauze.
Initial management can either be done as an inpatient or on an urgent outpatient basis, usually depending on how easily the pain can be controlled.
Indications for hospital admission
- Solitary kidney.
- Known non-functioning kidney.
- Inadequate pain relief or persistent pain.
- Inability to take adequate fluids due to nausea and vomiting.
- Poor social support.
- Inability to arrange urgent outpatient department follow-up.
- People over the age of 60 years should be admitted if there are concerns on clinical condition or diagnostic certainty (a leaking aortic aneurysm may present with identical symptoms).
Indication for urgent outpatient appointment
- Pain has been relieved.
- The patient is able to drink large volumes of fluid.
- Adequate social circumstances.
- No complications evident.
Initial management of acute presentation
- Non-steroidal anti-inflammatory drugs (NSAIDs), usually in the form of diclofenac IM or PR, should be offered first-line for the relief of the severe pain of renal colic. NSAIDs are more effective than opioids for this indication and have less tendency to cause nausea. However, if parenteral morphine is required in severe renal colic pain, this works quickly and can provide pain relief in the time taken for an NSAID to work. If opioids are needed then a Cochrane review concluded that it should not be pethidine.
- Provide antiemetics and rehydration therapy if needed.
- The majority of stones will pass spontaneously but may take 1-3 weeks; patients who have not passed a stone or who have continuing symptoms should have the progress of the stone monitored at a minimum of weekly intervals to assess the progression of the stone.
- Conservative management may be continued for up to three weeks unless the patient is unable to manage the pain, or if he or she develops signs of infection or obstruction.
- Medical expulsive therapy may be used to facilitate the passage of the stone. It is useful in cases where there is no obvious reason for immediate surgical removal. Calcium-channel blockers (eg, nifedipine) or alpha-blockers (eg, tamsulosin) are given. A corticosteroid such as prednisolone is occasionally added when an alpha-blocker is used but should not be given as monotherapy.
Managing patients at home
- All patients managed at home should drink a lot of fluids and, if possible, void urine into a container or through a tea strainer or gauze to catch any identifiable calculus.
- Analgesia: paracetamol is safe and effective for mild-to-moderate pain; codeine can be added if more pain relief is required. Paracetamol and codeine should be prescribed separately so they can be individually titrated.
- Patients managed at home should be offered fast-track investigation initiated by the hospital on receipt of a letter or email completed by the general practitioner.
- Patients should ideally receive an appointment for radiology within seven days of the onset of symptoms.
- An urgent urology outpatient appointment should be arranged for within one week if renal imaging shows a problem requiring intervention.
- Approximately 1 in 5 stones will not pass spontaneously and will require some form of intervention.
- If the ureter is blocked or could potentially become blocked (eg, when a larger stone will fragment following other forms of therapy), a JJ stent is usually inserted using a cystoscope. It is a thin hollow tube with both ends coiled (pigtail). It is also used as a temporary holding measure, as it prevents the ureter from contracting and thus reduces pain, buying time until a more definitive measure can be undertaken.
- Procedures to remove stones include:
- Extracorporeal shock wave lithotripsy (ESWL) – shock waves are directed over the stone to break it apart. The stone particles will then pass spontaneously.
- Percutaneous nephrolithotomy (PCNL) – used for large stones (>2 cm), staghorn calculi and also cystine stones. Stones are removed at the time of the procedure using a nephroscope.
- Ureteroscopy – this involves the use of laser to break up the stone and has an excellent success rate in experienced hands.
- Open surgery – rarely necessary and usually reserved for complicated cases or for those in whom all the above have failed – eg, multiple stones.
- Several options are available for the treatment of bladder stones. The percutaneous approach has lower morbidity, with similar results to transurethral surgery while ESWL has the lowest rate of elimination of bladder stones and is reserved for patients at high surgical risk.
- Complete blockage of the urinary flow from a kidney decreases glomerular filtration rate (GFR) and, if it persists for more than 48 hours, may cause irreversible renal damage.
- If ureteric stones cause symptoms after four weeks, there is a 20% risk of complications, including deterioration of renal function, sepsis and ureteric stricture.
- Infection can be life-threatening.
- Persisting obstruction predisposes to pyelonephritis.
- Most symptomatic renal stones are small (less than 5 mm in diameter) and pass spontaneously.
- Stones less than 5 mm in diameter pass spontaneously in up to 80% of people.
- Stones between 5 mm and 10 mm in diameter pass spontaneously in about 50% of people.
- Stones larger than 1 cm in diameter usually require intervention (urgent intervention is required if complete obstruction or infection is present).
- Two thirds of stones that pass spontaneously will do so within four weeks of onset of symptoms.
- A stone that has not passed within 1-2 months is unlikely to pass spontaneously.
- The following features predispose to recurrent stone formation:
- First attack before 25 years of age.
- Single functioning kidney.
- A disease that predisposes to stone formation.
- Abnormalities of the renal tract.
Recurrence of renal stones is common and therefore patients who have had a renal stone should be advised to adapt and adopt several lifestyle measures which will help to prevent or delay recurrence:
- Increase fluid intake to maintain urine output at 2-3 litres per day.
- Reduce salt intake.
- Reduce the amount of meat and animal protein eaten.
- Reduce oxalate intake (foods rich in oxalate include chocolate, rhubarb, nuts) and urate-rich foods (eg, offal and certain fish).
- Drink regular cranberry juice: increases citrate excretion and reduces oxalate and phosphate excretion.
- Maintain calcium intake at normal levels (lowering intake increases excretion of calcium oxalate).
- Depending on the composition of the stone, medication to prevent further stone formation is sometimes given – eg, thiazide diuretics (for calcium stones), allopurinol (for uric acid stones) and calcium citrate (for oxalate stones).
Frequently Asked Questions
Frequently Asked Questions
Q1: I had a kidney stone and my doctor just placed a stent, but did not take out the stone yet. Why?
A1: An infected kidney stone can be life threatening. If a stone is blocking the flow of urine and the urine upstream becomes infected, then sepsis (low blood pressure and potential organ failure) can develop. In this case the safest course of action is to treat with antibiotics and “bypass” the stone by placing a stent. This allows the infected urine to drain around the stone. The stone is still present, but is no longer causing obstruction. Breaking up the stone or pulling it out could increase the risk of sepsis and therefore is reserved until after the infection has been cleared; usually about 1-2 weeks after the stent has been placed.
Q2: What is a ureteral stent and why do I need one after a ureteroscopic stone procedure?
A2: At stent is a plastic tube with holes throughout it used to temporarily help urine drain from the kidney down to the bladder. They are typically 20-28cm long and are very soft (see image bleow). Stone pain is due to obstruction of the flow of urine with a buildup of pressure in the ureter and kidney. After ureteroscopy the ureter will be inflamed and swollen. Sometimes the ureteral swelling will close off the ureter and block the flow of urine causing pain similar to (or worse than) when the stone was present. The stent keeps the ureter open and the urine flowing until the inflammation and swelling resolves.
Q3: Why does the stent make me have to urinate so frequently?
A3: There are two “pigtail” curls on the stent, one in the kidney and one in the bladder. The curl resting in the bladder will irritate the lining of the bladder and trigger spasms. Bladder spasms give the patient the severe and immediate urge to urinate. Male patients sometimes experience pain at the tip of the penis associated with bladder spasms. Your doctor may prescribe medications to help control bladder spasms after your procedure.
Q4: Are there any medications that can help with my stent discomfort?
A4: Yes. There are several medications that can help, however, until the stent is removed there will always be some discomfort. A medication called Pyridium can help control stent pain. It is taken 3 times a day and should not be taken for more than 3 consecutive days. A side effect of this medication is the urine becoming a bright orange/red color. A class of medications called Anticholinergics can help control the bladder spasms and overactivity associated with a stent. Examples of these include: Ditropan (oxybutynin), Detrol, Vesicare, Enablex, Sanctura, and Toviaz. Side effects of these medications include dry mouth and constipation.
Q5: Is there anything else I can do to help relieve stent discomfort?
A5: Stay hydrated and sure your bowels are moving. Many of the pain medications you received before and after your procedure can cause constipation. Your bladder will be more irritated when you are constipated because the colon is very close to it. Use over the counter stool softeners such as Colace or Sennakot. Two tablespoons of milk of magnesia can help as well.
Q6: How long will the stent need to stay after my procedure?
A6: It depends upon how much work needs to be done to get the stone(s) out. If the stone is impacted or the ureter needs to be dilated for any reason, then it generally stays for 10-14 days. If there is minimal trauma to the ureter, then it may only need to stay a few days.
Q7: Why do I occasionally have blood in my urine after my procedure? Is it dangerous?
A7: Several things can cause the urine to look bloody after stone procedures. Passing stone fragments, inflammation of the ureter, and ureteral stents are the primary causes. If a stent was left in place, it can irritate the lining of the bladder causing intermittent bloody urine. Activity and dehydration are the two most common causes. It may last until the stent is removed. Generally it is not dangerous to have blood in the urine. A few drops of blood will make urine look like fruit punch. You may notice dark or black speckles or pieces coming out with bloody urine – these are blood clots and are not dangerous either. The best treatment is to increase hydration with non-caffeinated fluids. Things to be on the lookout for are the inability to urinate and fevers. If you experience either of these, then call our office as soon as possible.
Q8: Can I play golf with a ureteral stent in me?
A8: Yes. HOWEVER, be aware that increased physical activity will lead to increased stent discomfort and likely will result in increased blood in the urine. This is not dangerous. Make sure you stay well hydrated.
Q9: Can I have intercourse with a ureteral stent in me?
A9: See answer A8
Q10: I had a PCNL and there is fluid leaking around the tube left in my back. Is this dangerous?
A10: No. The tube is held in place with a small retention balloon. Sometimes the balloon blocks urine from flowing down the ureter and it will travel out around the tube. Simply reinforce the dressing. The leakage usually stops 2-3 days after the tube is removed and the incision starts to heal.
Q11: I am currently trying to pass a stone. Why do I have to urinate more frequently?
A11: As a stone gets closer to the bladder, it will irritate the bladder muscle and trigger a spasm or bladder contraction. This gives you the urge to urinate even though your bladder may not be full.
Q12: I am currently trying to pass a stone and have pain going into my groin or testicles. Why?
A12: The passing stone irritates the nerves that travel to the groin. Women may feel it in the groin or labia. Men may feel it in the groin or testicles. The pain is not originating in these areas, but feels as if it is. No specific treatment is necessary and the discomfort resolves after the stone passes or is removed.
Q13: I am currently trying to pass a stone. When should I go to the Emergency Room?
A13: If you are considering going to the ER always call our office first, even if it is after hours or on the weekend. Our physicians’ assistants and on call Urologist are always available to help guide you. Specific reasons to seek medical attention are the following:
- Fever > 101.5 degrees Fahrenheit. All stone patients should have a thermometer. If you develop a fever then you will require prompt treatment with antibiotics and a ureteral stent (see Q1). Call our office first. If our office is open we can usually see you immediately and avoid the delay of the ER. If it is after hours or on the weekend, call our service line (the office number) before going to the ER. Our physician assistants and on-call Urologist are available 24-7 and can frequently bypass the delay in the ER by having you directly admitted to the hospital
- Severe nausea and vomiting. If you can’t keep any liquids down (juice, water, or Gatorade), then you could become dehydrated. Call our office, even if it is after hours. Frequently a combination of pain and anti-nausea medications can relieve the situation and avoid an unnecessary trip to the ER. Some patients, however, may require intravenous hydration in the hospital.
- Severe pain. What is considered “severe” pain is different from person to person. Some can tolerate high levels of it and others cannot. Renal colic is usually short lived, but can be unbearable during an attack. If you are taking pain medications and are still having pain, call our office (even if it is after hours or on the weekend). We may be able to call in a different prescription and avoid an unnecessary trip to the ER. Some patients, however, will have to receive intravenous pain medications in the hospital.
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What’s a Ureteral Stent?
A ureteral stent is a small plastic tube placed inside the
to help urine (pee) pass from a kidney into the bladder.
A child may need a ureteral (yuh-REET-eh-rul) stent:
- after surgery to keep the urine pathway open
- if the ureter is narrow or blocked
- to make way for a kidney stone to pass
How Long Does a Ureteral Stent Stay In?
Some stents stay in for just a few days to a week. Others may stay in for several months. If your child has a stent, the urologist will let you know how long it’s needed.
How Is a Ureteral Stent Removed?
A ureteral stent that’s going to be in place for only a few days to a week usually has a string attached to the end of it. This string comes out of the urethra (where pee comes out) and is taped to the child’s leg. This type of stent is removed either at home or in the doctor’s office.
Stents that are in place for several weeks or months are removed by the urologist in the operating room.
How Can I Help My Child?
A ureteral stent sometimes can be uncomfortable and cause some blood in the pee. Here’s how to help your child feel more comfortable until the stent comes out.
Give medicines as directed:
- Medicine for bladder spasms: The stent can irritate the bladder, making it . This can be uncomfortable and make your child need to pee often. The stent also can cause pain with peeing, which sometimes is felt over the bladder or the back. Give the recommended medicine for spasms to help your child feel more comfortable. This medicine also can help reduce blood in the pee.
- Other medicines: If the doctor prescribed other medicines, give them exactly as directed.
Encourage your child to drink lots of caffeine-free liquids:
- Drinking and peeing a lot can help kids feel more comfortable and reduce blood in the pee.
- Send a water bottle to school or childcare to encourage your child to drink throughout the day.
Watch the amount of blood in the pee:
- It’s normal for your child’s pee to have some blood in it while the stent is in. As long as it’s light (it may look like pink lemonade or cranberry juice), it’s nothing to worry about.
Watch for constipation, which can make pain from a stent worse:
- Many kids have constipation after surgery or while taking medicine for spasms or pain. If your child is constipated, talk to the urologist. Often, medicines and diet changes can help.
Follow up with the
as instructed so that the stent is removed on time.
When Should I Call the Doctor?
Call the doctor right away if your child has a fever with shaking chills, back pain, or pain while peeing.
Also call the doctor if your child:
- is constipated (has hard or painful bowel movements, or isn’t pooping each day)
- has a fever
- has foul-smelling or cloudy pee
- has blood clots in the pee
- has pee that looks like tomato juice (bright red and thick)
- is vomiting
- has pain that doesn’t get better with the recommended medicine
- has severe pain
Reviewed by: T. Ernesto Figueroa, MD Date reviewed: March 2019
Other Qs & As
Abuse has made her fearful of sex
After cervical cancer is it still safe to have sex?
Can I give him hepatitis B through unprotected sex?
Can I have sex after a transient ischaemic attack (TIA)?
Can we have fulfilling sex even though I am a wheelchair user?
Disabled people and sexual activity
Does spina bifida prevent me from having a good sex life?
Fibroids in the womb
Having sex with menopausal women
I get bladder irritation during intercourse
I suffer from ankylosing spondylitis and am worried about my sex life
Is sex risky during a woman’s period?
My headaches after sex
My husband’s skin problem is affecting our sex life
Orgasm and disability
Sex after breast cancer
Sex after diathermy
Sex and intimacy after pregnancy
Sex and spina bifida
Sex during pregnancy
Sex life after hysterectomy
Sex problem after accident
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Sexual desire after a miscarriage
Sexual relations and epilepsy
She complains that her bladder hurts every time we have sex
Sick feelings during sex
We have cerebral palsy and would like some advice about sex
Constipation may be a risk factor for kidney disease
Constipation is a common gastrointestinal problem that affects tens of millions of Americans. Although the condition in itself is rarely dangerous, new research suggests constipation may be a sign of poor kidney health.
Share on PinterestResearchers have uncovered a link between constipation and kidney disease.
Constipation affects around 42 million Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Every year, constipation accounts for 2.5 million visits to the doctor.
Complications are very rare, but chronic, long-lasting constipation can lead to serious health issues.
Previous research has linked constipation to an increased risk of cardiovascular disease, presumably through its effects on intestinal bacteria.
An analysis of over 70,000 women found a 23 percent increased risk of cardiovascular disease in women with severe constipation.
A new study looks at the link between constipation and kidney health.
CKD, kidney failure risk up to 13 percent higher with constipation
Dr. Keiichi Sumida and Dr. Csaba Kovesdy, from the University of Tennessee Health Science Center and Memphis Veterans Affairs Medical Center, examined 3.5 million American veterans. These patients were first seen in 2004 and 2006 and then followed through 2013.
All participants had normal kidney function on their first examination, but as time progressed, some of the patients developed constipation and kidney disease.
Patients with constipation were 13 percent more likely to develop chronic kidney disease (CKD) and 9 percent more likely to have kidney failure.
Researchers also established a proportional association between the degree of severity in constipation and CKD and kidney failure.
Increasingly severe constipation was linked to a higher risk of developing kidney disease.
Dr. Kovesdy points to the link between our intestinal health and our kidneys, suggesting his study sheds light on the causes of kidney disease, as well as treatment and prevention.
“Our findings highlight the plausible link between the gut and the kidneys and provide additional insights into the pathogenesis of kidney disease progression. Our results suggest the need for careful observation of kidney function trajectory in patients with constipation, particularly among those with more severe constipation.”
Dr. Csaba Kovesdy
The results will be published in the next issue of the Journal of the American Society of Nephrology.
More research needed to establish causality
According to the Centers for Disease Control and Prevention (CDC), in 2014, more than 20 million people, or 10 percent of the American population, had CKD. Early CKD has no signs or symptoms, so many patients may not be aware they have it.
High blood pressure and diabetes are among the risk factors for CKD. Other risk factors include cardiovascular disease, obesity, and high cholesterol.
Dr. Kovesdy adds that further research is needed to see if constipation indeed plays a causal role in developing kidney disease. But if causality is proven, the same lifestyle changes and dietary interventions that help alleviate constipation might also protect patients’ kidney health.
Some of the changes in one’s diet that can help with constipation include drinking enough water and other fluids, such as vegetable juices and clear soups.
A diet rich in fiber can help with the symptoms, as well as an increased intake of probiotic foods such as yogurt and fermented foods. More exercise and having a daily routine can also help relieve the symptoms.
The progression of CKD can also be slowed down with dietary changes. A diet low in protein and salt has been shown to improve the condition of patients with CKD.
Learn about Karo syrup and its benefits for constipation.
Patient Blog: Sharing My Story of Bladder Cancer to Help Others
He gave me another blood test, another urine test, and another “bend over with the rubber glove” test. It was mid-July, so everything has been clicking along at a steady pace. I go back to see Dr. Seabury 1 week later for the results of these initial tests. All look ok, and he recommends a CT scan, and we set that up for the following week.
I went back the following week for the results of the CT scan. The doctor told me that all of my organs looked pretty good . . . except there was a “fuzzy spot down at the bottom of my bladder.” I must have had a befuddled look on my face, because then he tries to draw me a picture of it. He finally took me into his office to see the picture on his computer monitor. He pointed out all of my organs, and just as he had drawn it, a fuzzy spot down at the bottom of my bladder. He said “that should not be there and we need to get it out of there.” Dazed, my brain was somewhere else I guess, and I just said “ok, you know what’s best.” We set up outpatient surgery the following Thursday August 9th. He also said that I needed to have someone with me to drive me home due to the anesthesia. All is good at this point, as all he has called this thing is a “fuzzy spot.”
My wife took me for the cystoscopy. We were going to get that fuzzy spot out, and all went well. I am home that afternoon and the pain meds began to wear off. Did I happen to mention that I thought that I had a high pain threshold? I found out that day it wasn’t as high as I thought. The procedure involves a high-tech tool that really felt like a knitting needle with a lasso on the end of it to snag that fuzzy spot, turned out to be bigger than they thought, so they had to try again with a larger set of tools. Ouch! Being proud of myself, I went back to work the next morning, bragging to my coworkers about how I was not one of those old stubborn guys at all. I was the example of checking it out and “nipping it in the bud.” It didn’t dawn on me what that fuzzy spot could really be. We scheduled a follow-up a week later which I thought was just to make sure that I was ok.
A New Bladder
Amanda and I met up on Friday August 19th at the VA Urology office for our 2:30 appointment to go over the standard follow-up and the formality of seeing what the biopsy report said. Our vacation coincidently was starting later that day at 5:01 pm. We both had Nags Head on our minds. We rented a beach house for the week along with Amanda’s family. And what’s more, I am always fit and healthy. Back at the doctor’s office, Amanda and I were laughing and joking, waiting for Dr. Seabury to join us. He walked in carrying a stack of papers that he laid on the conference room table. He said, “I am not going to beat around the bush on this. What you have is an aggressive form of cancer that has roots, and those roots are growing on the inside wall of your bladder. We need to remove your bladder.”
“Do what?” I looked over at Amanda, and she had tears streaming down both cheeks. Dr. Seabury explained that with the location of the fuzzy spot he does not recommend other treatments or less invasive surgery. He recommends taking out the bladder and either have a stoma and carry a bag or placement of a new bladder.
I had never seen a bladder store or heard of a bladder transplant, so I was a bit perplexed. He explained that once the old bladder is out, they can make me a new one. Turns out that we have about a mile-and-a-half of intestines, and missing about one-and-a-half feet is not a problem. He illustrated this to us using a rolled-up piece of paper as my intestine. He then demonstrated chopping off each end of the roll of paper, sliced it long-ways, then laid it flat and took the opposite corners of the paper pulling them together to make a pouch which would be my new “holding tank,” aka bladder.
That seemed incredible. It did not take me long to choose which of the two options I wanted. I still like to body surf with my two sons in the Nags Head waves, so new bladder it is. Dr. Seabury does not do this high-tech specialized surgery, but one of his associates Dr. Franks does. We went along with this as a starting point and scheduled to meet with Dr. Franks after we returned from vacation. We left the office and walked out into the parking lot, knowing that our life has just been changed forever. We kissed, and I go back to work in a daze; Amanda, went home, devastated.
We decided to continue our plan for vacation, now knowing that I had cancer. I still did not hurt and had no outward signs or symptoms. Those specs sure were messing with me, though. We joked that they were taunting me since the outpatient surgery. Instead of specs they were clumps. So we went on vacation, and that allowed us to come to terms with what was coming up. We utilized that time to come up with our questions, and Amanda typed them into her smartphone.
We had a great vacation and believe it or not, her family treated me like normal and it was not a pity party. It was a time for inner perspective. A time to think about what life is all about. What is my purpose in life? Have I left my footprint anywhere? My life had mostly been about work and seeing how I could take care of how many people at once. Vacation ended, and we returned home and back to work we went. Daily I would ask myself, “why me?” Had I really done that much bad throughout my life, and this was going to be my punishment? I started listening more to Christian music. A lot more. That seemed to help.
The day came to meet with Dr. Franks, so both Amanda and I went, armed with her smartphone full of questions. Dr. Franks described what he would be doing and asked if we had any questions. Amanda asked the series of questions that we had come up with. An hour or so later, he looked over at me and asked me if I had any questions. I looked down thinking for a moment and then looked up and said, “Dr. Franks, it’s been pretty much common knowledge since I was in college that I am rather fond of 12-oz. beverages but only have an 8-oz. bladder, do you think you can make my new one a little bit bigger?” He grinned and said “we will see what we can do.” Surgery was scheduled for September 11.
After the meeting with Dr. Franks and before surgery, we began to tell everyone, now that we had our battle plan. We started with my mom over dinner, then my two sons, and then my dad. I purposely gave them the sugar-coated version of what surgery I was going to have and did not use the dreaded “C” word. I also told work and my extended camper family at Rockahock. I never knew that I had so many people pulling and praying for me, and I am still humbled by that. I also had five or six churches praying for me. I needed all of them, especially my home church. You see, they had the Prayer Team pray over both me and Amanda—not to heal me but to literally evict the cancer out of my body! The weekend before surgery I thought that I was going to just stay intoxicated; instead, I did chores mostly trying to get things “ready.”
Surgery day arrived, and the fact that it was on 9/11 didn’t bother me at all—I just turned up the message on the Christian radio station on the way to the hospital. We arrived and I had decided to not be depressed or mope about this. I went in smiling, laughing, and joking, maybe because I knew that I had so much power behind me, I don’t know. But I was not afraid or scared. I joked with the nurses, I joked with the anesthesiologist saying he looked just like rocker Ted Nugent (He really did!). I do not know about the surgery, but Amanda says something happened at 2:41-2:46 pm that day. Maybe, maybe not, but I think so. I am not the same guy that I was before. I think I got a “do-over,” and I am going to take advantage of it.
The short version of surgery is that the doctor had planned to also take out some lymph nodes, depending on what he saw. If he saw cancer into the first layer he would take out two. If he saw it on two layers, then he would take out all three layers. Incredibly he took none! We were on pins and needles until we heard him read the pathology report a couple of weeks later. Eighteen areas tested and eighteen areas clear.
My hospital stay after surgery was a learning experience. Amanda stayed with me the entire time. She was my rock through it all, continuing with great care even after I got home. Teaching myself how to work that new bladder was a slow process. It had to heal first, and once it did, we had to test it to remove all of the bypass hardware. I went back into the hospital first with a fever and pain. One of the prayer team members, Valerie, visited us in the hospital and told us not to worry that I was healed. Boy was she right on with that. My body ran a fever, rejecting the hardware. My new bladder was ready for use. After 5-and-a-half weeks of recovery time, I went back to work. “Slow and easy and don’t do anything stupid” was my motto. I had set small goals during my recovery time and since.
And everywhere I go, I keep telling my story.
That is it, the purpose of my life, or at least as I see it for now. I was spared to help save others. Remember, guys are sometimes pretty stupid. We forget that early detection can save us. Well, I’m here to help change that. I tell my story to anyone who will listen, and it’s amazing the stories that I hear in response. I guess I’m pretty vocal about bladder cancer. I honestly had never heard of bladder cancer until I had it. But when I was lying in the hospital bed a few days after surgery watching the 6:30 news, Brian Williams announced that “today we lost 1960’s crooner Andy Williams, singer of Moon River. And he died of bladder cancer.”
I was at my campground visiting about 6 weeks after surgery, telling my story to bunches of people, one of whom is my next door neighbor, who said to me, “Rick I want to thank you.” I asked him what for? He went on to tell me that he started having some of the same symptoms 3-4 weeks after I told him my story, and he and he went to his doctor who said he was probably just passing kidney stones. Remembering my story, he asked for a referral to a urologist who tested him and determined that he, too, had bladder cancer. Because he caught it early he only needed outpatient surgery and periodic testing and monitoring.
I know now that God has a plan and purpose for me. I just did not know it before. So much has happened over the last year or so. I am so blessed, and as Big Daddy Weave says, “I am redeemed.” My story continues . . .
7 Things To Know about Kidney Stones
Our bodies have sometimes interesting reactions to certain problems. A shoe rubbing on your foot creates a blister that protects the skin layers below. When you breath in too much dust, you cough to clear out the debris.
And when fluids and certain substances in your body are out of balance, kidney stones can form. They’re a common disorder of the urinary tract. Each year kidney stone problems cause more than a million visits to health care providers and 300,000 emergency room visits. One out of every 11 people have had a kidney stone.
Who’s More at Risk for Kidney Stones?
Although anyone can have a kidney stone, some people are more susceptible.
- If you’ve had a kidney stone before, you have a 50 percent chance of having another one within 5 to 7 years.
- Men get kidney stones more often.
- They’re more common in non-Hispanic white people.
- Overweight people have a higher risk for the stones.
A stone can form in your kidney when substances in your urine such as sodium, animal protein and calcium become highly concentrated. This may happen due to your diet or not drinking enough water.
The stone can be the size of a grain of sand or the size of a pearl. In extreme cases, they can be as big as a golf ball.
A smaller stone can pass through the body naturally. With larger stones, a health care professional’s help may be needed. In more severe cases, the stone can get stuck in the urinary tract and cause a painful blockage and possible bleeding.
The signs of a stone that may require professional help include:
- Burning when you urinate.
- Urine that smells bad or appears cloudy.
- Extreme pain in your back or side. The pain typically does not go away.
- Fever and chills.
- Blood in your urine.
To diagnose a kidney stone, your health care professional may use:
- Blood test.
- Abdominal X-ray.
- CT scan.
To treat a kidney stone that doesn’t pass on its own, your health care professional may:
- Use shock waves that pass through the body and break up the stone(s).
- Insert a wire-thin camera and tool through the urethra (it carries urine out of your body). The tool can be used to extract the stone. If needed, the physician can use a different tool to break the stone up using a laser. The smaller pieces can flow out of the body in the urine.
- Use minimally invasive surgery to remove the stone(s).
The procedure used to remove the stone will depend on its size and what it’s made of.
There are four general types of kidney stones:
Calcium stones are the most common kidney stones. They come in two forms: calcium oxalate stones and calcium phosphate stones.
The calcium oxalate stone is caused by high calcium and oxalate levels. Oxalate is a substance found naturally in foods such as spinach, bran flakes, rhubarb, beets, potato chips, French fries, nuts and nut butters.
Calcium phosphate stones result from a combination of high levels of calcium in the urine and urine that is alkaline — that is it has a high pH level.
Uric acid stones can develop if your urine is consistently acidic, which can happen if your diet high in purines — substances found in animal proteins in meats, fish and shellfish. When uric acid is concentrated in the urine, it can form a stone by itself or with calcium.
Struvite stones can result from kidney infections.
Cystine stones can result from a genetic disorder that causes cystine (a naturally occurring amino acid) to leak through the kidneys and into the urine, forming crystals that can accumulate into stones.
How Can Kidney Stones Be Prevented?
The first step in preventing a kidney stone is to understand what can cause them. If you have kidney stones, your health care professional may ask you to use a small basket to catch the stone so it can be brought in to be analyzed. Surgically removed stones can also be analyzed. You may also be asked to collect urine to measure fluid and mineral levels in your body.
You may be able to prevent future kidney stones by changing your fluid intake. Depending on the type of stones you’re susceptible to, your health care provider may suggest you change your intake of sodium, animal protein, calcium and foods high in oxalate. Make sure your diet includes plenty of fruits and vegetables. Add seltzer to your diet. The National Institutes of Health offers a diet for kidney stone prevention.
In some cases, your health care professional may suggest medications to help prevent kidney stones.
If you have questions about kidney stones, visit with your health care professional about your risks and prevention approaches that might work best for you.