Bladder stones

Bladder stones are small stones that form inside the bladder. They can irritate the wall of the bladder and disrupt the flow of urine out of the bladder.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you have this condition then you should see a doctor within two weeks.

How is it diagnosed?

Urine and blood tests will be done initially. If these indicate the presence of stones, you will have an X-ray or computerised tomography (CT) scan of your bladder.

What is the treatment?

You may be able to pass your bladder stones by drinking plenty of water.

Most bladder stones, however, are removed by surgery.

When to worry?

If you develop any of the following symptoms, please see a doctor immediately:

  • unable to pass urine for more than six hours
  • blood in urine
  • severe abdominal or back pain
  • urinary problems and a fever
  • abnormal drowsiness or loss of consciousness.

Introduction

Bladder stones are small stones that form inside the bladder. They can irritate the wall of the bladder and disrupt the flow of urine out of the bladder.

This can cause symptoms such as:

  • pain, which can often be severe, in the lower abdomen
  • changes to the normal pattern of urination, such as having to pass urine more frequently or waking up in the night needing to go to the toilet
  • blood in your urine
  • pain when urinating

Read more about the symptoms of bladder stones.

When to see your doctor

It is recommended that you contact your doctor if you experience any of the symptoms mentioned above. They are not necessarily the result of bladder stones but they will require further investigation.

Why bladder stones happen

The most common cause of bladder stones is when a person is unable to completely empty the urine from their bladder.

If urine sits in the bladder for a long time, the chemicals in the urine begin to form crystals which come together and harden to form bladder stones.

Reasons why a person may be unable to empty their bladder completely include:

  • in men, having an enlarged prostate gland that blocks the flow of urine out of the bladder
  • an injury to the spine that damages the nerves used to control the bladder

Read more about the causes of bladder stones.

A poor diet can also contribute to the formation of bladder stones. A diet lacking in nutrients can change the chemical make-up of urine making the formation of stones more likely.

A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains.

Treatment

Surgery is usually required to remove the stones from the bladder. The most common procedure is known as a cystolitholapaxy, where a small laser is used to break up the stones before they are removed.

It is also important to treat the underlying causes of bladder stones (where possible) to prevent new stones developing in the future.

Read more about treating bladder stones.

Who is affected?

Most cases of bladder stones affect older men aged 50 or above, due to the link with prostate enlargement.

Bladder stones can affect children, but this is much less common, with an average of 20 to 40 cases a year.

Symptoms

In some cases, bladder stones do not cause any symptoms. This is because they can be small enough to be passed out of the bladder during urination.

However, most people with bladder stones do experience symptoms because the stones either irritate the wall of the bladder or block the normal flow of urine out of the bladder.

Symptoms of bladder stones include:

  • lower abdominal pain
  • in men, pain in the penis and scrotum
  • pain around the back, buttocks and hips, which can be made worse when moving or exercising (in both men and women)
  • pain when urinating
  • blood in your urine
  • intermittent (stop-start) urination
  • needing to urinate more frequently than usual
  • waking up during the night because you need to urinate
  • difficulty beginning to urinate

Additional symptoms in children include:

  • in boys, a persistent and often painful erection, that is unrelated to sexual desire (the medical term for this is priapism)
  • bedwetting

When to seek medical advice

It is strongly recommended that you contact your doctor if you experience any of the following symptoms:

  • persistent abdominal pain
  • a change in your normal pattern of urination
  • blood in your urine

These symptoms are not necessarily the result of bladder stones but they will require further investigation.

Causes

The most common cause of bladder stones is an inability to completely empty your bladder of urine.

Urine is produced by your kidneys. It is made up of water mixed with waste products that the kidneys remove from your blood. One of the waste products is urea, which is made up of nitrogen and carbon.

If urine is allowed to stay in your bladder, the chemicals in urea will begin to stick together and form crystals. Over time, the crystals will start to harden and form bladder stones.

Some common reasons why people are unable to empty their bladder fully are described below.

Prostate enlargement

The prostate is a small gland that is only found in men. It is located behind the pelvis between the penis and the bladder, and surrounds the urethra. The urethra is the tube that carries urine from the bladder to the end of the penis and out of the body.

The main function of the prostate is to help with the production of semen. In many men, the prostate becomes enlarged as they grow older.

In around one third of men over the age of 50 the prostate gland puts pressure on the urethra and interrupts the normal flow of urine out of the bladder.

With treatment. It’s unusual for men with an enlarged prostate to develop bladder stones. However, in a small minority of men who fail to respond to treatment, there is an increased risk of developing bladder stones.

Read more about prostate enlargement.

Neurogenic bladder

Neurogenic bladder is a condition where the nerves that control the bladder are damaged, which means that a person is unable to empty their bladder fully.

Neurogenic bladder can be the result of:

  • serious injury to your spinal column (a long band of nerves that runs from the brain down the centre of the spine) resulting in some degree of paralysis
  • conditions that cause damage to the nervous system such as motor neurone disease or spina bifida

Most people with a neurogenic bladder require a catheter to empty their bladder. A catheter is a tube that is inserted into the urethra and moved up into the bladder. The urine is drained out of the bladder through the catheter. This is known as urinary catheterisation.

However, a catheter, while reasonably effective, is not a perfect substitute for normal bladder control and often leaves a small amount of urine in the bladder. This can lead to the formation of bladder stones.

It is estimated that around 1 in 10 people with a neurogenic bladder will develop bladder stones at some point in their life.

Cystocele

A cystocele is a condition that affects women and develops when the wall of the bladder becomes weakened and begins to drop down on to the vagina. This can affect the normal flow of urine out of the bladder.

A cystocele can develop during a period of excessive straining, such as childbirth, chronic constipation or heavy lifting.

Bladder diverticula

Bladder diverticula are pouches that develop in the wall of the bladder. If the diverticula grow to a certain size, it can become difficult for a person to empty their bladder fully.

Bladder diverticula can be present at birth or develop as a complication of infection or prostate enlargement.

Bladder augmentation surgery

There is a type of surgery known as bladder augmentation surgery where a piece of the bowel is removed and attached to the bladder to make it larger.

This can be useful in treating a type of urinary incontinence known as urge incontinence.

Research suggests that around 1 in 20 people who undergo this type of surgery will develop bladder stones.

Diet

A diet that is high in fat, sugar or salt but low in vitamin A and vitamin B can increase the risk of bladder stones, especially if a person is also not getting enough fluids to drink (dehydration).

All three of these factors can alter the chemical composition of urine, making the formation of bladder stones more likely.

Kidneys Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.

Diagnosis

If your doctor suspects that you have a bladder stone, they will refer you to hospital for testing.

It is likely that you will first be given blood and urine tests. A blood test will detect if there is an infection inside the bladder.

If your urine test shows unusually high acid levels then this may be a sign that bladder stones have formed inside your bladder.

The next stage is to take an X-ray of your bladder. Not all types of bladder stones will show up clearly on X-rays, so a negative X-ray result does not always mean you do not have bladder stones.

Because of this, an X-ray is usually followed by a test known as a computed tomography (CT) scan.

In a CT scan a series of X-rays is taken. These are then assembled by a computer to build up a more detailed pitcure of your kidneys and surrounding tissue.

A CT scan can usually locate stones with a high degree of accuracy.

Abnormalities in the bladder can also be identified using a cystoscopy. In this procedure, a thin, hollow viewing tube called a cystoscope is inserted into your urethra (the opening in the penis or vagina through which you urinate) to view the inside of your bladder.

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.

Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.

The urethra is a tube that carries urine from the bladder to the outside of the body.

Veins are blood vessels that carry blood from the rest of the body back to the heart.

An X-ray is a painless way of producing pictures of inside the body using radiation.

Treatment

It may be possible to flush bladder stones out of your bladder by drinking lots of water (around 1.2 litres or 6-8 glasses a day).

But as most people with bladder stones have problems completely emptying urine from their bladder it is unlikely that the stones will pass out using this method.

Surgery

Almost all people with bladder stones will require some type of surgery. The different types of surgery for bladder stones are listed below.

Transurethral cystolitholapaxy

The most widely used technique to treat adults with bladder stones is known as transurethral cystolitholapaxy.

During a transurethral cystolitholapaxy the surgeon will insert a small flexible tube that contains a camera at the end (a cystoscope) into your urethra and then up into your bladder.

The camera is then used to locate any stones. Lasers or ultrasound waves are then transmitted from the cystoscope. These break up the stones into smaller fragments, which can be washed out of your bladder with fluids.

A transurethral cystolitholapaxy is carried out under a local anaesthetic, so that it is not painful.

During the cystolitholapaxy procedure, there is a risk that you will develop an infection, so you may be given antibiotics as a precaution.

Percutaneous suprapubic cystolitholapaxy

As a child’s urethra is much smaller than that of an adult, using the cystolitholapaxy procedure described above carries a greater risk of damaging the urethra in children. A procedure called percutaneous suprapubic cystolitholapaxy is often used instead.

A percutaneous suprapubic cystolitholapaxy is also sometimes used in adults who have very large stones.

During the procedure the surgeon makes a small incision in the skin, just above the genitals. A further incision is made in the bladder and the stones are then removed.

A percutaneous suprapubic cystolitholapaxy can be carried out using a local or general anaesthetic. Younger children may find being awake during surgery too frightening so they may prefer a general anaesthetic.

Open cystostomy

Open cystostomy is similar to a percutaneous suprapubic cystolitholapaxy except the surgeon makes a much larger incision in the abdomen and bladder.

An open cystostomy is often used in men where the prostate has grown so large that it obstructs other procedures.

Alternatively, an open cystostomy may be combined with other types of surgery, such as removing some or all of the prostate or bladder diverticula (pouches that develop in the lining of the bladder).

An open cystostomy is carried out under a general anaesthetic.

The disadvantage of an open cystostomy is that it causes more post-operative pain and has a longer recovery time.

Complications of surgery

The most common complication of bladder stone surgery is an infection of the bladder or urethra. These are collectively known as urinary tract infections or UTIs.

UTIs affect around 1 in 10 people who have undergone bladder surgery and they can normally be treated with antibiotics.

Recovery and follow-up

If you have transurethral cystolitholapaxy or percutaneous suprapubic cystolitholapaxy you will normally be able to go home once the effects of the anaesthetic have worn off.

In open cystostomy it may take several days before you are well enough to go home.

You will probably be asked to attend a follow-up appointment where X-rays or a CT scan can be used to check that all the fragments of the bladder stones have been removed from your bladder.

Treating the underlying cause

Once the bladder stones have been removed it is necessary to treat the underlying cause to avoid new bladder stones forming.

Prostate enlargement

Prostate enlargement can be treated using medication that can both help reduce the size of the prostate and relax the bladder, making it easier to pass urine.

If medication fails to work then surgery may be required to remove some or all of the prostate.

Read more about the treatment of prostate enlargement.

Neurogenic bladder

If you have a neurogenic bladder (inability to control the bladder due to nerve damage) and you develop bladder stones it is often a sign that you need to change the way in which you are draining your bladder. You may need further training in fitting your catheter or you may need to change the type of catheter you are using.

Read more about urinary catheterisation.

Cystocele

Mild to moderate cases of cystocele (a condition affecting women where the walls of the bladder weaken and begin to drop down into the vagina) can be treated using a device called a pessary.

A pessary is designed to fit inside the vagina and hold the bladder in its correct location.

More severe cases may require surgery to strengthen and support the walls of the bladder.

Bladder diverticula

Bladder diverticula (pouches that develop in the wall of the bladder) usually require surgery to remove any pouches.

Blood Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart. Cystoscope A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra. Painkillers Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen. Ultrasound Ultrasound scans are a way of producing pictures of inside the body using sound waves.

Prevention

Drink plenty of water

The most effective way to prevent bladder stones developing (or returning) is to drink plenty of water.

Exactly how much water you should drink will depend on:

  • your age
  • your size
  • your level of physical activity
  • whether you have any underlying health conditions

Your doctor can advise you on how much water to drink.

Eat a healthy balanced diet

Eating a balanced diet can also help prevent the formation of bladder stones. A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains.

It is also important to limit your consumption of sugar and salt because both of these substances can increase the risk of bladder stones developing. Try not to eat more than 6g (0.2oz) of salt a day.

Many foods such as fruit and dairy products contain natural sugars, so you can get the sugar that your body needs by eating these foods.

Avoid food and drink that have had sugar added to them, such as:

  • fizzy drinks
  • sweets
  • chocolate
  • biscuits
  • ice cream
  • jam
  • cakes
  • pastries
Content supplied by NHS Choices