Every year, half a million people go to emergency rooms because they have kidney stones, and about one in ten people will have one at some point in their lives. You have two kidneys, and their main job is to clean the waste and toxins out of your blood. Usually, the kidneys get rid of these wastes by flushing them out as urine. Every 24 hours, your kidneys clean 189 liters (50 gallons) of blood and get rid of 64 ounces (1.9 liters) of waste.
But sometimes, there are too many waste products in the blood that the kidneys can’t get rid of. These leftover waste products can form tiny crystals that, over time, group together to make “stones” that get bigger and bigger. Most kidney stones are made of calcium oxalate, but there are also stones made of uric acid, struvite, and cystine.
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Things get really bad when one of these stones moves out of the kidney and into the ureter, a narrow tube that transfers urine from the kidney to the bladder. When that happens, it can feel like you’ve been stabbed in the back. Kidney stones hurt when they move out of the kidney and block the ureter. This makes urine build up behind them, which stretches the ureter and other tissues like a balloon.
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Pain is hard to measure, but people often say that passing a kidney stone hurts as much as giving birth or worse. But if you thought that a sharp clump of crystals slowly moving through your urinary tract caused the excruciating pain of kidney stones, you’d be wrong. Kidney stones can cause many symptoms, from fever and vomiting to sharp pain in the stomach and back.
Dr. Timothy Averch, a kidney stone specialist at Prisma Health Urology in Columbia, South Carolina, says that most people think the pain comes from the stone itself. “Patients will frequently say, ‘It must have a lot of rough edges or spikes because this one hurts a lot.’ Or it’s really large, and that’s what hurts so badly. That actually has nothing to do with the pain.”
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If a kidney stone is big enough, it can get stuck in the narrow ureter, causing urine to build up behind it. Since the urine has nowhere to go, it puts more and more pressure on the narrow ureter and the kidney. This makes the tissues stretch out like a balloon.
Averch says that the pain people feel when they have kidney stones is caused by this stretching. Averch explains, “You feel it in your back first, and then it can radiate around the front and down to the groin. It’s pretty excruciating for most.”
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Different nerves in the body can sense things like touch and temperature. Averch says that your kidneys and ureter, like your intestines, bladder, and bowels, have nerves that can sense swelling or expansion. A bowel blockage is also very painful, but kidney stones happen much more often.
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Averch says that the pain from kidney stones is “colic” because it comes and goes in waves. This is because the ureter uses peristalsis, which is the movement of muscles in waves, to move urine from the kidney to the bladder in groups or packets. If the path is blocked, the pressure goes up every time the ureter squeezes unintentionally, and the pain worsens.
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Both women and men have a tube called the urethra that leads from the bladder to the outside of the body. Averch also says that people often think that passing a kidney stone through the urethra is the most painful part of having one. That’s the part that Averch’s male patients definitely worry about the most. But, Averch says most of these fears are unfounded.
Averch explains, “The urethra, in men and women, is much wider than the ureter — almost twice the size. Patients will frequently say to me, ‘Oh, I’ll know when I pee it out.’ Often, they actually don’t.”
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When kidney stones don’t pass out with medication, surgery is the next option. One such surgery involves breaking up the kidney stones within the kidney by blasts or shockwaves from a laser. However, the biggest pieces can sometimes still remain intact. Even if you pee out the broken-up stones, it can feel like you are peeing out “shards of glass.”
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In some cases, a stent is put inside the ureter to open the way from the kidney to the bladder. The stent can remain in for two weeks, or more or less. Ureteral stents are tubes made of plastic that are 10 to 15 inches (25 to 38 cm) long and are put through the urethra all the way to the kidney to let urine flow back to the bladder.
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In many cases where kidney stones were removed, a ureteral stent is used to keep the ureter from becoming blocked again by swelling after kidney stone removal surgery. The stent is inserted when the patient is heavily sedated, but the patient remains awake and conscious when it is removed.
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If a person can’t pass a kidney stone on their own, they need surgery. The Federal Drug Administration (FDA) recently introduced a robotic-assisted endoscope that can use lasers to break up kidney stones and vacuum up the pieces. Averch was a consultant on the technology.
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