Everything you need to know about bladder stones

If you’re unable to fully empty your bladder, you’re at a higher risk of developing bladder stones. And even though both men and women can get bladder stones, they are most common among men over the age of 50. But let’s look at it in more detail.

WHAT ARE POSSIBLE SYMPTOMS OF BLADDER STONES?

Having bladder stones won’t automatically cause any symptoms as they can be small enough for you to pass when going for a pee. Often you won’t even notice it! If bladder stones are bigger, however, they will be quite noticeable as they’ll either block your urine flow or irritate your bladder wall. In children bladder stones are very rare but if they happen, they can lead to bedwetting and boys might experience a painful erection that can last for hours. In adults, the most common symptoms of bladder stones are:

  • Severe pain in your lower abdomen
  • Cloudy, blood, and dark-coloured urine
  • Pain in or around your penis if you’re a man
  • Difficulty or pain when peeing
  • Having to pee more frequently, particularly at night

WHEN SHOULD YOU SEEK HELP?

If you experience any of the symptoms mentioned above, it’s always good to make an appointment with your GP. Even though these symptoms don’t automatically mean that you have bladder stones, they should always be checked out by a healthcare professional. If your GP suspects that you have bladder stones, they will usually refer you to a hospital for further testing.

WHAT HAPPENS AT THE HOSPITAL?

As a first step, your blood and urine will usually be checked for any signs of infection. If that doesn’t reveal anything, the next step will often be an X-ray of your bladder. Be aware that not every bladder stone will definitely show up on an X-ray, so even if your doctor can’t see anything, it unfortunately doesn’t mean that there isn’t a sneaky stone hiding somewhere. Should your X-ray be inconclusive as well, your doctor might suggest a cystoscopy. This means that they will insert a cystoscope – this is a flexible tube with a camera on one end – into your urethra and move it all the way up into your bladder. This gives your doctor the possibility to have a closer look at your bladder and discover any possible bladder stones.

WHAT CAUSES BLADDER STONES?

As we’ve already mentioned, bladder stones usually form when you’re unable to empty fully empty your bladder. This is because the chemicals in the urine that stays in your bladder will eventually stick together and form little crystals. At some point, these crystals will form a small, hard lump which is called a bladder stone. But let’s look at some reasons why you might not be able to empty your bladder fully.

Prostate enlargement

If you’re a man, you have a prostate gland. This is found between your penis and your bladder and sits around your urethra (a little bit like a donut!). As you get older, your prostate will get bigger and can affect the urine flow from your bladder which can lead to some urine constantly staying in the bladder. This will put you at a higher risk of developing bladder stones.

Neurogenic bladder

If you suffer from a neurogenic bladder, it means that the nerves that send messages between your bladder and your brain are damaged which prevents your bladder from emptying fully. This can either be caused by an injury to the spinal cord or a medical condition that affects the nervous system. In many cases, people with a neurogenic bladder will either need an indwelling urinary catheter or use intermittent self-catheterisation as a way to empty their bladder. And even though the use of a catheter is generally quite effective, it can leave just a small bit of urine in the bladder which can contribute to the development of bladder stones.

Cystocele

This is a condition that only affects women and happens when the bladder wall gets weak and drops into the vagina which can lead to a blockage of the urine flow out of the bladder. It can happen when you have to strain excessively, for example during childbirth or when lifting something especially heavy. It also sometimes happens to women who suffer from severe constipation and have to strain a lot on the toilet.

Bladder diverticula

If you suffer from bladder diverticula, little pouches will develop in the wall of your bladder. As long as these are small, they likely won’t cause you any problems. If they get too big, however, it can become difficult for you to empty your bladder fully. Bladder diverticula can either be present from birth or develop as part of an infection in the bladder.

Bladder augmentation surgery

During bladder augmentation surgery, a piece of bowel will be used to make your bladder larger. Although it’s an effective treatment for urge incontinence, it can play a part in developing bladder stones. This is because your bladder doesn’t work like it’s used to anymore and it’s more difficult for you to empty your bladder.

Diet

In the UK it’s rather unusual for bladder stones to develop because of a poor diet, but it’s quite common in other parts of the world, especially in developing countries. A diet high in fat, sugar, or salt and low in vitamin A and B can change the chemical make-up of your urine, increasing your risk of developing bladder stones.

HOW ARE BLADDER STONES TREATED?

In many cases, surgery will be required to remove bladder stones in order to not cause any damage or injury to your urethra. If your bladder stones are fairly small, it might be possible to flush them out of your bladder by drinking lots and lots of water, but this might not work if you can’t fully empty your bladder. But let’s look at some of the available treatment options.

Transurethral cystolitholapaxy (TC)

This procedure is most commonly used to treat bladder stones in adults. Your doctor will insert a small, flexible tube with a camera – a cystoscope – into your urethra and up into the bladder in order to locate your bladder stones. Then they will use either a crushing device or laser or ultrasound waves coming from the cystoscope to break the stones into smaller pieces which can then be washed out of your bladder with plenty of fluids. This procedure can either be done under general anaesthesia or with local anaesthetic but either way, you shouldn’t feel any pain. However, TC comes with an increased risk of infection, so your doctor might prescribe you some antibiotics as a precaution.

Percutaneous suprapubic cystoliholapaxy

This procedure is mainly used to treat bladder stones in children in order to avoid damaging their urethra in the process. It might also be used if you’re an adult and your bladder stones are particularly large. With this type of treatment, the cystoscope won’t be inserted into your urethra but via a small cut on your lower abdomen. Your doctor will make another small cut in the bladder, so your stones can be removed. This whole procedure will generally be done under general anaesthesia.

Open cystostomy

An open cystostomy is often used to remove bladder stones in men with a very enlarged prostate or if the bladder stones are very large. The procedure itself is fairly similar to the one explained above, except that the cut in your abdomen and bladder will be bigger. If you have any other problems that need to be taken care of surgically, for example removing parts of your prostate or bladder diverticula, this will often be done in the same procedure. Although it’s an effective treatment, an open cystostomy also means that your recovery time will be longer and causes more pain than the other options and you’ll likely end up having a catheter for a few days after surgery.

WHAT ARE POSSIBLE COMPLICATIONS OF BLADDER STONE SURGERY?

The most common and frequent complication of bladder stone surgery is an infection of either the bladder or the urethra, also known as a urinary tract infection. This affects about 1 in 10 people who’ve had bladder surgery and is usually effectively treated with a course of antibiotics.

RECOVERY & FOLLOW-UP AFTER YOUR BLADDER STONE SURGERY

After having a transurethral cystolitholapaxy or a percutaneous suprapubic cystolitholapaxy you’ll usually have to stay in hospital for a couple of days to recover. If you had an open cystostomy, on the other hand, you might have to remain in hospital for several days before you’re well enough to be discharged. After your surgery, you might be asked to come to a routine follow-up examination where an X-ray or CT scan can be done to make sure that all the fragments of your bladder stones have been removed.

HOW THE CAUSE FOR BLADDER STONES CAN BE TREATED

Once your bladder stones have been removed, it’s also important to treat the underlying cause in order to avoid new bladder stones forming.

Prostate enlargement

This can be treated using medication that helps to reduce the size of your prostate which, in turn, will relieve the pressure on your bladder and help you to empty it fully again. If medication hasn’t worked, you may need to have surgery in order to remove some or all of your prostate.

Neurogenic bladder

If you have a neurogenic bladder and you’ve developed bladder stones, it’s often a sign that you might need to change the way you empty your bladder. You may need further training in fitting your catheter, you might need to change the type of catheter you’re using, or you might need some medication to help control your bladder.

Cystocele

You might be able to be treated with a device called pessary. This is designed to fit inside your vagina and hold your bladder in its correct position. If your case is rather severe, a pessary might not be enough, and you might require surgery to strengthen and support your bladder walls.

Bladder diverticula

If you have bladder diverticula and they are likely to blame for your bladder stones, you might need to have surgery in order to remove them.

CAN YOU PREVENT BLADDER STONES?

If you’ve had bladder stones previously, they can come back but there are things you can do to try and prevent this from happening. Here are some of our top tips:

  • Increase the amount you drink daily to 2 to 3 litres in order to make your urine less concentrated
  • Always make sure to empty your bladder regularly without delaying it
  • Try double voiding to empty your bladder more effectively
  • Try to avoid constipation

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