Overview-Bladder stones
Bladder stones are hard lumps of minerals that can form inside the bladder when it's not completely empty of urine.
They may not cause any symptoms if they're small enough to be passed out of the bladder when you pee.
But most people with bladder stones do experience symptoms because the stones either irritate the wall of the bladder or block the flow of urine.
Typical symptoms of bladder stones include:
- lower abdominal pain, which can often be severe (men may also have pain in or around their penis)
- pain or difficulty when peeing
- peeing more frequently (particularly at night)
- cloudy or dark-coloured urine
- blood in the urine
Most cases of bladder stones affect men aged 50 or older because of the link with prostate enlargement. But both men and women can get bladder stones.
It's rare for bladder stones to affect children. In children, they can lead to bedwetting, and some boys may experience priapism, a persistent and often painful erection that can last for hours.
When to see your GP
See your GP if you experience any of the above symptoms, particularly if you have persistent abdominal pain, need to pee more frequently, or have blood in your urine.
These symptoms may not necessarily be caused by bladder stones, but need to be investigated further.
If your GP suspects you have a stone in your bladder, you'll be referred to hospital for testing.
A blood and a urine test will probably be carried out first. A blood test will detect if there's an infection inside your bladder.
The next stage is to take an X-ray of your bladder. Not all types of bladder stones show up clearly on X-rays, so a negative X-ray result doesn't always mean that you don't have bladder stones.
An ultrasound scan may be used instead of an X-ray. Bladder stones can also be identified using a cystoscopy.
This is where a thin fibreoptic tube with a light and a camera at one end (a cystoscope) is inserted into the urethra (the tube that carries urine out of the body) and moved up into the bladder.
The camera relays images to a screen, where they can be seen by the urologist (specialist in treating bladder conditions).
What causes bladder stones?
Bladder stones usually form when you can't completely empty your bladder of urine.
A common reason for this in men is having an enlarged prostate gland that blocks the flow of urine.
If urine sits in the bladder for a long time, chemicals in the urine form crystals, which harden into bladder stones.
Treating bladder stones
Surgery is usually needed to remove the stones from the bladder. The most common procedure is a cystolitholapaxy, where a thin tube (cystoscope) with a camera at the end is used to find the bladder stones.
The cystoscope will then use stone-crushing devices, lasers or ultrasound to break up the stones before they're removed.
Where possible, it's important to treat the underlying causes of bladder stones to prevent new stones developing in the future.
Preventing bladder stones
If you have had bladder stones, they can come back. There are things you can do to try to prevent this happening.
You can try to:
- increase your daily fluid intake to 2 to 3 litres to lower the concentration of your urine
- regularly empty your bladder without delaying
- urinate again 10 to 20 seconds after your first attempt (if you're unable to empty your bladder completely first time); this is called double voiding and helps empty the bladder more efficiently
- avoid constipation (regular laxatives may be recommended)
The bladder and kidneys
The kidneys filter waste products out of the blood, which are mixed with water to create urine. Urine flows from the kidneys to the bladder, where it's stored.
When the bladder is full and you're ready to pee, urine passes out of your body through a tube called the urethra.
Causes-Bladder stones
Bladder stones usually form when you can't completely empty your bladder of urine.
Urine is produced by your kidneys. It's 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 any urine remains in your bladder, the chemicals in urea will stick together and form crystals. Over time, the crystals will harden and form bladder stones.
This page explains the main reasons why it might not be possible to empty the bladder fully.
Prostate enlargement
The prostate gland is a small gland only found in men. It's found between the penis and the bladder, and surrounds the urethra (the tube through which urine passes out of the body).
Many men experience prostate enlargement as they grow older. Their enlarged prostate can press on the urethra and block the flow of urine from their bladder.
This is normally successfully treated, but the few men who fail to respond to treatment will have an increased risk of developing bladder stones.
Damaged nerves (neurogenic bladder)
Neurogenic bladder is a condition where the nerves that control the bladder are damaged. This prevents a person emptying their bladder fully.
It can be caused by an injury to the nerves in the spine or a condition that damages the nervous system, such as motor neurone disease or spina bifida.
Most people with a neurogenic bladder need to have a tube called a catheter inserted into their bladder to drain it of urine. This process is known as urinary catheterisation.
Even though a catheter is reasonably effective, it often leaves a small amount of urine in the bladder, which can lead to the formation of bladder stones.
Cystocele
A cystocele is a condition that affects women, and occurs when the wall of the bladder becomes weakened and drops down into the vagina. This can block the flow of urine out of the bladder.
A cystocele can develop during a period of excessive straining, such as during childbirth or heavy lifting, or while on the toilet with constipation.
Bladder diverticula
Bladder diverticula are pouches that develop in the wall of the bladder. If the diverticula get too big, 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
Bladder augmentation surgery is where a piece of the bowel is removed and attached to the bladder to make it larger.
It can be a useful way of treating a type of urinary incontinence known as urge incontinence. But it can sometimes be a factor in developing bladder stones.
Diet
In the UK it's unusual for bladder stones to be caused by a poor diet, but this is relatively common in parts of the developing world.
A diet high in fat, sugar or salt and low in vitamin A and vitamin B can increase the risk of bladder stones developing, particularly if a person is also not drinking enough fluids.
This can alter the chemical make-up of urine, making the formation of bladder stones more likely.
Treatment-Bladder stones
Surgery will usually be needed to remove bladder stones.
It may be possible to flush small bladder stones out of your bladder by drinking lots of water, but this may not work if you can't completely empty your bladder of urine.
Transurethral cystolitholapaxy
A transurethral cystolitholapaxy is the most common procedure used to treat adults with bladder stones.
The surgeon inserts a small, rigid tube with a camera at the end (a cystoscope) into your urethra and up into your bladder. The camera is used to help locate the bladder stones.
A crushing device, lasers or ultrasound waves transmitted from the cystoscope can be used to break up the stones into smaller fragments, which can be washed out of your bladder with fluids.
A transurethral cystolitholapaxy is carried out under either a local anaesthetic or a general anaesthetic, so you shouldn't feel any pain during the procedure.
There's a risk of developing an infection during the procedure, so you may be given antibiotics as a precaution. There's also a small risk of injury to the bladder.
Percutaneous suprapubic cystolitholapaxy
A percutaneous suprapubic cystolitholapaxy is mainly used to treat children to avoid damaging their urethra. It's also sometimes used for adults with large bladder stones.
Instead of inserting a tube into the urethra, the surgeon makes a small cut in the skin of the lower abdomen.
Another cut is then made in the bladder so the stones can be removed. This will be done using a general anaesthetic.
Open cystostomy
An open cystostomy is often used to remove bladder stones in men with a very large prostate, or if the stone itself is very large.
It's a similar procedure to percutaneous suprapubic cystolitholapaxy, except the surgeon makes a much larger cut in the abdomen and bladder.
It 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).
The disadvantage of an open cystostomy is that it causes more pain afterwards and has a longer recovery time than the other types of surgery. But an open cystostomy will be needed if the bladder stone is large.
You'll need to use a catheter for a day or two after the procedure.
Complications of surgery
The most common complication of bladder stone surgery is infection of the bladder or urethra, known as a urinary tract infection (UTI).
UTIs affect about 1 in 10 people who have bladder surgery and can usually be treated with antibiotics.
Recovery and follow-up
After having a transurethral cystolitholapaxy or percutaneous suprapubic cystolitholapaxy, you'll usually need to stay in hospital for a few days to recover.
If you have had an open cystostomy, it may be several days before you're well enough to go home.
After surgery, you may be asked to attend a follow-up appointment where an X-ray or CT scan can be used to check that all fragments of the bladder stones have been removed from your bladder.
Treating the underlying cause
Once the bladder stones have been removed, the underlying cause will need to be treated to avoid new bladder stones forming.
Prostate enlargement
Prostate enlargement can be treated using medication to help reduce the size of the prostate. This will relieve the pressure on the bladder, making it easier for you to pee.
If medication doesn't work, surgery may be needed to remove some or all of the prostate.
Neurogenic bladder
A neurogenic bladder is an inability to control the bladder because of nerve damage.
If you develop bladder stones and have this condition, it's often a sign you need to change the way you're draining your bladder.
You may need further training in fitting your catheter, or you may need to change the type of catheter you're using and use medication to help control the bladder.
Cystocele
Some people with a cystocele (where the walls of the bladder weaken and 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 position.
More severe cases of cystocele may require surgery to strengthen and support the walls of the bladder.
Bladder diverticula
If you have bladder diverticula (pouches that develop in the wall of the bladder), surgery may be needed to remove them.