Kidney stones and the end of the world

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A kidney stone:  don’t tell me it’s not the end of the world. 

Sure, I’m better today, but yesterday I was dying.  At least it felt like it.  I hadn’t had pain like that since my son was born 17 years ago.  Very similar. 

Scary, too – what if the pain hadn’t gone away????

In the era of modern medicine we have an answer for kidney stones that don’t pass.  Lithotripsy, surgery, basket retrieval – there is an option for everyone. 

In post-modern medicine, what will we do?  Perhaps what I did yesterday:  wait it out.

Of course, I, a trained doctor, could diagnose myself.  I could monitor the passage of the stone down the ureter and into the bladder.  Fortunately (?) I’d just had a root canal and had a few narcotics on hand.  Unfortunately, they didn’t help the dental pain nor the kidney stone pain.  Either the ibuprofen helped or the stone had already entered the bladder.  Either way, after about 6 hours I could finally rest (with the help of a hot bath and some Benadryl).

But at TEOTWAWKI how will people cope?  And taking that back a step, how will they know what’s wrong with them?  Of course, anyone who’s had one may recognize another, but a large number of kidney stones occur in patients who’ve never had one.

Interestingly, not all kidney stones produce pain.  The pain from a kidney stone is related to obstruction of a hollow viscus.  In plain English that means that a tube-like structure in the body, one which normally allows passage of a fluid (or feces), is obstructed by a stone (or a baby, or a plug of feces).  In an effort to expel the obstruction, the muscular lining of the tube contracts, much like labor contractions.  Just as not every woman has severe labor pains, however, not every person with a kidney stone suffers extreme pains.  This is partly related to the size of the stone, but probably also related to a person’s internal neurologic wiring.  Kidney stone pain is generally one-sided and is little-relieved by change in position.  The onset is often sudden, as a stone lodges in the ureter tubing.  The pain may come in waves or be fairly constant. 

Kidney stones may also produce bleeding as the stone scrapes along the ureter (tube between the kidneys and bladder).  Once it reaches the bladder, the pain usually lets up, though both bleeding and pain may recur as the stone passes from the bladder through the urethra, out of the body. 

Other symptoms of kidney stones include the urge to urinate, frequent urination of small amounts, inability to urinate, burning on urination, nausea, and vomiting. 

In 25+ years of medical experience, I would estimate that over 95% of kidney stones pass on their own, that is, without surgical intervention. 

At TEOTWAWKI having a skilled health professional to diagnose the condition would be ideal.  Visible blood in the urine supports the diagnosis, though infection may cause this as well.  Usually urinary infection has a more gradual onset than symptoms of passing a kidney stone.

Patients with mild to moderate pain require no or minimal medication.  Tylenol or ibuprofen may suffice.  Drinking extra water helps push the stone through the ureter (which may hurt).  Sometimes diuretics (water pills) are used to encourage the kidney to make more urine, and help the stone along.  In a person with a history of infection or a significant amount of bleeding, taking an oral antibiotic for at least 1-3 days may be advisable to prevent infection (trimethoprim-sulfa DS twice daily, ciprofloxin 250-500 mg twice daily, macrodantin 50-100 mg twice daily, possibly amoxicillin 250-500 mg. three times daily, although this is less effective). 

In a person with severe pain, some sort of pain relief is required.  Narcotics usually help most people, but a supply may not be available.  Tramadol may be sufficient in many cases (50-100 mg. every 3 to 6 hours), as may ibuprofen (600-800 mg. every 4-6 hours).  Either of these may be combined with acetaminophen (Tylenol, 500-1000 mg every 4-8 hours).  (If you’re not sure of the diagnosis, don’t use ibuprofen or aspirin, as these may make stomach problems worse.) 

A hot bath may relieve the discomfort to some degree.  OTC anti-emetic meds (Dramamine, Bonine, meclizine – 25 mg every 6-12 hours) can alleviate nausea and vomiting.  If the pain isn’t too bad and you’re hoping to sleep it off, diphenhydramine (Benadryl) 25-50 mg. orally may help you rest.  It didn’t occur to me to try a glass of wine.  If one is sure of the diagnosis, a little alcohol may allow you to rest.  However, alcohol can irritate the stomach as well, and should be used with caution. 

Straining the urine through a fine strainer, a coffee filter, or even a T-shirt may help you recover a kidney stone and confirm the diagnosis. 

These days, if you think you have a kidney stone or are experiencing similar symptoms, I advise seeking professional help.  But in the aftermath of global crisis, you may be on your own.  For most people, if the stone doesn’t pass in a day, it will within a few days of taking increased fluids. 

For the few percent who don’t obtain relief, let’s hope a surgeon or two is still available. 


Kidney Stones
Image by Trevor Blake via Flickr



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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
This entry was posted in Abdominal pain, Acetaminophen - Tylenol, Acute diseases, Bloody urine, Bonine - meclizine, Difficulty urinating, Dramamine - meclizine, Flank pain, Frequent urination, Ibuprofen, Ibuprofen, Kidney stone, Meclizine, Medical archives, Nausea, NSAIDs, OTC Nausea/vomiting meds, OTC NSAIDs, OTC Pain meds, Over-the-counter meds, Symptoms, Vomiting, Vomiting and tagged , , , , , , , . Bookmark the permalink.

12 Responses to Kidney stones and the end of the world

  1. Kashif says:

    Hi I am from Pakistan i have been looking for these tablets but i am yet to find ROWATINEX in my country……

  2. Renee says:

    Wow, I was feeling it with him, but only 6 hours? lol

    I’ve had 4 of them! The first was impacted and we finally took it out after a couple of weeks of trying to pass it and the other 3 were lithotripsied after months of trying to pass them. It us just like labor pains!! I was told the S.E. was the kidney stone capital of the country, something about all the limestone in the water? It’s been 6 years since I have had one and boy, I sure wouldn’t want to have one without some good medical care!

  3. s wm carson says:

    Dear Dr. Koelker and her readers-

    First, thank you for doing this criitcal work! Terrific site, and l will get the book ASAP. An Olympic pistol coach @ the training center in Colo Spgs provided me with this terrific formulation some 15 years ago. He stated that it had never in his experience failed to provide rapid relief, and he never traveled without it. l previously have suffered every few years, since the late ’60’s and have since provided this to numerous friends, acquaintances, family, and near strangers! It is made in Germany, was prohibited to import until a couple of years ago (a neighbor has told me that it is now available). Taken at the onset of the attack, and @ intervals during, relief is complete, and rapid – usually within a couple of days! The German pharmacuetical company is ROWA WAGNER & the product is labled “ROWAtinex” w/ a registry # R-901 500 capsules have lasted me for years, giving most of the to other sufferers. My sister brought a bottle to me in ’96 and l believe they have retained their potency to date – no complaints at least. Dr. Koelkerr, I would be most interested in your assessment of this! My college German doesn’t take me into accurate label interpretation- guessing some extracts of balsam/fir esters & camphor? Every best thought!

  4. Peter S. says:

    2 oz of Real lemon twice a day with a full glass of water, 12 to 16 oz, has done wonders for my kidney stones for about 3 years. In the morning with my Nutrition and BP meds and in the evening with my nutrition. You should also stay away from raw onion and garlic. Cooked is OK. I had one serious attack about 3 years ago when I lapsed and ate a bunch of red onion with a hamburger. I do eat a pretty straight forward western diet but, I also take the best nutrition I can find and have for a very long time. 30 years as does my wife and 4 year old grandson who lives with us. We are 73 and 72. Of course lots of veggies and salads but, also red meat once or twice a week. No fast food. Maybe once a year. We also have a garden every year.

  5. Suz says:

    The pain from a kidney stone was excruciating for me and I was unable to pass mine since it was the size of the big marble looking one in the pictures above. No matter how many fluids or straight lemon juice you consume, one that size isn’t going to break down and be passed. I had surgery and also had my gallbladder out at the same time. Gallstones were also building up even though I hadn’t experienced as much pain from them as I had from the kidney stone. Makes me wonder how long I’d been “working” on those stones of both types.

    • Suz makes two good points: stones don’t develop overnight and big ones cannot pass. The take-home lesson is prevention. Keeping the urine dilute can prevent formation of stones and slow the growth of those that have already started. Ideally we’d all be drinking a good 64 ounces of water a day, or more. Growing stones is like growing crystals – crystals cannot grow in a dilute solution. Dilute urine looks nearly clear. Concentrated urine is dark yellow. Drinking enough water to keep one’s urine very light yellow is a great idea.

  6. m l griffith says:

    Cleavers tea is a miracle for kidney stones.

    • Thanks for bringing this herbal treatment to my attention. I don’t find much in the medical literature regarding cleavers tea, except that it does have a diuretic effect (like a water pill). Diuretics are sometimes used to help a person pass a kidney stone, but there are dangers of this. Doctors always tell people needing to pass a kidney stone to drink a lot of water to flush it down the ureter and out through the bladder. Just as turning on a water hose may dislodge an obstructing chunk of ice, a higher volume of urine can push a stone on through the ureter (tube from kidneys to bladder) or urethra (tube from bladder to outside). Diuretics work the same way. Keep in mind, however, that if a stone is badly stuck, this will make the pain intensify. In a worst-case scenario, the urinary pressure will back up and damage the kidneys. Before taking cleavers tea I’d suggest consulting a physician (if there’s one handy) or at a minimum try drinking a gallon of water a day for a few days. Anyone taking a diuretic runs the risk of dehydration, so drinking plenty of fluids remains a must.

  7. Michael R says:

    Was dating a massage therapist when I was passing a large rough oxalate stone from right kidney into bladder. Wasn’t sure what was going on, neither was she. However she did deep massage in the ureter area as the stone was going down. It did something important, easing passage and easing pain, even though neither of us really knew it was a kidney stone. Eventually passed out.

    • In other parts of the world, hands-on therapies are used to relieve pain – light touch and massage, along with gentle encouragement and love. Americans are used to pills, but human connection and concern help as well.

  8. Cynthia Sherlock says:

    Excellent article. Too bad a personal experience led to such great details.

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