Ask us: How will I know when a stone has dropped into the bladder?

In our “Ask a kidney stone doctor” section, we field questions from stone formers or their family members. Today’s question is about knowing when a stone has passed successfully. See other questions and answers or ask your own question here.

July 26, 2011

Question from a stone former actively passing a stone:

I have been diagnosed with a kidney stone.  I am experiencing pain that has now moved to my side.  Occasionally I will get waves of overall abdominal pain, but the sharp pains are still generally located to the side.  How will I be able to tell when the stone has dropped to the bladder?
I’ve been drinking 4L of water (at least) a day for 8 days now and the stone still has not passed. I would rather now go into work and keep on with my life until the stone passes – I am just concerned with knowing the warning signs of when the stone is very close to passing.

 

Answer:

During stone episodes, stones generally cause a predictable sequence
of symptoms as they move down the ureter. Initially, pain is located
in the back when the stone is located up near the kidney. As the stone
moves further down, the pain can also be located in the side and in
the abdomen. When the stone is in the lower part of the ureter, the
pain moves toward the front of the abdomen. Once a stone is entering
into the bladder, patients may also feel the urgency to urinate and
can feel pain in the groin. Once the stone makes it into the bladder,
there should be a relief of pain. While this sequence is typical, some
patients may experience different symptoms. We have more information
on this on our “What causes kidney stone pain?” page.

Staying hydrated is a good idea but it is not clear if it speeds the
passage of stones (make sure though to not drink more than about 1
liter in an hour, as water intoxication can occur with intakes of 2
liters an hour or higher). Use of certain medications, such as
tamsulosin, does appear to shorten stone passage. You should know
though that use of this medication for this purpose is “off label” and
should be discussed with your treating physician. Other factors that
influence the likelihood and speed of stone passage includes the size
of the stone and its location. Stones can take up to 6-8 weeks to
pass. If they have not passed by then, treatment may be required.

 

Before making any medical decisions, always consult with your treating physician.

About Dr. Mike Nguyen

Mike M Nguyen, MD, MPH, is a urologist and an Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA. He specializes in the treatment of kidney stones with both surgery and dietary prevention and the in the treatment of kidney and prostate cancer using the latest robotic surgical approaches. He sees patients at clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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32 Responses to Ask us: How will I know when a stone has dropped into the bladder?

  1. LauraM says:

    I’m 35yrs old and have had (without exaggeration) about 30 stones since I was 18. For awhile i was getting them about every 3 months. Ive been stone free for about the last year or so until a month ago. It started very different from any other stones Ive had. I noticed some pain in my upper flank (under my ribs) that morning. As i went on with my daily routine it seemed to go away so I thought nothing more of it. That evening it came back with a vengeance. The pain was only in my back so I wasn’t sure if it was a kidney stone or not. Mine usually start in the middle under my ribs in my abdomen and move to one side or the other. I made a trip to the ER and sure enough it was a stone. A very small one, only 2mm and it shouldn’t be causing any pain at all. I was also diagnosed with a kidney infection. antibiotics weren’t working so they had to be changed 5 days later to something else. All the while Im eating pain pills like candy which have their own evil side effects. This was a horrible and very drawn out experience. Usually within a day or 2 of the initial pain I have passed the stone and all is well. Anyway, During all of this I was finally able to get into see “the best” urologist around. I was pleased with her as she was insisting on a 48hr Urinalysis once I heal to find out what is causing them. Apparently there are some meds they can prescribe to prevent the development of stones once they know what they are made of…..YES! FINALLY a light at the end of the stone tunnel.
    So after 2 weeks I go into see her for a recheck and mentioned I had felt something on my left side the day before that felt like it may be another stone. She brushed it off saying there was nothing in my left kidney when they scanned me 2 weeks before so it was probably a pulled muscle. I took that at face value and went on…no more pains on my left side so I thought, well I guess shes right.
    It has been exactly a month since the horrible kidney on the right side experience and 4 days ago, I notice the same pain in the morning like i did before but this time on the left side. just like last time I went on about my day and it went away. That evening it came back and was excruciating! i decided to take some left over pain meds and see my Dr the next day. I went to my reg Dr the next morning who did nothing but a urinalysis which showed small amount of blood and bilirubin. She was unsure if this was an infection or a kidney stone so she sent me on my way with more pain meds and an antibiotic. She did ask me to call her the next day to tel her how I was feeling.
    Day 2 and feeling like Ive been hit by a truck I call her and tell her I wasn’t any better. She suggested I call my urologist and see how quick I can get in to see her.
    No return call until the end of the day and the Dr has already gone. I was told to go to an urgent care and get a urinalysis. I explained I had already had that done the day before. So then it was “Ill let the Dr know but shes gone for the day so it will be tomorrow before I can get back to you” Day 3 I’m still in insane pain, nauseous, major headache, low grade temp and just don’t feel good all over. 4:30pm another call from the urologist nurse who says the Dr will be glad to prescribe me meloxicam…wait. Meloxicam? yes, for the muscle pain…. this is not muscle pain, this is the exact same pain as before. well, your scan shows a small 2mm stone which shouldn’t be causing any pain….wait, what scan?… the scan you had done a month ago…. right! and that was on my right side, which i have passed, this is on my LEFT and exactly like the pain i had on the right……. well there was nothing on your left side in that scan so it isn’t a stone….. At this point I’m livid. She says there’s no way i have a stone if they didn’t see it on the scan before bc it takes a while to form a stone…. So a while like 3 mos? bc I was getting them every three months before. Shes speechless, she cant explain the blood or the bilirubin in my urine except that the bilirubin is from my liver. so clearly SOMETHING is wrong.
    Yesterday I went back to my reg Dr still feeling horrible. She tells me to go to the ER bc they can do an entire workup and scan that they cant do at their office….
    Before I could get to the ER yesterday afternoon I felt the pain move from my flank to my lower back and lots of pressure in my lower abdomen. Great the stone has passed to my bladder and it wont show on a scan at this point. My entire back hurt all night. This morning I still feel horrible. I definitely feel residual pain in my flank but I feel painfully bloated and achy all over my tummy and back. I still have a bad headache and the nausea. Should I still go to the ER or is it too late? What, if anything will they be able to tell now if it has passed into my bladder? Also, I did some research and stones can form in just a months time.

  2. teenie says:

    I had a 5cm stone 5 years ago, my pain was hip and groin,not my back. I’ve had the same pain for maybe 6 months. Finally I got a DC to order a hip xray and my ultrasound. Started taking vinegar and lemon juice, 1 tsp each. 3 x / day
    One week ago…
    Results mild hydronephrosis and distal blockage. Horrible pain after 32 oz of water after ultrasound. Pain control with 2 ibuprophen that night.
    Okay, finding stuff online is a risk, it is a risk, but I did this:
    2 oz lemon juice, 2 oz light olive oil, mixed it, drank it and then 12 oz of water. I felt sick.Pain was now in back and wrapping around to front. two days later.
    Pain was bad and I needed the CT scan so I went to the ER. Results it was 5x3cm stone in my bladder. The next day I took a long walk (5miles on the beach) crazy.
    The next day online I found this: basil and honey 1 tsp of each. So I had pesto and honey, followed by 8 oz of water and in 20 minutes passed the huge stone. No pain.
    Residual pain remains, so I’m drinking Marshmallow root (boiled) water, and kidney tonic by Herbs etc. All this occurred in one week, after I waited for 6 months of depression, pain, chiropractor, accupuncture, because my primary didn’t order an ultrasound in March…. Oh well, it all worked out fine…. No invasive mess like 5 years ago. I suspect 5 years ago I ate way to much spinach salad, and this time it was all the sweet potatoes. Best of luck to all. My crazy internet cures, could have been a coincidense.

  3. teenie says:

    I had a 5cm stone 5 years ago, my pain was hip and groin,not my back. I’ve had the same pain for maybe 6 months. Finally I got a DC to order a hip xray and my ultrasound. Started taking vinegar and lemon juice, 1 tsp each. 3 x / day
    One week ago…
    Results mild hydronephrosis and distal blockage. Horrible pain after 32 oz of water after ultrasound. Pain control with 2 ibuprophen that night.
    Okay, finding stuff online is a risk, it is a risk, but I did this:
    2 oz lemon juice, 2 oz light olive oil, mixed it, drank it and then 12 oz of water. I felt sick.Pain was now in back and wrapping around to front. two days later.
    Pain was bad and I needed the CT scan so I went to the ER. Results it was 5x3cm stone in my bladder. The next day I took a long walk (5miles on the beach) crazy.
    The next day online I found this: basil and honey 1 tsp of each. So I had pesto and honey, followed by 8 oz of water and in 20 minutes passed the huge stone. No pain.
    Residual pain remains, so I’m drinking Marshmallow root (boiled) water, and kidney tonic by Herbs etc. All this occurred in one week, after I waited for 6 months of depression, pain, chiropractor, accupuncture, because my primary didn’t order an ultrasound in March…. Oh well, it all worked out fine…. No invasive mess like 5 years ago. I suspect 5 years ago I ate way to much spinach salad, and this time it was all the sweet potatoes. Best of luck to all. My crazy internet cures, could have been a coincidense. Everyone is different, but without these share sites, what would we do?

  4. Kris says:

    I currently am taking an antibiotic for an infection I had due to a stone. How do I know if this is in fact gone? It caused awful symptoms for about 4 days. Should I have a test to see if it’s out?

    • Jim says:

      Every stone is different, even to people like me who seem to get them about every twenty-four months. The following are my experiences of calcium kidney stones in a male. I have no idea about other stones or the female experience.
      The first sign is often a feeling of bloating in your stomach and a need to move your bowels. Then, the colic (aching in the back and flank) starts and some people will get intense pain requiring urgent relief. Others, such as me, can often get through with OTC painkillers. The initial journey is from the kidney into the ureter – the tube which links to the bladder. This tube is like a collapsed drinking straw and the pain comes from the muscles trying to express the stone downwards. Often, this journey doesn’t take long and if you are lucky, the stone move to the base of your ureter quite quickly. Once there, if you are even luckier, it will pass into your bladder – more on that later. However, it is very common for the stone to get stuck at the ureter/bladder junction. The good news is that this rarely causes colic pain. If it does or you can feel a ‘swelling’ sensation in the affected kidney, go to ER as you may well have a blocked ureter and that is an emergency which needs to be dealt with.
      Unfortunately, the stone can stay in this lower position for weeks or even months. This tends to cause irritation rather than severe pain or malaise. From time to time, you will feel a slight sharp pain as it moves or is irritated. You can also feel nothing at all! The best feeling in the world (for a stone sufferer anyway) is the point at which the stone finally enters your bladder. It can happen anytime, in bed, driving, in a bar – anytime. You’ll know it’s about to happen because you’ll get a strange sensation in your stomach and for a split second, a sharp pain at the tip of your penis. After that, nothing. Every symptom just disappears instantly. The next time you need to urinate – a suggestion is to do this as soon as possible – you should strain your urine. The stone is likely to move from your bladder to urethra at the end of urination. Again, with luck, it will pop out – painlessly. However, it is quite normal for the stone to get stuck in the urethra as well – just never ends, does it? This is not a major problem and won’t cause pain because the urethra is quite large and elastic. Just keep drinking the water and if you can, try some gentle force through your stream – when it eventually pops-out, it needs to be diagnosed.
      Problems: If the stone is too big, it’s going to have to come out by intervention. The intervention depends on where it is in your body. In the kidney, it’s a little time-bomb but will not cause any pain so best left alone. At the top or middle of the ureter, keyhole surgery may be required. At the base of the ureter, it’s going to have to come out using a cytoscopy procedure to grab it. A stuck stone can cause infection as the urine backs up behind it. You’ll know if this happens as you’ll feel generally unwell.
      Prevention: Drink water until your urine is nearly white. You should also be doing this during the episode.It’s a real pain I know, but it helps. Carry a bottle and keep drinking. Have an IVP scan (different name in different countries) every year or so to see if you have any more stones in your kidneys. If you do, then you can be given Extra-Corporeal-Lithotripsy which is a machine that smashes the stones into very small particles using sound waves so they pass with very little discomfort. – a much better option.

  5. KaDwiggleHeimer 3rd. says:

    I was scanned, CT’d….,picturing a 7mm kidney stone on May 30th. 2015. This is July, 9th. approximately, 5 wks. later…..I’ve experienced, on, off episodes, of pain, since then. The doctor didn’t even prescribe me any antibiotics in case of infection……They only prescribed me medicine for pain, and to help me urinate……Is there a possible chance of getting any infection, during the process of, naturally passing this stone…..I’ve been taking Renavive, since June 1st……to help dissolve any kind, or size of stone. Any comments, or feedback, will be much appreciated……ty…………

  6. Tracy says:

    I have been diagnosed with a 5cm stone in my right kidney and 1cm in the left. I have had pain in the kidney area for 5 weeks now. The stone does not appear to be moving but I have been told I need to pass it naturally with no surgical intervention. How long am I supposed to put up with the pain till something will be done or how long can it take to pass naturally ?

  7. Jen Wilson says:

    Just got diagnosed with my first kidney stone. I dont know the exact size but said not real big but it is partially obstructing my left ureter. Its been about 6 or 7 days since I first noticed it. Intense back pain and now only pain in my bladder and to the left so probably still stuck. Drinking lemonade, taking FLOMAX, ANTIBIOTIC, walking and trying to move around as much as possible. Using strainer and have not yet passed it. This is a nerve-racking experience where at any moment it could get really bad and I would have to return to the hospital. I feel like a ticking time bomb. After researching diets to avoid kidney stones it seems you need to know what kind of stone it is first…so in the mean time I am at a loss of what to eat. Heard the following is not good: spinach, red meats and animal protein, fish, berries, chocolate, coffee, pepsi or coke, salt anything salty, high fructose corn syrup which leaves canned fruits out. So really it seems one must stick to a diet of beans and veggies and some fruit. Any suggestions on what else to eat? Also, average amount of time needed to pass a stone?

    • Michelle says:

      I have passed 29 of those little buggers in the last 20 years. I have had some require surgery and some not. What I have learned is that I need to drink lots of fluids before there is a stone, in order to flush the calcium deposits out of my kidneys before they become a problem. The other thing I learned is that after 3 stones, it pretty much is a kidney disease and you should see a nephrologist and not just a urologist. Urologists are great when there is a stone, but Nephrologists can figure out why you keep getting them. Once the stone passes, for me, I aim to drink about 2 gallons of fluids a day in the mild temp months and 3 gallons of fluids a day in the hot months. Until the stone passes though, don’t drink that much as you don’t want urine to back up in your kidney. The best advice I can give you- do some jumping jacks. I know it sounds dumb, but it really does work. My stones often get stuck in the junction between the ureter and the bladder and this is the best way I have found to dislodge them. It isn’t comfortable feeling like you are peeing glass either and pyridium helps me. Try it and see- Good luck.

    • Cheryl says:

      I had a 4mm stone which took about a month to pass, (diagnosed with a CAT scan). It started with severe abdominal pain as it passed from my kidney to the ureter and seemed to plant itself there for weeks. While in the ureter it pressed against my bladder and caused the constant feeling of having to urinate, sometime painfully. I drank a lot of water and started running- gravity helps!! I think what caused my stone was adding a daily dose of “green juice” to my diet- kale, spinach etc. These contain oxalates which can form a stone;

  8. Marsha Walmsley says:

    I have had 11 kidney stones removed in four years now I am going on year 5 and I have six more stones already. I have tried all kids of things but nothing works. I have done everything the doctor said and still nothing works. I am in pain all the time and I just want it to stop. I have gone through private for help. but they don’t know why I am having so many stones so fast. at first they thought I mite have MSK a rare kidney disease but now they r not sure. I have now two kidney specialist working on my case and the wait is just taking too long.

    • Jann says:

      Take Hydrangea, Kidney Activator, & Mashmallow. From http://www.naturesunshine.com
      Take care of yourself.
      Thank me later

    • LauraM says:

      any idea how fast yours are forming? Im having a battle right now with the urologist who claims I cant have a stone in my left kidney since they just did a scan a month ago and my right had one but my left didnt. I think thats the most ridiculous thing ive ever heard. The Dr wont even see me even though I have the exact pain on my left side as I did a month ago on my right. Hope you get some answers soon. They are in fact miserable!

  9. MJ says:

    I was diagnosed with kidney stones a few months ago. Initially, I had no problems. Later I began to experience pain in my right side. A friend who is into natural healing told me to drink a mixture of 8 ounces of water with 2 tablespoons of organic apple cider vinegar (Braggs). 3 times a day to dissolve the kidney stones. Did this for a week. It worked for me.

  10. Sara says:

    I have a 1.0 cm stone in my left ureter it’s in the same spot I had a 4mm stone at few months ago I have narrow tubes so they had to surgically remove the 4mm what are the odds the 1 cm stone will pass?

  11. Rey says:

    The pain i’m feeling right now is at the side of my abdomen. So does it mean that the stone is in my ureter now? Thank you.

  12. deep ghosh says:

    How is a laser tretment done for removing stone from kidney size 4mm ?

    • Emily says:

      I had the laser treatment done first off I got 3 stones when I was pregnant and I learned what I can and cannot eat or drink certain foods or drinks caused a lot of pain every time I was in pain I’d drink more water and eat more salads well every year for 5 years I had to keep going to the ER and they would tell me the same thing that it should pass and drink more water well one day I was in a lot of pain and it was a different kind of pain I had chills I was weak couldn’t eat or drink without throwing it up no matter how hungry I was so I ended up going to the er and was admitted for a week they told me that I had the same kidney stones that I had 5 years earlier that they just grew and there was no way if pass them and they don’t know why someone told me I would because they were 10mm which is huge well I had a bladder infection a kidney infection and another infection I forgot what it was but anyway my kidney was 3xs the normal size and I was put on A LOT of meds and the stone had blocked my ureter tub so I went to a urologist and made an appointment he said it was the worst he’s ever seen and he has done his job for over 10 years usually the 1st visit is where they talk to you about options but for me he rushed me in for the surgery and he said I was close to death I looked horrible and he’s never had to rush someone in he didn’t even believe my story until he saw the ex rays so I went in they give u a cap and gown they put you asleep and when I woke up I was in constant pain because I had a stint in to prevent my ureter tube from closing and a catheter in and well you’ll be in pain until booth are removed which is aprx a week

  13. deep ghosh says:

    How is a laser tretment done for removing stone from kidney size 4mm ?is it painless??

  14. deep ghosh says:

    How shud i remove 4mm calculi stone from my right kidney,4months back it was 3.45mm as now its grown to 4mm m very tensed n worried ?is there ne medicine that cud pass out this stone or any painless treatment??

  15. shanks says:

    I have a 5mm stone that has moved to bladder. Am on pain killers and chinese herbal medicines.trying to avoid procedure

  16. Sherri says:

    I have a 16mm stone that was blocking my right kidney. I had a stent placed 4 days ago and will be scheduled for ESWL soon. Very frustrated with learning that the procedure will probable have to be repeated several times to break up the stone. My doctor said that I was not a candidate for the laser treatment due to where and size of the stone and does not recommend surgical removal. I do not want to keep on repeating the shock wave procedure and suffer with continual pain trying to hopefully pass the fragments. I want this stone out now! I understand surgery is a drastic option but Wouldn’t surgery be a better option to get rid of the problem all at once? I have never had a stone before and want this thing removed.

    • Abhilash says:

      Please try homeopathy, it is working for me, i am having 1.6 cm stone in my kidney and 5 mm in the ureter, now passed the 5 mm without any pain and doctor told that 1.6 cm stone will be able to pass after getting it broken into minute particles, i will not recommend homeopathy if its an emergency case, I am able to cope up with the pain as its not that much severe (at first it was with vomiting too), I am waiting for more stones to pass.

  17. sujit says:

    I had a kidney stone of size 15mm in my right kidney, I came to know it after the ultrasound process when I have at the time of my terrible back pain. the doctor suggest me to take medicine and I have the medicine. now I do not have any pain. so how will I know whether my kidney stone pass away or not. if not what step should I take?

  18. Lou says:

    I have had several but the one I have now is the worst since the first 15 years ago. Lot of pain getting into the urters , but it has stalled entering the bladder , 6 weeks, lot of penal pain. 2cm, going back next week, if it hasn’t moved surgery, very scared of the stent….cysocopy, was horrible

  19. Adrian says:

    In June, a CT scan spotted a 5mm stone at the exit to my left kidney. I took Tamsulosin and around 4 weeks later I’d passed the stone. I hadn’t felt the stone move so was convinced it was still in my kidney and I’d need surgery. On the evening before I passed the stone, I had discomfort in my groin, an urgency to pee and a tightening and relaxing of my penis. This eased up after a while. When I had a pee it was obvious there was a partial obstruction which I’m guessing was around the prostate area. I took prescription pain killers and compatible anti-inflamatories and went to bed. In the morning I knew what was going to happen – some pressure, discomfort and out popped the stone. I couldn’t believe the lack of pain between June and when the stone appeared at the end of July. I’d had a lot of pain and blood in the previous 6 months which my doctor thought was associated with a couple of smaller stones. The 4.5mm stone I had 10 years ago was a nightmare so I know I got off very lightly this time.

    • Charlene Crosthwaite says:

      I can relate to your problem. I’ve passed a total of six stones. Two were in the area of my bladder when found, but a larger stone 1.7 centimeter completely blocked my left ureter, so the pain was extremely intense. Had lots of previous pain apparently while the stones made their way down ahead of the large stone. The position was told to me by ER doctor. Next morning before having a stent inserted, I passed the two small stones. That was on Friday morning. Pain continued over the weekend, but not nearly as bad. On Monday three more small stones passed. Had two lithotripies done to break up the large stones. Shortly after, I had the stent removed and actually passed the largest stone to date (the size of a pea). That one actually burned a lot upon passing. Probably because the stent had been removed earlier in the day. I was thankful that the doctor suggested taking pain pills left over from the second lithotripsy. Stones still remain in the kidney and I’m hoping they stay where they are, in the lower pole of my kidney. X-ray next month will tell for sure.
      I also stayed extremely hydrated, lots of lemonade and flavored waters. I really do think that helped a lot. But would really just like to hear they’re all gone!

  20. Rajendra says:

    IHave the kidney stone in my kidn

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