They generally aren’t innately painful, but the pressure they are capable of creating if their journey through your urinary system is in any way interrupted can be uncomfortable at best and excruciating at worst. They might not be hereditary, but, if your family members have them, there’s a good chance you will share the suffering. And, if you aren’t serious about changing the way you eat and drink once you get them, you are likely to have to deal with them again.
They are kidney stones, and they are more common in South Carolina and the rest of the Southeast than in any other region of the United States.
“There’s a big difference in geography. We have the highest incidence of kidney stones than anywhere else in the country,” said Dr. Marshall Scott Wingo of Lowcountry Urology Clinics. “We don’t know why, but it probably has to do with it being hotter and more humid here and people are more likely to be dehydrated. We think humidity makes a difference.”
“The Southern states are the stone belt,” Dr. Gabriel Fiscus of Prisma Health in Greenville added.
The two urologists agree that dehydration is a major factor in determining whether stones form in your kidneys. The most common type, calcium oxalate stones, show up when the normal concentration of water, salts and minerals found in your urine is out of balance. In addition to heat and humidity, diet and exercise most likely help decide whether you develop kidney stones. Dr. Wingo pointed out that to avoid this possibly painful issue, you should drink lots of water, moderate your salt intake and stay active. He said high-oxalate diets that include large amounts of tea, coffee, soda and dark vegetables aren’t helpful.
Dr. Fiscus added that peanuts, rhubarb and spinach are high in oxalates and suggested a heart-healthy diet with “everything in moderation.” He said citrus fruits inhibit stone formation, so adding lemon or lime to your water is probably a good move. He said kidney stones are associated with issues such as obesity, hypertension and diabetes, as well as consuming too much sodium and animal protein.
People sometimes pass small stones, the size of a grain of sugar or a little more substantial, without knowing it. Larger stones, especially those that make their way from the kidneys to a ureter, a narrow duct that leads to the bladder, can cause intense back pain that might radiate around to the abdomen; nausea; vomiting; and painful urination.
According to Dr. Wingo, good hydration is the best strategy to help avoid kidney stones, along with a 24-hour urine collection that should reveal what’s going on with kidney function and the level of electrolytes in the patient’s urine. Potassium citrate tablets and thiazide diuretics such as chlorthalidone, a drug that reduces the level of calcium in the urine, are options, as is the drug tamsulosin, which can be used to help a patient pass a small stone. The drug relaxes the ureter and increases the chance of passing a stone of less than 5 mm in diameter.
If none of this relieves the symptoms, it’s probably necessary to attack the stones. There are two main options to treat stones, including extracorporeal shock wave lithotripsy, or ESWL. Sound waves generated from outside the body, pinpointed using X-ray imaging, break up a stone into pieces small enough to be eliminated with urination.
Another option uses a miniaturized digital camera mounted inside a small, flexible tube and a laser inserted through the penis or uretha into the bladder. Pulsed laser energy breaks the stone up into small pieces.
In both procedures, the patient is asleep.
How does a physician decide which method would work best? It depends on the location and size of the stone, Dr. Wingo pointed out. For those that are of the smaller variety and closer to the kidney, lithotripsy works fine, but he said he probably would use pulsed laser energy for larger stones.
Dr. Fiscus said for very large stones, patients can be treated with percutaneous nephrolithotomy, or PCNL. A small incision is made in the patient’s back, and the physician uses a scope and an instrument that allows him to pluck or vacuum the stones.
If you have kidney stones once, are you more likely to have them again? Dr. Wingo pointed out that if you don’t make any changes in diet or lifestyle, you have at least a 50% chance of this problem recurring.
“If you make modifications, you can reduce your risk to near zero,” he concluded. “It just depends on how aggressive you are with your modifications.”
By Brian Sherman
