Kidney stones are a painful disorder of the urinary tract. Urolithiasis is the medical term used to describe stones occuring in the urinary tract. These stones occur four times more often in men than in women, with 240,000 to 720,000 Americans affected yearly. The pain of having a stone has been compared to that of childbirth. The stones can be made of calcium, uric acid, oxalate, struvite, or cystine.

You may have no symptoms if the stone is noted on an X ray for an unrelated condition. Or you may have some or all of the following.

• Sudden onset of excruciating pain in the buttocks area
• Abdominal pain
• Nausea and vomiting
• You are constantly moving to relieve the pain
• Pain in the genital area as the stone moves
• Fever and chills

Kidney stones occur because the small bowel absorbs too much calcium, your diet is too high in calcium or another mineral, you have intestinal problems, a urinary tract infection, or an inherited disorder. You may not be drinking enough fluids (especially in the summer) or exercising enough.

If you are in extreme pain, your health care provider may give you a strong pain reliever. Then your health care provider will need a urine sample to check for infection and to see if your urine is acid or alkaline, which indicates the type of stone. You may need to collect your urine for 24 hours if this is not your first stone. Your provider will also take a blood sample.

With time, the stone generally passes out of the body by itself. If it doesn't or if you have severe pain, bleeding, fever, nausea, or can't urinate, your provider can shatter the stone with shock waves (an outpatient procedure), and the smaller pieces can pass with much less pain. Only rarely is surgery needed.

Usually taking pain relievers and drinking at least six to eight glasses of water a day, plus one at bedtime and another during the night, enables the stone to pass more easily. You may need to urinate through a strainer to collect the stone and give it to your health care provider for analysis.

You may need pain medication while the stone is moving through your system. After it passes, you may need other drugs so that you don't form stones again. Drugs may include

• Narcotics to control severe pain
• Allopurinol, 100 to 300 mg daily to control hyperuricemia
• Potassium citrate, 100 mEq tablets twice daily to raise urinary pH
• Hydrochlorothiazide, 25 to 50 mg daily for calcium type I stones
• Cellulose sodium phosphate 10 g daily for calcium type I stones; to decrease bowel absorption
• Orthophosphates for calcium type III stones; to inhibit vitamin B synthesis

Surgery is recommended for patients with severe pain that does not respond to medications, for those with serious bleeding, and persistent fever, nausea, or significant urinary obstruction. If no medical treatment is provided after surgery, stones recur in 50% of patients within five years.

• Urethroscopy—a diagnostic proceedure for identifying stones in lower third of ureter
• Extracorporeal Shock Wave Lithotripsy (ESWI)—an outpatient proceedure in which shock waves are used to shatter stones under 2 cm
• Percutaneous nephrolithotripsy—a surgical proceedure for removing large or dense kidney stones; instruments are inserted into the kidney to break up stones

Symptomatic urolithiasis requires medical attention. Alternative therapies aid in reducing the risk of recurrent episodes and increasing the overall vitality of the urogenital system. Start with nutritional guidelines for prevention of recurrence. Herbs and homeopathic remedies can be used for acute pain relief and long-term toning of the urinary tract.

• Reduce your intake of sugar, refined foods, animal products (meats and dairy), caffeine, alcohol, soda, and salt.
• Drink more water and eat more fiber, vegetables, whole grains, and vegetable proteins.
• Cut down on oxalate-containing foods such as spinach, rhubarb, beets, nuts, chocolate, black tea, wheat bran, strawberries, and beans.
• Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
• Magnesium citrate (200 to 400 mg per day) may increase the solubility of calcium oxalate and calcium phosphate.
• Pyridoxine (B6, 10 to 100 mg per day) is essential for the metabolism of oxalic acid, a component of some stones.
• Folic acid (5 mg per day) helps break down uric acid stones.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your health care provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

• For acute pain relief, combine tinctures of wild yam (Dioscorea villosa), cramp bark (Viburnum opulus), kava (Piper methysticum), and Jamaica dogwood (Piscidia piscipula). Take 15 drops every 15 minutes for up to 8 doses.
• Drink an infusion of equal parts of gravel root (Eupatorium purpureum), corn silk (Zea mays), pipissewa (Chimaphila umbellata), and kava. Use 1 tsp. of herb mixture per 1 cup water. Drink 3 to 4 cups per day.

Some of the most common remedies used for urolithiasis are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours until your symptoms get better.

• Berberis for sharp sticking pains that radiate to your groin
• Colocynthis for restlessness and pain that feels better when you bend forward
• Ocimum for nausea and vomiting from the pain

Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to skin, cover with a clean soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days.

Fifty percent of patients pass the stone in 48 hours. If there are complications, your health care provider may refer you to a urologist or admit you to the hospital. After you pass the stone, keep drinking fluids and change your diet to reduce the chance of forming more stones in the future.

Shock-wave therapy is not appropriate for women of childbearing age. If you think you might be pregnant, tell your health care provider. He or she will also want to rule out ectopic pregnancy or a ruptured ovarian cyst.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St Louis, Mo: Mosby-Year Book; 1999.

Grases F, et al. Urolithiasis and phytotherapy. Int Urol Nephrol. 1994;26:507-511.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.

Scalzo R. Naturopathic Handbook of Herbal Formulas. Durango, Colo: 2nd ed. Kivaki Press; 1994.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment 1994. Norwalk, Conn: Appleton & Lange; 1994.